ADHD diagnosed just before I turned 45. Because my brain stopped working and I basically burnt out… I am absolutely positive it’s linked with hormone fluctuations.
In retrospect the symptoms have always been there, even as a child, I was send to see a psychiatrist at age 9 who diagnosed me as a perfectionist. And I was diagnosed with depression/anxiety at age 20.
But… it was really the last couple of years where my ability to cope with being tilted just dissolved into nothing, my antidepressant dose was creeping up and it was only going to see a new psychiatrist that the possibility of ADHD was raised.
3 months later and I’m working out life on Ritalin - which has honestly been a game changer. It makes me feel calm, I can structure my day again and I’m not constantly staring into space. It stops me spiralling into panic if something doesn’t go as planned.
This is incredible- I've been hoping you might write about this at some point. I was diagnosed formally just this year (age 50). I had previous indicators I had been able to overlook because I was able to compensate and did well academically (think messy purse girl). But I can attest to the shit hitting the fan in perimenopause and it felt more severe than brain fog. In my therapy practice I've also met a number of women who have reported similar experiences which prompted me to start looking into this relationship more thoroughly. I echo that any woman who feels they are suffering severe brain fog can consider whether an ADHD assessment might be helpful. It certainly helps to tease out which symptoms are perimenopause and which are pre-existing and being exacerbated by peri.
I'm interested in the evidence that this may not emerge for some women until age 12- I'll be curious to see what more comes from that. I've also been curious about this idea that those with ADHD could have different sensitivities to HRT?
If you don't mind sharing, How were you diagnosed? did you see a psychiatrist or use an online company? Are you taking meds (HRT and/or ADHD)? are they helping?
I decided to go through a formal assessment with a psychologist- it’s a bit pricey but I know there are some online resources that are often lower fee. So far I am not on HRT because I still have very regular cycles and I haven’t tried ADHD meds so far- I am using behavioural strategies.
Diagnosed last week at 56 after fighting severe PMDD and major depression for the last ten years, joint pain and brain fog for the last five. Many symptoms that got overlooked in childhood because I was the “good kid.”
Thanks for this! It’s a super important topic. I got diagnosed at 47 and my world here in Switzerland seems to be teeming with perimenopausal women finally getting an ADHD diagnosis.
Thank you for writing this and putting together so many pieces of what is known, what has been observed, and where it might go in terms of future research. I am another one of those late-diagnosed smart girls– last year, at 58, after a full neurobiological assessment. I was already on hormone therapy, having passed through the worst of the menostorms, but as many other commenters have described so well it was the heightened inability to finish any task and the persistent brain fog that caused my therapist to suggest assessment.
This diagnosis changed my life more than I expected. It changed our family dynamic: Our teenaged son with ADHD is no longer alone; my spouse is finally learning about ADHD and how to live with two such persons. I take Medikinet (methylphenidate formulated for adults) and have changed my lifestyle to prioritize physical activity and proper rest. And most of all, I have forgiven myself for all the 'failures' and regrets I've been schlepping around for 50 years.
Thank you for writing about this. I look forward to seeing what further research shows.
Was diagnosed with ADHD (prompted by daughter with ADHD) at 65 - peri menopause was hell - menopausal at 59 - Vyvance was a game changer for some issues (would definitely have helped my younger me) & now exploring MRT to possibly improve some of the symptoms (? even more)
In hindsight, ADHD symptoms definitely worsened with peri menopause. Can’t imagine what either would have been like if I hadn’t self medicated with activity & exercise since childhood.
Diagnosed with ADHD at 41. I thought I had early onset dementia, that's how bad it was. My therapist says I was masking heavily in my younger years. I have noticed that my ADHD meds are useless during my periods. Now in menopause and on HT, the dose makes or breaks how well my meds work. ADHD is so complex and those who study it are finding so many connections between it and a long list of other issues. I have 3 daughters and 2 sons - 2 daughters are dx with ADHD, I suspect the youngest will be; oldest son is dx and younger son is a maybe.
Thank you for sharing that! I'm having ADHD like symptoms and have 2 daughters who might go that way as well. For your daughters, check out my TEDx talk on making #periodsOptional at the bottom of www.pandiahealth.com/periodsoptional It may help them given that ADHD gets worse with menstruation during the luteal phase.
As a reproductive psychiatrist, I found this article very interesting. I’m glad that you were able to discuss the links between hormonal fluctuations and ADHD. All relevant and important. From my perspective, I think it’s important to add that not every peri- or menopausal woman who wonders if she has ADHD actually does. Its important to sort it out rather than offer trials of stimulants. Stimulants can be harmful or even dangerous for some patients. And, committing to regular stimulant therapy is time consuming and sometimes costly. My approach is to refer new onset cases or ones that are not obvious for neuropsychological testing. The testing is helpful in teasing apart what area of the brain is afflicted and why. Sometimes patients are given very different diagnoses after testing. What looked like ADHD could be profound depression, a neuro processing problem, undiagnosed dyslexia, etc. once the diagnosis is clarified there is the opportunity to address the symptoms in an informed way. Therefore, if think it would be importantly to be very sure of an ADHD diagnosis in peri- and menopausal women. Refer to you friendly neighborhood reproductive psychiatrist!
Thanks! I wasn’t suggesting people should start a stimulant without a diagnosis of ADHD, rather be referred for evaluation of brain fog is a primary symptom or one that persists despite management of other menopause symptoms.
Would you mind clarifying the final paragraph of the "What About Therapy" section? The takeaway is unclear to me. I get the last part where it says that if your primary concerns mimic standard ADHD issues, try an ADHD med. But before that, it says that when women with cognitive and/or exacerbated ADHD symptoms ALSO have classic menopause symptoms (e.g., hot flashes, night sweats, sleep), they should "address those first and see if things improve." Does this mean see if MHT helps address those issues as a whole, or does it mean we should try to problem-solve each of those issues one by one, in some other way? (not MHT)
Also, just checking if this sentence is right or a typo?... "We don’t know if women with ADHD respond to MHT in the same way as women without MHT." Couldn't follow that, but not sure if it's my pesky Exec function misfiring, or if it should be "without ADHD" at the end.
THANK YOU so much for pursuing the ADHD + menopause topic. Long neglected. Can't wait to learn more.
The idea behind starting with MHT first when there are bad symptoms of menopause is treating those symptoms may lessen the burden. It's not wring to try an ADHD med first, but disturbed sleep especially can have so many downstream effects.
Definitely can attest to this being the right path! I tried ADHD meds first, then HRT. The ADHD meds helped, but I felt edgy and agitated all the time. Started HRT and there was such a dramatic improvement in many things, including my ability to think more clearly, so I decided to drop the ADHD meds to see how I felt. I found that the HRT and lifestyle changes (diet, gym 4-5 times a week, regular mindfulness practice) were enough to make it manageable AND I felt more relaxed/like myself. Side note--a slew of food intolerances that also came with menopause mostly removed carbs and sugar from my diet to such a degree that I think that was part of the improvement in ADHD symptoms. I notice that when I do allow myself the occasional indulgences or my gym habit is disrupted, the next couple of days it's harder to focus, rumination kicks in more, etc. Seems to track with what they recommend about diet/exercise changes helping with ADHD as well!
It's funny, if you take out the part about stimulants, this entire article could be written about menopause and autism (instead of ADHD) and still be true. Now there is some 'symptom' overlap between ADHD and autism, and also a huge percentage of people who have both. But there's something more than that as well, I feel.
I was diagnosed with autism at age 40 but I've definitely had 'symptoms' all my life and was missed as a child like many many other girls were. I do not have ADHD (was assessed for it) but I've definitely had severe cognitive symptoms similar to how this article describes in the past few years, and I don't expect anything to get easier as I reach my mid-40s. :( Doctors and therapists haven't been able to help me. At this point I'm managing everything myself like it's a chronic illness by pacing myself & restructuring my life. I'm unable to live the life I want to. I hope research will help those younger than me.
I echo others appreciation for this post. One thing that has really helped me is understanding that emotional regulation falls under executive functioning. The combination of struggles with executive functioning (which encompasses emotional regulation) and the crazy hormonal shifts during perimenopause have left me feeling like a monster. Reading about PMDD and ADHD overlaps helped me feel less crazy. When writing about this topic, it might help to lay out all the things that fall under executive functioning.
Thank you for writing this. I have been curious about this topic for a while- both for my patients and for myself! Interesting that the women currently hitting menopause were the girls who were under diagnosed with adhd which was considered a disorder of misbehaving little boys. Also curious how many people with ADHD are drawn to obgyn - a field where there is often some fire to put out and drag our attention away from the tedious tasks. I thrived on that earlier in my career but more recently I really struggle to manage all the interruptions.
Just was diagnosed, at 53, with ADHD after a few years of what has felt like burnout - also was diagnosed with breast cancer last year and started tamoxifen recently and it is kicking my ass in the brain fog and depression department. Thank you for writing this just at this moment. It’s helped make a connection between a lot of the things that have been happening, this past year and since starting medication.
Late diagnosed ADHD due to perimenopause exacerbating everything for me. MHT makes a massive difference for me. I had extremely frustrating issues with transdermal absorption and ended up on oral. I have a raft of small bone joint and muscle symptoms, not to a level that I think I have hEDS, but I wonder if my collagen isn't 100% normal and this impacts transdermal absorption.
I only got diagnosed 3 months ago, so I've only been trying stimulants for a few months & I'm still on a low dose, but so far they don't do a huge amount for me. I see a lot of posts on Facebook with other women saying the opposite, that MHT didn't help much and stimulants did. I suspect it's far more complex and nuanced depending on the particular mix of various comorbidities each person has.
I've been slowly working my way through this review that tracks well with my personal story. I will be interested to see how it plays out as more research is done. https://doi.org/10.1016/j.neuroscience.2025.01.031
I read your recent email about the attention economy, yesterday, and replied directly to that email. Then I finally signed up for this Substack and hope I can get to better answers and a more supportive/responsive community. Mine is an 8+-year story -- so far -- of trying to address my symptoms and still feeling like I haven't figured it out.
I was diagnosed at 40 with ADHD after struggling royally through a masters degree, almost killing myself to get the best grades I'd ever gotten in my life, and finishing 6 months late. This was in 2006 and it took 2 tries - the first free one via the university's psych. dept. determining that I was merely depressed and had a math disorder - to get a diagnosis. I ended up paying a lot of bucks for a more thorough diagnosis that included an extensive interview with me and my mother (who had recently handed me all of my report cards - in preparing to move -, every one of which had comments about my dreaminess/distractedness and/or multiple late or missing assignments.)
I wasn't comfortable with medicating it at that time and worked out multiple other supports including working with a coach for a time. At 52-ish, my peri-menopause symptoms began showing up, starting with hot flashes and increasingly poor sleep (already a challenge all of my life) and progressing into brain fog and short term memory loss and a rise in my adhd symptoms.
Classically, my GP in 2018 told me I needed to just get used to managing the menopause symptoms and I lived with them for a few years. (I also found your book, sometime after the pandemic and read through it, cover to cover! Additionally, I'd tried having conversations with friends, but most were younger and not dealing with this - nor was it yet a public conversation.) I then found an ob-gyn (my first one; no pregnancies or children ever) who prescribed a Combi patch. It stopped the hot flashes, but my sleep and brain fog issues didn't really improve. When I went back to her a whole year later, she told me that if it wasn't working there wasn't an option to increase the dose - or change anything - and that she could refer me for dementia testing. This is when I (going home to read up on it a bit) discovered that the ADHD and (peri-)menopause combination was likely a challenging one and the cause of these exacerbated symptoms. With no one seemingly local to discuss this, I'd found an email for a Dutch psychologist who was speaking about the use of stimulant meds improving things. I reached out to her and she linked some NIH articles about Vyvanse being used to address hormone fluctuations in women and teenage girls. I found an online prescriber and started Vyvanse - the lowest dose possible.
I then found some of those influencers you've been warning about, but they were the loudest voices out there and a lot of what they had to say made a lot of sense. (Yes, I had read your book, but it seems this was the latest info and made the most sense to follow.) So, I purchased some books, listened to a lot of podcasts and interviews and sought an online HRT provider that takes insurance. I'm still with that provider and they have been willing to try different levels of HRT, including separating my estrogen doses (patch) from my progesterone (pill form).
I've been with the online provider since last October. My estrogen doses have been increased, as well as the progesterone. I've added in a testosterone cream (purchased from Australia) to see if that might help with alertness. I was also prescribed an estrogen cream on top of the patch (which I decided not to use because I'm already overwhelmed with all of the other hormonal applications added into my routine. I remain on the Vyvanse although I would like to get off of it.
I made one more attempt, a few months ago, to find an in-person ob-gyn. She was listed under a "menopause care" clinic and had Menopause Society certifications. Having found a good friend to share my journey, she offered to accompany me on this first visit. I submitted my story in an online form (although my brain had completely forgotten about this) and loaded up a bag with all of the books I'd collected in my efforts to address all of this. What I got out of this appt - besides the usual wellness checkup - was a berating by this doctor for even looking to any of these influencers for help in an information and care-access vacuum. She made me feel horrible and ignorant and revealed - as the appt went on - that she had only focused on a few points of my pre-submitted story that annoyed her and completely got wrong some other key information I'd provided. My friend and I walked out of that appointment aghast at what had just happened. I actually attempted to email her via MyChart, but the restrictions didn't allow such an email, so I submitted a complaint via an online survey I was asked to fill out after the visit.
Add to all of this same period so many foundational things that have been shifting and changing (some of this very common at this time; some of it not): significant relationships, housing (3 moves), work (very cognitively demanding as well and shifts in the type and the physical locations), loss of a brother, aging parent - not to mention the political challenges of the times - oh, and the pandemic!
At this point, I'm waking up woozy each morning due to the level of progesterone, but I'm getting more sleep. Nonetheless, I'm still exhausted all the time. My exercise routine has been severely disrupted, which I know is not helping. My meditation routine is almost non-existent. My motivation is lower than ever. My ability to reach out to and connect with friends is not so good and I still don't feel I've really addressed what needs to be addressed. I don't even know where to start to get it truly addressed and I only have so much time and money to spend on all of this where I've already spent so much time and money - even with some of the better American health insurance coverage.
I haven't given up and I'm not asking for any treatment advice here, but thought sharing my story around this would help add to the anecdotal evidence of all the challenges faces by so many of us - even with the information now available! I am grateful for finally getting myself to this platform. Thanks, again, for your voice!!
ADHD diagnosed just before I turned 45. Because my brain stopped working and I basically burnt out… I am absolutely positive it’s linked with hormone fluctuations.
In retrospect the symptoms have always been there, even as a child, I was send to see a psychiatrist at age 9 who diagnosed me as a perfectionist. And I was diagnosed with depression/anxiety at age 20.
But… it was really the last couple of years where my ability to cope with being tilted just dissolved into nothing, my antidepressant dose was creeping up and it was only going to see a new psychiatrist that the possibility of ADHD was raised.
3 months later and I’m working out life on Ritalin - which has honestly been a game changer. It makes me feel calm, I can structure my day again and I’m not constantly staring into space. It stops me spiralling into panic if something doesn’t go as planned.
This is incredible- I've been hoping you might write about this at some point. I was diagnosed formally just this year (age 50). I had previous indicators I had been able to overlook because I was able to compensate and did well academically (think messy purse girl). But I can attest to the shit hitting the fan in perimenopause and it felt more severe than brain fog. In my therapy practice I've also met a number of women who have reported similar experiences which prompted me to start looking into this relationship more thoroughly. I echo that any woman who feels they are suffering severe brain fog can consider whether an ADHD assessment might be helpful. It certainly helps to tease out which symptoms are perimenopause and which are pre-existing and being exacerbated by peri.
I'm interested in the evidence that this may not emerge for some women until age 12- I'll be curious to see what more comes from that. I've also been curious about this idea that those with ADHD could have different sensitivities to HRT?
Thank you so much for this!
If you don't mind sharing, How were you diagnosed? did you see a psychiatrist or use an online company? Are you taking meds (HRT and/or ADHD)? are they helping?
I decided to go through a formal assessment with a psychologist- it’s a bit pricey but I know there are some online resources that are often lower fee. So far I am not on HRT because I still have very regular cycles and I haven’t tried ADHD meds so far- I am using behavioural strategies.
Diagnosed last week at 56 after fighting severe PMDD and major depression for the last ten years, joint pain and brain fog for the last five. Many symptoms that got overlooked in childhood because I was the “good kid.”
Thank you for writing about this!
Thanks for this! It’s a super important topic. I got diagnosed at 47 and my world here in Switzerland seems to be teeming with perimenopausal women finally getting an ADHD diagnosis.
Thank you for writing this and putting together so many pieces of what is known, what has been observed, and where it might go in terms of future research. I am another one of those late-diagnosed smart girls– last year, at 58, after a full neurobiological assessment. I was already on hormone therapy, having passed through the worst of the menostorms, but as many other commenters have described so well it was the heightened inability to finish any task and the persistent brain fog that caused my therapist to suggest assessment.
This diagnosis changed my life more than I expected. It changed our family dynamic: Our teenaged son with ADHD is no longer alone; my spouse is finally learning about ADHD and how to live with two such persons. I take Medikinet (methylphenidate formulated for adults) and have changed my lifestyle to prioritize physical activity and proper rest. And most of all, I have forgiven myself for all the 'failures' and regrets I've been schlepping around for 50 years.
Thank you for sharing!
Thank you for writing about this. I look forward to seeing what further research shows.
Was diagnosed with ADHD (prompted by daughter with ADHD) at 65 - peri menopause was hell - menopausal at 59 - Vyvance was a game changer for some issues (would definitely have helped my younger me) & now exploring MRT to possibly improve some of the symptoms (? even more)
In hindsight, ADHD symptoms definitely worsened with peri menopause. Can’t imagine what either would have been like if I hadn’t self medicated with activity & exercise since childhood.
Diagnosed with ADHD at 41. I thought I had early onset dementia, that's how bad it was. My therapist says I was masking heavily in my younger years. I have noticed that my ADHD meds are useless during my periods. Now in menopause and on HT, the dose makes or breaks how well my meds work. ADHD is so complex and those who study it are finding so many connections between it and a long list of other issues. I have 3 daughters and 2 sons - 2 daughters are dx with ADHD, I suspect the youngest will be; oldest son is dx and younger son is a maybe.
Thank you for sharing that! I'm having ADHD like symptoms and have 2 daughters who might go that way as well. For your daughters, check out my TEDx talk on making #periodsOptional at the bottom of www.pandiahealth.com/periodsoptional It may help them given that ADHD gets worse with menstruation during the luteal phase.
As a reproductive psychiatrist, I found this article very interesting. I’m glad that you were able to discuss the links between hormonal fluctuations and ADHD. All relevant and important. From my perspective, I think it’s important to add that not every peri- or menopausal woman who wonders if she has ADHD actually does. Its important to sort it out rather than offer trials of stimulants. Stimulants can be harmful or even dangerous for some patients. And, committing to regular stimulant therapy is time consuming and sometimes costly. My approach is to refer new onset cases or ones that are not obvious for neuropsychological testing. The testing is helpful in teasing apart what area of the brain is afflicted and why. Sometimes patients are given very different diagnoses after testing. What looked like ADHD could be profound depression, a neuro processing problem, undiagnosed dyslexia, etc. once the diagnosis is clarified there is the opportunity to address the symptoms in an informed way. Therefore, if think it would be importantly to be very sure of an ADHD diagnosis in peri- and menopausal women. Refer to you friendly neighborhood reproductive psychiatrist!
Thanks! I wasn’t suggesting people should start a stimulant without a diagnosis of ADHD, rather be referred for evaluation of brain fog is a primary symptom or one that persists despite management of other menopause symptoms.
Would you mind clarifying the final paragraph of the "What About Therapy" section? The takeaway is unclear to me. I get the last part where it says that if your primary concerns mimic standard ADHD issues, try an ADHD med. But before that, it says that when women with cognitive and/or exacerbated ADHD symptoms ALSO have classic menopause symptoms (e.g., hot flashes, night sweats, sleep), they should "address those first and see if things improve." Does this mean see if MHT helps address those issues as a whole, or does it mean we should try to problem-solve each of those issues one by one, in some other way? (not MHT)
Also, just checking if this sentence is right or a typo?... "We don’t know if women with ADHD respond to MHT in the same way as women without MHT." Couldn't follow that, but not sure if it's my pesky Exec function misfiring, or if it should be "without ADHD" at the end.
THANK YOU so much for pursuing the ADHD + menopause topic. Long neglected. Can't wait to learn more.
The idea behind starting with MHT first when there are bad symptoms of menopause is treating those symptoms may lessen the burden. It's not wring to try an ADHD med first, but disturbed sleep especially can have so many downstream effects.
Thanks for catching the typo, it's corrected.
Definitely can attest to this being the right path! I tried ADHD meds first, then HRT. The ADHD meds helped, but I felt edgy and agitated all the time. Started HRT and there was such a dramatic improvement in many things, including my ability to think more clearly, so I decided to drop the ADHD meds to see how I felt. I found that the HRT and lifestyle changes (diet, gym 4-5 times a week, regular mindfulness practice) were enough to make it manageable AND I felt more relaxed/like myself. Side note--a slew of food intolerances that also came with menopause mostly removed carbs and sugar from my diet to such a degree that I think that was part of the improvement in ADHD symptoms. I notice that when I do allow myself the occasional indulgences or my gym habit is disrupted, the next couple of days it's harder to focus, rumination kicks in more, etc. Seems to track with what they recommend about diet/exercise changes helping with ADHD as well!
It's funny, if you take out the part about stimulants, this entire article could be written about menopause and autism (instead of ADHD) and still be true. Now there is some 'symptom' overlap between ADHD and autism, and also a huge percentage of people who have both. But there's something more than that as well, I feel.
I was diagnosed with autism at age 40 but I've definitely had 'symptoms' all my life and was missed as a child like many many other girls were. I do not have ADHD (was assessed for it) but I've definitely had severe cognitive symptoms similar to how this article describes in the past few years, and I don't expect anything to get easier as I reach my mid-40s. :( Doctors and therapists haven't been able to help me. At this point I'm managing everything myself like it's a chronic illness by pacing myself & restructuring my life. I'm unable to live the life I want to. I hope research will help those younger than me.
I echo others appreciation for this post. One thing that has really helped me is understanding that emotional regulation falls under executive functioning. The combination of struggles with executive functioning (which encompasses emotional regulation) and the crazy hormonal shifts during perimenopause have left me feeling like a monster. Reading about PMDD and ADHD overlaps helped me feel less crazy. When writing about this topic, it might help to lay out all the things that fall under executive functioning.
Thank you for writing this. I have been curious about this topic for a while- both for my patients and for myself! Interesting that the women currently hitting menopause were the girls who were under diagnosed with adhd which was considered a disorder of misbehaving little boys. Also curious how many people with ADHD are drawn to obgyn - a field where there is often some fire to put out and drag our attention away from the tedious tasks. I thrived on that earlier in my career but more recently I really struggle to manage all the interruptions.
If there is ever a study, I want to be included!!
Just was diagnosed, at 53, with ADHD after a few years of what has felt like burnout - also was diagnosed with breast cancer last year and started tamoxifen recently and it is kicking my ass in the brain fog and depression department. Thank you for writing this just at this moment. It’s helped make a connection between a lot of the things that have been happening, this past year and since starting medication.
Late diagnosed ADHD due to perimenopause exacerbating everything for me. MHT makes a massive difference for me. I had extremely frustrating issues with transdermal absorption and ended up on oral. I have a raft of small bone joint and muscle symptoms, not to a level that I think I have hEDS, but I wonder if my collagen isn't 100% normal and this impacts transdermal absorption.
I only got diagnosed 3 months ago, so I've only been trying stimulants for a few months & I'm still on a low dose, but so far they don't do a huge amount for me. I see a lot of posts on Facebook with other women saying the opposite, that MHT didn't help much and stimulants did. I suspect it's far more complex and nuanced depending on the particular mix of various comorbidities each person has.
I've been slowly working my way through this review that tracks well with my personal story. I will be interested to see how it plays out as more research is done. https://doi.org/10.1016/j.neuroscience.2025.01.031
I read your recent email about the attention economy, yesterday, and replied directly to that email. Then I finally signed up for this Substack and hope I can get to better answers and a more supportive/responsive community. Mine is an 8+-year story -- so far -- of trying to address my symptoms and still feeling like I haven't figured it out.
I was diagnosed at 40 with ADHD after struggling royally through a masters degree, almost killing myself to get the best grades I'd ever gotten in my life, and finishing 6 months late. This was in 2006 and it took 2 tries - the first free one via the university's psych. dept. determining that I was merely depressed and had a math disorder - to get a diagnosis. I ended up paying a lot of bucks for a more thorough diagnosis that included an extensive interview with me and my mother (who had recently handed me all of my report cards - in preparing to move -, every one of which had comments about my dreaminess/distractedness and/or multiple late or missing assignments.)
I wasn't comfortable with medicating it at that time and worked out multiple other supports including working with a coach for a time. At 52-ish, my peri-menopause symptoms began showing up, starting with hot flashes and increasingly poor sleep (already a challenge all of my life) and progressing into brain fog and short term memory loss and a rise in my adhd symptoms.
Classically, my GP in 2018 told me I needed to just get used to managing the menopause symptoms and I lived with them for a few years. (I also found your book, sometime after the pandemic and read through it, cover to cover! Additionally, I'd tried having conversations with friends, but most were younger and not dealing with this - nor was it yet a public conversation.) I then found an ob-gyn (my first one; no pregnancies or children ever) who prescribed a Combi patch. It stopped the hot flashes, but my sleep and brain fog issues didn't really improve. When I went back to her a whole year later, she told me that if it wasn't working there wasn't an option to increase the dose - or change anything - and that she could refer me for dementia testing. This is when I (going home to read up on it a bit) discovered that the ADHD and (peri-)menopause combination was likely a challenging one and the cause of these exacerbated symptoms. With no one seemingly local to discuss this, I'd found an email for a Dutch psychologist who was speaking about the use of stimulant meds improving things. I reached out to her and she linked some NIH articles about Vyvanse being used to address hormone fluctuations in women and teenage girls. I found an online prescriber and started Vyvanse - the lowest dose possible.
I then found some of those influencers you've been warning about, but they were the loudest voices out there and a lot of what they had to say made a lot of sense. (Yes, I had read your book, but it seems this was the latest info and made the most sense to follow.) So, I purchased some books, listened to a lot of podcasts and interviews and sought an online HRT provider that takes insurance. I'm still with that provider and they have been willing to try different levels of HRT, including separating my estrogen doses (patch) from my progesterone (pill form).
I've been with the online provider since last October. My estrogen doses have been increased, as well as the progesterone. I've added in a testosterone cream (purchased from Australia) to see if that might help with alertness. I was also prescribed an estrogen cream on top of the patch (which I decided not to use because I'm already overwhelmed with all of the other hormonal applications added into my routine. I remain on the Vyvanse although I would like to get off of it.
I made one more attempt, a few months ago, to find an in-person ob-gyn. She was listed under a "menopause care" clinic and had Menopause Society certifications. Having found a good friend to share my journey, she offered to accompany me on this first visit. I submitted my story in an online form (although my brain had completely forgotten about this) and loaded up a bag with all of the books I'd collected in my efforts to address all of this. What I got out of this appt - besides the usual wellness checkup - was a berating by this doctor for even looking to any of these influencers for help in an information and care-access vacuum. She made me feel horrible and ignorant and revealed - as the appt went on - that she had only focused on a few points of my pre-submitted story that annoyed her and completely got wrong some other key information I'd provided. My friend and I walked out of that appointment aghast at what had just happened. I actually attempted to email her via MyChart, but the restrictions didn't allow such an email, so I submitted a complaint via an online survey I was asked to fill out after the visit.
Add to all of this same period so many foundational things that have been shifting and changing (some of this very common at this time; some of it not): significant relationships, housing (3 moves), work (very cognitively demanding as well and shifts in the type and the physical locations), loss of a brother, aging parent - not to mention the political challenges of the times - oh, and the pandemic!
At this point, I'm waking up woozy each morning due to the level of progesterone, but I'm getting more sleep. Nonetheless, I'm still exhausted all the time. My exercise routine has been severely disrupted, which I know is not helping. My meditation routine is almost non-existent. My motivation is lower than ever. My ability to reach out to and connect with friends is not so good and I still don't feel I've really addressed what needs to be addressed. I don't even know where to start to get it truly addressed and I only have so much time and money to spend on all of this where I've already spent so much time and money - even with some of the better American health insurance coverage.
I haven't given up and I'm not asking for any treatment advice here, but thought sharing my story around this would help add to the anecdotal evidence of all the challenges faces by so many of us - even with the information now available! I am grateful for finally getting myself to this platform. Thanks, again, for your voice!!