Hormones and ADD (ADHD) in Women
Patricia O. Quinn, M.D.
"I'm 43 and since the "flashes" began,
my ADD (ADHD) symptoms are so much worse."... I'm a 56
year old woman with ADD (ADHD) on Ritalin and for the last
few years my medication does not seem to be working as well
as it did several years ago."... "I'm 53 and seem
to have more problems with depression and ADD (ADHD) now that
I am entering menopause."
Hussey (1990) first addressed the issue of hormones and
their relationship to ADD (ADHD) by noting that girls with
ADD (ADHD) may have increasingly severe problems with the
onset of puberty. He wrote that increased hormonal fluctuations
throughout the phases of the menstrual cycle might result
in increased symptomatology. Zametkin reports that girls show
a decrease in cerebral glucose metabolism at puberty that
is not seen in boys. This decrease is dependent on degree
of physical (sexual) maturity and thus specific to sexual
developmental stage rather than chronological age. Therefore,
it only seems logical to look into the correlation between
hormones particularly estrogen and ADD (ADHD) in women.
Studies in women have shown that estrogen improves memory
and cognitive functioning. Research using objective psychometric
tests has reported higher score for women taking estrogen.
Estrogen appears to exert a global effect on cognition enhancing
or maintaining aspects of verbal memory, but does not appear
to have a similar effect on spatial memory.
In addition, it is now known that estrogen exerts profound
effects on mood, mental states, and memory. Low levels of
estrogen in women are associated with PMS, postnatal depression
and post-menopausal depression. It has been proposed that
whenever brain estrogen falls below the "minimum brain
estrogen" requirement, for whatever reason and at whatever
age, brain dysfunction may result.
I have found this to be a very critical, but often overlooked
area in treating women with ADD (ADHD). I often hear from
women who report that as they enter perimenopause and the
"flashes" begin, they have more problems with their
ADD (ADHD) symptoms or that their stimulant medication does
not seem to be working as well as it did previously.
Women with ADD (ADHD) need to be aware of several perimenopausal
and menopausal issues. First, menopause comes with a whole
host of symptoms including memory problems and mood changes,
in addition to the hot flashes, insomnia, etc. Women entering
menopause frequently complain of difficulty with short-term
verbal memory, word retrieval, and mental clarity. These symptoms
are now thought to relate to decreasing estrogen levels that
affect the brain. As a woman with ADD (ADHD), you need to
work with a physician who is aware of the interaction between
ADD (ADHD) symptoms and estrogen levels.
Perimenopause is also a time associated with mood changes
and the onset of depression in some women who have had no
previous history of the disorder. These women report feeling
sad, irritable, tired and worried, as well as having difficulty
sleeping. This depression and the cognitive deficits associated
with decreasing levels of estrogen that occur as a woman enters
menopause, combined with ADD (ADHD) symptoms may cause a woman
with ADD (ADHD) to have difficulty coping her ADD (ADHD) symptoms
as well as she was previously. She may find herself becoming
less functional as she enters this phase of her life. I find
this is often the reason why a woman seeks help for her ADD
(ADHD) for the first time in her late 30s, 40s, and 50s. At
that time, she may present to a physician with full-blown
ADD (ADHD) or a worsening case, if they have been diagnosed
previously.
Physicians need to take all of this information into account
and design a holistic approach to assist women with ADD (ADHD)
in getting back on a more even keel. Treating ADD (ADHD) in
women at the various life stages is a challenge and no two
women have the same needs. Stimulant medication dosage may
need to be increased and most women need symptom coverage
for 16 to 20 hours per day. In addition, sleep issues need
to be addressed. Multiple doses of long-acting stimulants
depending on their duration are advisable; and the new non-stimulant
product lasting 24 hours may need to be considered along with
a stimulant. Antidepressants and estrogen or thyroid hormone
supplements may also be warranted in certain cases.
Women should also practice good self-care eating a wholesome,
nutritious, well-balanced diet, and getting plenty of exercise
and sleep. She should discuss her symptoms with a physician
and bring up the possibility of taking vitamin supplements
and using alternative therapies to boost estrogen or omega-3
fatty acids. Above all, a woman with ADD (ADHD) should be
kind to herself and get all of the help and support she can
to make this difficult transition time more comfortable for
her.
For more understanding of these issues, the following
books are recommended:
Understanding
Women with ADHD by Kathleen Nadeau, Ph.D. and Patricia
Quinn, M.D.
Gender Issues
and ADHD: Research, Diagnosis and Treatment by Patricia
Quinn, M.D. and Kathleen Nadeau, Ph.D.
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