ADHD AND HORMONES
DHD AND ESTROGEN – IS IT A THING?
Let us talk about hormones – everybody’s favourite topic. Well, what about hormones? We know that the brain is a target organ for estrogen and that estrogen has a profound effect on mood states and memory. It does this by enhancing the monoamine (about 30% of serotonin and dopamine) release at the synapse. That is the result of estrogen enhancement. It happens for both men and women. Men have estrogen which stays relatively stable in their bodies up to a late age. Women on the other hand, have fluctuating estrogen.
HOW DOES IT AFFECT WOMEN OVER A LIFETIME?
Starting in puberty we will see the cyclical fluctuations of estrogen during menstruation. During pregnancy we have very high levels and with post-partum, the estrogen levels fall again. Symptoms may include sleep problems, forgetfulness, brain fog, irritability, depression and anxiety. Some women notice a shift in their mood and mental capacity almost immediately when they become pregnant. Ever wondered where “baby brain” and “baby blues” come from? Peri-menopausally, the estrogen levels start to decrease. Most women’s estrogen levels start to fall about a decade before they go into menopause. This may be late 30’s, early 40’s and gradually coming down until menopause. In their 50’s, women’s estrogen levels are very low. Men continue to have higher estrogen levels well into their 70’s.
WHAT IS THE CONNECTION?
Women with ADHD are especially sensitive to lower estrogen levels. It helps to understand that whenever estrogen levels fall below what scientists call the ‘minimum brain estrogen requirement’, then brain dysfunction happens because the amount of neurotransmitters decrease by 30%. Dopamine decreases before a period, with peri-menopause and lower serotonin right after having a baby. That is why we see Pre-menstrual Syndrome (PMS) in women as serotonin decreases, an enhancement of ADD symptoms before their period, with peri-menopause and in menopause. It is called pre-menstrual magnification of ADD symptomology or magnification of ADD symptoms in peri-menopause.
DOES HRT LESSEN ADHD SYMPTOMS?
While menopause causes ADHD like symptoms (or makes existing ADHD worse), Hormone Replacement Therapy (HRT) is complicated. It has pro’s and con’s. Some women will consider it to keep their estrogen levels up or simply to prevent them from fluctuating. The effects of HRT on ADHD can vary. It depends on the age of when the person begins therapy, what menopausal stage she is in, her activity level, any previous estrogen therapy, socio-economic status and the form of HRT used. Each case needs to be discussed individually with a health care professional, based on each person’s risk factors.
WILL MY ADHD MEDICATION STILL BE EFFECTIVE?
Several studies investigated whether medications used to treat ADHD are becoming less effective. Very often women in their late 30’s, early and mid 40’s will say:” My meds just don’t seem to work as well as they used to.” One of the things to consider is whether a person is in peri-menopause or entering menopause. As their estrogen levels decrease, they may not be as responsive to their stimulant medications as they had been before. Alternatively, their symptoms have increased and their current level of medication may not be as effective in treating those increasing symptoms.
There are multiple clinical trials and published studies are available on the internet for reference.
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