Menopause and Mid-life Transitions for Women with ADD
Kathleen Nadeau, Ph.D.
In midlife, a woman with ADD (ADHD) makes major transitions.
Biologically, she goes through perimenopause and enters menopause.
Interpersonally, family responsibilities are typically waning.
In her fifties, a woman with ADD (ADHD) has new choices before
her. Perhaps this is a time to pursue a long-neglected dream
- to return to school, to develop a dormant talent, to establish
a different lifestyle that is more compatible with her needs
as a woman with ADD (ADHD).
It is critical for a woman with ADD (ADHD) to be aware of
the powerful interaction of ADD (ADHD) symptoms and declining
estrogen levels. Many women whose ADD (ADHD) symptoms have
been successfully treated with psychostimulants report that
their stimulants are less effective during perimenopause and
menopause. Because there is little dialogue between physicians
who treat adults with ADHD and those who treat women in menopause,
the interactions of ADD (ADHD) symptoms with estrogen levels
are not yet widely known or appreciated. It is not unusual
for a physician treating ADHD to have little information on
this stimulant-hormone interaction. As a result, it may be
necessary for a woman with ADHD to help educate her physician
about these interactions in order to receive effective medication
In mid-life, the opportunity to re-design her lifestyle
beckons, if a woman with ADD (ADHD) will heed its call. Whether
she is a single parent, renegotiating expectations with newly
adult offspring, a married woman, renegotiating with children
and spouse alike, or a single woman looking toward a shift
in career focus, she has the option to lower her daily stress
level by changing the expectations of herself and of others.
A woman in mid-life may feel entrapped by the expectations
of others. She may be the primary caretaker of an aging parent;
she may over-function for her young adult children; she may
have been a supportive spouse who now wants to focus energy
on her own projects; or she may be a career woman whose employer
expects workplace demands to take precedence over personal
Because people with ADD (ADHD) tend to be "reactive"
to their environment, women with ADD (ADHD) may face a particularly
difficult challenge when they try to stop focusing on the
expectations of others and focus more on their own needs and
Finding a new Balance
The primary mid-life goal for a woman with ADD (ADHD) is
to create a new sense of balance in her life - balance within
herself, and balance between herself and significant others.
The challenge for her is to slow down the merry-go-round she's
been riding for so long - slow it down so that she can go
for a walk in the woods, for a soak in the hot tub, or spend
a calm moment in meditation or yoga. She needs time to ask
herself whether she wants to keep riding the merry-go-round.
Finding new directions after the "merry-go-round"
Like other women, many women with ADD (ADHD) have put hopes
or ambitions on hold while raising a family, planning to put
more energy into their own projects when they have more time.
But when a woman has ADD (ADHD), she faces an extra challenge
in pursuing a new direction. The skills a woman needs to follow
through on her hopes and dreams are often the very skills
that are most challenging.
During child-raising years, a woman with ADD (ADHD) may
have felt unable to pursue her own dreams. But now, as time
and opportunity open up, she may overwhelmed and directionless.
How do I get started? Where should I begin? A woman with ADD
(ADHD) may react to "free" time by feeling paralyzed
and unable to move forward. Instead of writing that book she's
always dreamed of, or applying for the graduate program she's
postponed for years, she may find she's more likely to continue
to respond to the needs, requests, or ideas of others.
With ADD (ADHD)-reactivity, it's easier to answer the ringing
telephone or respond to a request than to stick to your own
plans for the day, easier to follow the beaten path than to
strike out in your own direction. For a woman who forgets
what she intended to do in the time it takes to walk downstairs,
developing new habits and setting out toward long-postponed
goals can seem impossible.
Support and structure to make changes
To make her dreams come true, she needs support and structure.
Structure can come in the form of a partner - someone to share
the dream, to be accountable to, someone to plan with, someone
to brainstorm with. Structure can also come in the form of
a job. For example, if a woman's ultimate dream is to start
her own enterprise, she may begin by working for someone from
whom she can learn the skills she needs to strike out on her
Groups can also be important sources of structure and support.
She can join a group of women with similar goals - stay-at
home moms returning to the workplace, women who hope to become
artists or writers, women training for the same profession,
women starting their own enterprises - such groups can provide
support, encouragement, advice and contacts.
Enrolling in a class can provide both structure and support.
The regularly scheduled class can help her keep on track,
while contact with the teacher and with fellow students can
provide her with emotional support and encouragement as she
develops or enhances the skills she needs to follow her dream.
Counseling or psychotherapy
Working with a professional in counseling or psychotherapy
may be very useful to help a mid-life woman with ADD (ADHD)
take stock in her life, to rekindle old dreams or develop
new ones better-suited to the self that she has become. "The
way it's always been" no longer needs to be. Yet habit
and expectations can have a powerful pull.
If she's married or is a mother, she needs to work toward
creating a different balance in her relationship with her
husband or young adult children. Psychotherapy may help her
stay on track as she learns to give herself permission to
take care of herself and to renegotiate long-standing patterns
with her spouse.
Psychotherapy is often the best approach for understanding
the emotional and interpersonal issues that are getting in
her way. However, when a woman is clear about what she wants
to do, but can't seem to mobilize herself to do it, coaching
may prove very helpful. For example, if a woman has decided
to return to school to earn a degree, a coach can help her
get on track and stay on track, teaching her to set realistic
goals, to break large goals into do-able steps, and to remain
focused and motivated as she works toward her goal.
Pulling it all together
Mid-life can be a time of possibility and change for a woman
with ADD (ADHD), a time to reassess, to find more time for
herself, and to set her sights on new goals. With structure,
strategies and supports in place, midlife is a golden opportunity
for a woman with ADD (ADHD) - a time to reassess earlier choices
that were made without understanding ADD (ADHD) - an opportunity
to reduce chronic stress, to become more balanced, and to
accomplish things she only dreamed in earlier years.
Resources for women with ADD (ADHD):
and ADHD edited by Patricia Quinn, M.D. and Kathleen Nadeau,
Women with ADHD edited by Kathleen Nadeau, Ph.D. and Patricia
ADD by Sari Solden.
Focus Series: ADD and Fibromyalgia - A group of articles
previously published in ADDvance Magazine that focus on issues
of fibromyalgia in women with ADHD.