The role of progesterone in perimenopause and its impact on ADHD symptoms
For many women, perimenopause can feel like an emotional and physical rollercoaster. Throw ADHD into the mix, and things can become even more challenging. One key player in this story is progesterone, a hormone that tends to decline during perimenopause. While much attention is often placed on oestrogen, it’s essential to understand how progesterone changes can also impact ADHD symptoms.
Why does progesterone matter for ADHD?
Progesterone is often referred to as the “calming hormone” because of its role in mood regulation, sleep, and emotional stability. For women with ADHD, whose executive functioning and emotional regulation are already more vulnerable, a decline in progesterone during perimenopause can exacerbate symptoms such as:
Increased anxiety and irritability
Poor emotional regulation
Heightened sensitivity to stress
Sleep disturbances, which further impair focus and memory
The hormone’s calming effect is largely due to its role in boosting GABA (gamma-aminobutyric acid), a neurotransmitter that helps reduce feelings of stress and promote relaxation. With less progesterone available, women with ADHD may find themselves feeling more reactive, less patient, and more prone to emotional outbursts.
Progesterone, ADHD, and executive functioning
For women with ADHD, executive functioning skills such as planning, prioritising, and organising are often a struggle. Research has shown that hormonal fluctuations during the menstrual cycle already impact these skills in women with ADHD. As progesterone levels decline during perimenopause, these challenges can intensify, leading to:
Increased forgetfulness or “brain fog”
Difficulty staying on task
Feeling overwhelmed by everyday responsibilities
This decline in progesterone can also worsen the emotional dysregulation that is common in ADHD, contributing to more significant episodes of frustration, anger, or sadness.
What does the research say?
Dr. Patricia Quinn, a leading expert in ADHD and women’s health, has spoken extensively about how hormonal shifts impact ADHD. In her book Understanding Women with ADHD, she discusses how declining progesterone levels during perimenopause can lead to heightened ADHD symptoms. Similarly, Dr. Sandra Kooj, a psychiatrist specialising in ADHD, highlights that many women report a significant worsening of symptoms as they enter perimenopause, often prompting late diagnoses of ADHD.
A 2018 study published in the Journal of Attention Disorders found that women with ADHD experienced more severe premenstrual symptoms, including mood swings and irritability, compared to women without ADHD. These findings suggest a link between hormonal sensitivity and ADHD, which becomes more pronounced during perimenopause.
Case studies: real women, real challenges (names changed for confidentiality)
Take Sarah, a 46-year-old woman who had lived with undiagnosed ADHD for most of her life. As she entered perimenopause, she noticed a dramatic increase in her irritability and a significant decline in her ability to focus at work. After consulting her GP, she started hormone replacement therapy (HRT) with a combination of oestrogen and progesterone. Within a few months, she reported better emotional stability and improved sleep, which, in turn, helped her ADHD symptoms.
Similarly, Claire, a 42-year-old mother of two, found herself experiencing “brain fog” so severe that she couldn’t remember basic details about her children’s schedules. She attributed it to perimenopause but later discovered that her declining progesterone levels were amplifying her undiagnosed ADHD symptoms. After receiving an ADHD diagnosis and incorporating progesterone into her HRT plan, she experienced significant relief.
How can women manage these challenges?
If you’re navigating perimenopause and struggling with ADHD symptoms, here are some strategies to consider:
Hormone replacement therapy (HRT):
Many women benefit from HRT, particularly a combination of oestrogen and progesterone. Dr. Louise Newson, a menopause specialist, advocates for personalised HRT plans that consider ADHD and neurodivergence. Her Balance app can help you track symptoms and then have the information to hand to enable you to discuss them with a healthcare provider.Lifestyle changes:
Incorporating regular exercise, a balanced diet, and mindfulness practices can help manage stress and promote emotional stability.ADHD coaching or therapy:
Working with an ADHD coach or therapist can provide strategies tailored to managing both perimenopause and ADHD challenges. Coaching focuses on practical tools for improving organisation, emotional regulation, and self-compassion.Medication adjustments:
For women already taking ADHD medication, perimenopause may require adjustments in dosage or timing. Discussing these changes with a menopause specialist can be helpful.Support networks:
Joining support groups for women with ADHD or perimenopause can provide a sense of community and shared understanding.
Perimenopause is a significant transition in a woman’s life, and for those with ADHD, it can feel particularly overwhelming. Understanding the role of progesterone and how its decline impacts ADHD symptoms is a crucial first step in finding relief. By seeking professional advice, exploring treatment options like HRT, and adopting practical strategies, women can navigate this stage with greater confidence and support.
If you’re experiencing worsening ADHD symptoms during perimenopause, remember that you’re not alone. The right resources, strategies, and support can make all the difference in helping you thrive during this stage of life.
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