Perimenopause Problems: How Changing Hormones Exacerbate ADHD Symptoms
by Devon Frye, ADDitude
August 8, 2017

An ADDitude reader wrote: “I am a 42-year-old business executive diagnosed with ADHD. I have a confession to make. Lately, I don’t like calling people on the phone or returning calls. I think perimenopause may be causing this glitch. I also find myself getting confused and shutting down when confronted with a bunch of projects at work all at once. I need more time to process things. I know I have ADHD, and I know my hormone profile is changing. I take medication, but what strategies do you have to ease this collision course between diagnosis and hormones? What can I do to make things easier on myself?”

ADHD symptoms change as we age, and as life circumstances become more complicated and stressful. Hormones, in particular, often exacerbate ADHD symptoms as women edge closer to menopause. In fact, as you’ve pointed out in your question, this worsening of symptoms may occur during perimenopause, when estrogen levels begin to drop.

We know that when estrogen levels decrease, cognition suffers. Women struggle with memory, word retrieval, and other cognitive activities. In fact, for some, the change in cognitive function is so drastic that some think they are developing dementia or Alzheimer’s. Lower levels of estrogen may cause depression. During this time of hormonal fluctuations, we find that ADHD medication and strategies for managing ADHD symptoms may not work as effectively as they once did.

Your new difficulty in dealing with phone calls and feeling overwhelmed when faced with multiple projects may be due to your estrogen deficits. Changing hormone levels, combined with ADHD, creates a tough situation for a lot of women in the workplace.

What’s a Woman to Do?
The first thing I suggest is to discuss these new challenges with your physician or medical provider. Look back and think if these struggles have been there all along, or if they are worse since perimenopause. You’ll want to also rule out any other reason for your current challenges outside of the ADHD/hormone connection — thyroid disease, allergies, and so on.

If your medical provider gives you a clean bill of health, discuss your situation with your prescribing doctor. Many doctors make the mistake of increasing stimulant medication for women whose hormonal changes are causing the kinds of challenges you describe. Patricia Quinn, M.D., an expert on ADHD and hormones, suggests that this may not be the best solution. She suggests discussing possible hormone replacement therapy with the doctor.

Another possible explanation for your difficulties is additional stress in your life. Is your boss demanding more of you lately? Are there other things going on in your life that are challenging you mentally?

Here are some strategies women can use when, like you, they feel overwhelmed at work. The first step, always, is to identify the problems.

Phone Challenges


  • You say that you hate calling people on the phone. One way around this is to schedule your calls early in the day, so you don’t think about them very long. Try making calls first thing in the morning, when not a lot is going on, and check them off your to-do list.

    Make calls first thing in the a.m. and cross them off your list.

    Is there someone at work who can take some of the phone calls off your plate? Maybe trade tasks — do something a colleague hates to do in exchange for her making some of the phone calls. Bartering chores is a great way to deal with difficult tasks.
  •  If that’s not possible, identify what exactly makes you hate the phone calls so much. Do you get bored? Do you feel anxious? Are you afraid you might forget what to say? Do you hate the prep or follow-up involved?
  •  If you get distracted on the phone, playing with fidgets and doodling on a piece of paper can keep you focused. I stayed focused on lectures in college by doodling in the margins of my notebooks.
  •  Instead of phone calls, encourage clients or other business contacts to email or send text messages to you.


Workflow Challenges
As we age, we not only deal with hormonal changes, but with an aging brain as well. As a result, we are more easily overwhelmed. It can become harder to juggle all the things thrown at us.


  •  Bring in more support, if possible. If you have assistants, hand off more responsibilities to them. Many with ADHD have a terrible time delegating, partly because it can trigger a sense of perceived failure (“I should be able to do it all myself”). Help them to help you by working together on setting up systems that work, starting with a schedule.
  • Stop taking everything on. Learn to say no (when appropriate). Negotiate extra time for getting tasks done.
  • Write it down. When you begin to feel overwhelmed, analyze what is upsetting you. Perhaps you feel you don’t have enough time to take on all the projects that have landed on your desk. Try whittling down larger projects into mini-tasks. One way to do that is to write an outline:
    1. Describe the project.
    2. What needs to be done first?
    3. What needs to be done next?
    4. What is the deadline?
    5. Who can help me take on parts of this project?
    6. What can she do?


    Writing things down reduces stress on the ADHD brain. Some people find that using a voice recorder to break down a task can be helpful, too.


Deadline Challenges
 If you wait until the last minute to finish a project — a common problem for people with ADHD — set up a schedule to divide the project into parts, and assign each part a day and a time. For instance:

Monday
9 a.m.: phone calls to xyz
11 a.m.: Spend a half hour working on report
Noon: lunch
1 p.m.: Write the first paragraph of the analysis report

Use visuals to avoid taxing your brain.

Challenges with the Boss
 Many people are overwhelmed when a boss “spits out” orders or expectations, especially verbal commands. If your boss does that, get in the habit of carrying a pad and taking notes as you discuss new assignments, or ask him or her to write down the specifics of what you need to do. Say that this is the best way for you to get the job done, as it gives you the opportunity to re-read the plan. Again, having your boss email you the assignment in detail is an excellent way to deal with his demands when your brain is already tired.

Professionals on Board
 Working with professionals familiar with ADHD can bring tremendous relief to someone who doesn’t feel up to a task. In your case, it may be working with an ADHD coach who can help you set up systems at work, and hold you accountable for getting things done. The job of a coach is to encourage you and work with your strengths. You can find an ADHD coach in the ADDitude Directory.

 Another option is to work with a professional organizer, who can de-clutter and organize your office with you. Make sure the person you hire understands ADHD-related challenges, so he or she is not judging you as you organize your office.