When Margaret struggled with perimenopausal symptoms, she discovered another diagnosis had been hiding in plain sight…
When I was 47, something started to change. Sore breasts began making sleep uncomfortable. Most days I felt unwell, and fatigue became more apparent. I was drained, irritable and frequently low despite being on an antidepressant for three years. I was also having to cope with a challenging home environment due to my children’s needs and struggles (due to diagnosed and undiagnosed neurodivergence).
Everything hurt, including my sense of self. Then came hot flushes that engulfed me with nausea and dizziness. I tried red clover, phytoestrogens and sage leaf tablets, with varying degrees of success. Increasingly, I felt trapped in a complex web of symptoms, I struggled to regulate my attention and my emotions, and I felt stuck in something that I couldn’t find my way out of. I used mindfulness, CBT approaches, essential oils and supplements. To add insult to injury, debilitating migraines began.
I’ve always been informed about my health since my life was impacted by endometriosis and adenomyosis when I was 13. I was aware you sometimes follow your mother in terms of the age of onset for perimenopause and I realised this was what was probably happening to me. My mum had a breakdown with her perimenopause though, although at the time it wasn’t recognised as the cause. It is now clear to me she is neurodivergent, but this wasn’t known either so this period was devastating – for her, for my father and my 13-year-old self.
RELATED: Will I have an early menopause like my mum?
Looking back at my experiences – and for any hints of what had been hiding in plain sight – I had always felt tired but had curious bursts of energy and extroverted enthusiasm, lots of ideas and was very sociable. But life felt like a gargantuan juggling act. Periods of fatigue and mini burnouts where low mood would occur was a repeating cycle in my teens. I attributed a lot of the fatigue to my endometriosis, which ekes life out of you through pain and other symptoms.
Since childhood I have had on loop in my head the question, “what is wrong with me?”, as I found it hard to retain and recall factual information, making learning and exams very challenging. Because of this, I didn’t have the opportunity to show my abilities in school. There’s been a lot of lost potential. Thankfully I found my niche and motivator in social work and have since gained two master’s degrees.
Now in my perimenopause, I kept forcing myself to wade through treacle, striving to get to a better place. I struggled with multiple daily tasks, lacked motivation; I would forget things and be in a spin with any planning required. Eventually I’d get things done but experienced little satisfaction from it. I couldn’t understand myself anymore and started internalising these struggles as failures and character flaws.
My GP and I discussed the possibility of perimenopause, and she agreed my symptoms indicated this and that HRT would be the next step. I was relieved there was a way forward. I was prescribed two pumps of oestrogen gel (I’d had a Mirena coil for some years to help my endometriosis). Within a few weeks I experienced a positive impact from the oestrogen: no more sore breasts, aching bones and feeling unwell.
However, I still had 50 things going on in my head simultaneously all vying for attention, which I could not switch off or prioritise. I would forget the detail of conversation. I found it harder to follow instructions for complex games or construction toys. I got more frustrated with myself and tasks I had to do, and lost interest in shopping and cooking.
I felt I was deteriorating cognitively, to the point where I tested myself for early onset dementia (a the time I had a part time job for a charity working with people with dementia). I no longer recognised myself. Although I wasn’t disorientated, ‘time blindness’ would get the better of me. This meant I thought I could fit more into a certain amount of time than I could, and I would find it difficult to plan far enough ahead.
RELATED: Brain fog or dementia?
My migraines accelerated with the triad of lockdown, home schooling, and working. When things took a turn for the worse, following a nasty drug interaction called serotonin syndrome, I realised I had to resign. I felt I had lost so much because of perimenopause.
It was a friend who suggested I may be neurodivergent and ADHD. I wanted to try to find answers to my struggles and engrossed myself in research – my hyperfocus has some benefits at times. With a sense of urgency and impulsiveness, I booked an assessment with a private psychiatrist online – I hadn’t realised there’s a legal Right To Choose process in England via the NHS – and received a formal diagnosis of ADHD.
RELATED: Hormones and ADHD with Dr Louise Newson and Dr Judith Mohring
Through my reading I discovered that oestrogen changes had been impacting my undiagnosed ADHD through the neurotransmitters of dopamine (a core component of ADHD and executive functioning), serotonin (linked to mood) and acetylcholine (linked to memory). My two male psychiatrists did not discuss or link the impact of perimenopause with my ADHD. I have since been raising this issue with my consultant to improve awareness. He tells me the majority of his patients are experiencing perimenopause.
Recent consensus is that ADHD does not affect males more than females, it’s just that ADHD is harder to identify in girls and women because it is often more internalised and hidden, and the diagnostic criteria are more orientated to a male presentation. Gender norms and stereotypes also significantly disadvantage women with ADHD in terms of receiving recognition and diagnosis. There seems to be more understanding of men not being able to juggle the mental load and multitasking needed for work, family and home life that modern life requires.
I have had some success controlling my ADHD symptoms with the help of HRT in combination with my ADHD medication - I am currently on my fourth type of ADHD meds and my third type of HRT due to shortages. I still feel that I haven’t returned fully to myself and wonder if testosterone might be the next step in helping with my executive function (planning, organisation, working memory, attention and other thinking skills).
RELATED: The importance of testosterone for women
ADHDers are tenacious and resilient. I can’t imagine how I would be if it weren’t for my HRT. And without the changes that happened at perimenopause, I might not have realised I was neurodivergent ADHD, so that is a blessing. I now have a road map for myself and I use my experience for good to help others.”
Find Margaret on Facebook at Margaret Reed Roberts Writer
RELATED: When ADHD collides with perimenopause with Margaret Reed Roberts
