Once again, I want to remind you of the neurodiversity paradigm. A paradigm that is founded on the belief that all brains are unique and that it’s important to understand, accept and embrace these differences. With this, there is no single ‘right’ neurotype even though the world is largely set up to best support a ‘neurotypical’ brain. This means that neurodivergent folk often feel like ‘square pegs in round holes’ and have to ‘work harder’ to meet the social and cultural expectations of society. 

Navigating the complexities of ADHD during perimenopause requires a multifaceted approach that respects the individuality and unique needs of each woman. Treatment pathways should be holistic, neuroaffirming, and embedded within a neurodiversity paradigm, recognising that ADHD is not a deficit but a different way of thinking and experiencing the world. 

When considering treatment, particularly in relation to ADHD, it’s important to understand what you hope to achieve. In my mind, while I look forward to the day that the world is constructed in such a way that supports ALL brains, we aren’t quite there. But it’s SUPER important that you remember that treatment for your ADHD isn’t about fixing’ your ‘wrong’ or ‘broken’ or ‘disordered’ brain. Nope. It’s about making it easier for you to ‘adult’ in the areas that are the most challenging for, and/or important to, you. It’s also about discovering your strengths because there are many! You just can’t see them because what you don’t realise is … not everyone has them.

In addition to this, it is important to know that there are lots of ways that you can better support yourself when it comes to your unique ADHD challenges. Given that ADHD is life-long, there is no need to rush out and try to do everything at once. I guess as an ADHDer that is unlikely anyway. You may well struggle to identify what you want to do, let alone take the action. This might be where you can ask for some help with that, from someone you trust. Either way, it’s YOUR decision as to what step you want to take and when you want to take it.

Keep this in mind as you read on.

First Things First

It’s important to know that in Australia, if you want to take medication that is typically prescribed to assist with ADHD you’ll need to see a Psychiatrist. Some psychiatrists will arrange co-prescribing arrangements whereby they may see you on a yearly basis to review you (and prescribe) and in the alternate 6-months, you can see your GP and they can prescribe that exact medication / does. Those that offer this, will only do so in certain circumstances. However, before you can even see a psychiatrist, you need to be referred by your GP. You may wonder why I’ve then spoken about a psychological assessment in the prior blog. Well for a couple of reasons. 

Firstly, the process that a psychologist takes you through in order to assess for ADHD is extensive. It’s thoroughness increases its robustness and (often of greater importance to our clients) is very enlightening. The detailed discussions assist individuals to deeply reflect on how ADHD has (or hasn’t) shown up in their lives - throughout their lives. Most psychologists are neuroaffirming and as such, approach the assessment from this perspective. What this means is that you won’t only be talking about the challenges ADHD presents (although that’s critical for a diagnosis), you’ll also become far more aware of the gifts it’s given.

In addition to this, while waitlists for psychologists can be long, they are typically shorter than those for a psychiatrist. ADHDers aren’t always patient at the best of times and the long waiting game can create so much anxiety that they simply don't bother making an appointment with a psychiatrist. Plus, many psychiatrists close their books and only open them at a particular time (which they usually tell you). Totally fine. But again, someone with ADHD can just find this too hard and/or forget about doing it when the books are opened again. Seeing a psychologist with ADHD expertise and being diagnosed with ADHD (or not) is often a huge relief. You’ll be provided with a report which won’t necessarily see you jump the queue with the psychiatrist, but will definitely assist them in their assessment. 

Finally, some people know they won't be seeking medication whether they are diagnosed with ADHD or not. In these instances, I've found that these people simply want clarity about their diagnosis and how it manifests in their life. The baggage that we collect as undiagnosed ADHDers over our years of life given the challenges we face (like ‘you’re lazy’, ‘you’re stupid’, ‘you’re hopeless’ etc..) is often the hardest to carry. Being (finally) diagnosed with ADHD can kick start the process of healing, developing self-compassion and identify the next steps to take specific to their needs.

It’s also critical that women choose what’s right for them. Some women won’t want to try medication, whether it be for their ADHD and/or perimenopause. That’s completely their choice. However I do strongly advise that all women are educated about the range of treatment pathways, including medication AND also other options. This suggestion rests on the firm knowledge that there is considerable misinformation ‘out there’. Further, while you may know someone who has pursued a particular treatment pathway and found it amazing, lacking or horrible, it’s important to remember that every person is different. 

Whether you try medication or not is always up to you. But I do encourage you to ensure you are informed of ALL your options.

Medication - The Basics

Medication can play a crucial role in managing ADHD symptoms and research has shown that it’s effective for most people. There are a range of medications to assist people with ADHD and it does take some tweaking to work out what type and dose is best for you. For some people, they are blown away by the huge benefits they experience when they take the medication. For others, it’s less obvious and in fact, can be quite difficult to spot. 

Menopause Hormone Therapy (MHT) formerly known as Hormone Replacement Therapy (HRT) has also been shown to be helpful for most women when it comes to reducing the intensity or frequency of their menopausal symptoms. It can also take a fair amount of trial and error to work out what is the best type and dose for you.  It’s important to know that MHT is referred to as body-identical hormones and that means that on a molecular level, it is identical to what we naturally produce. There’s reasonable evidence to indicate that taking MHT reduces the risk of cardiovascular disease, dementia, Alzheimers, diabetes and osteoporosis. 

Personalised Medication Management: ADHD Medication and Menopause Hormone Therapy (MHT)

If you are considering either medication for your ADHD or MHT, it’s super helpful to track your symptoms. With regard to your ADHD challenges, identify those that bug YOU the most and then track them from the time you first start trialling medication. I can tell you right now, your Psychiatrist is going to want feedback in order to determine whether anything needs to be changed. You can find a handy ‘Tracker’ here (and I’ll also add that ADDitude is a good website with loads of helpful articles). The same goes for MHT. The range of symptoms associated with perimenopause are varied in nature, frequency and intensity. Some women feel the benefit of MHT very quickly whereas for others, it might take a few months. Either way, knowing your symptoms from the outset and then tracking them as you trial MHT is going to be really helpful. And yes, your menopause-informed GP will be asking these kinds of questions too. The Balance App is a great resource for tracking your symptoms and also has helpful articles for you to learn more.

What is really important when you are a perimenopausal ADHDer is that your psychiatrist and menopause-informed GP communicate with one another. If you have read Part 3 of this Series, you’d recall that there is considerable clinical evidence to show that the challenges of ADHD tend to fluctuate in tandem with a women’s menstrual cycle. Prior to perimenopause, many women ‘cycle dose’ in order to best manage this. Cycle dosing is essentially a practice where women (under the care of their psychiatrist) alter the dose of their ADHD medication at various points in their cycle. Once they work out the best doses for each stage, they then repeat that pattern of medication cyclically (i.e. month to month). 

Given that hormones fluctuate unpredictably during perimenopause, ADHD challenges can intensify. While the same approach can be taken in theory, the actual practice might need to be changed to manage ADHD challenges during perimenopause. So where a woman may have known to change her dose of medication in the luteal phase of her cycle, it becomes harder (but not impossible) to know when that might happen during perimenopause. 

The ideal scenario would be for a woman to begin perimenopause with as much knowledge about the differing stages of her menstrual cycle and physical symptoms that are common in the various stages. However, that’s not the only information to pay attention to. Prior to perimenopause our energy, mood, cognitive functioning and how we feel about ourselves (deep within) tend to change too. Knowing the rhythm of these changes (and at what stage of our cycle they ‘show up’) also helps us to understand our experience during perimenopause.

The ‘complication’ that comes with being a perimenopausal ADHDer is, as mentioned, a very clear reason why it’s important for your menopause-informed GP and Psychiatrist to communicate with one another. However, understanding your cycle, your ADHD and how each impacts the other, requires deep reflection and often guidance. It’s for this reason that working with a Psychologist with some training in Menstrual Cycle Awareness can be particularly helpful. It can take time but I’d encourage you to hang in there as for most women, when they dive into truly understanding their cycle, it makes quite a difference.

Psychological Therapy

Psychological therapies can be an effective non-pharmacological approach for managing ADHD and navigating perimenopause. Cognitive Behavioural Therapy is a model that most people have heard of. Even though it has a broad evidence-based, it tends to get a bad rap. This is largely due to the misconception that CBT implies ‘it’s all in your head’.  This is definitely not the premise of CBT. Rather, CBT leans towards helping people develop strategies to manage symptoms / challenges and build ‘good’ habits. It’s also about helping people address any negative thought patterns that add extra struggle to an ‘already-hard-enough-issue’. 

As an example, when I think of the delights of hot flushes, CBT isn’t to convince anyone that they aren’t happening or that they aren’t a big deal. No. The focus would be to help them not make them anymore awful than they are! And as humans, we load up an already difficult experience with even more negativity. We judge ourselves and our response and create pretty awful stories about ourselves (i.e. that there’s something weak/wrong/dramatic with me). These are the parts of the experience that CBT can help us with. And as we learn to untangle our real experience from the unhelpful self-criticism, our capacity to cope and beliefs in ourselves that we can cope, increases.

But that’s not all therapists have to offer. I want to back up a bit here and point out (highlight, underline and bold) that as women navigating the menopausal years we’ve lived a LOT of life. What I really mean, we’ve faced tough times before. And often, quite a few. Sadly, some of us have significant trauma histories that ‘flare up’. Others have mental health histories and experience a recurrence during the menopausal years. But even putting those ‘biggies’ aside, we all have lives filled with relationships, responsibilities and careers and each of these at some point will be a source of stress. We might want to think that the only ‘thing’ going on for us is menopause, but that’s just not my personal or professional experience. Nope. We have been through a LOT and still have a LOT going on. And in these instances, a more complex approach (beyond MHT, ADHD meds and/or CBT) is warranted.

Fortunately, therapists undertake training in many other models of treatment. Over my nearly-30-years of practice, I’ve done a fair bit. Some of my ‘favourites’ include gestalt and somatic psychotherapy, schema therapy, EMDR, attachment based therapy, MBT, ACT and trauma sensitive yoga. Find a mid to late career psychologist and you’ll find someone who has this kind of breadth of training. And because of that, you find someone who can tailor the approach to what is best for YOU.

But it’s not just about MHT vs CBT vs the other models mentioned. Nor is it just about reducing/ managing symptoms vs dealing with ‘complex mental health issues’ vs ‘the stressors of midlife’. There’s something far deeper occurring for us as we navigate the menopausal years. What’s changing during the menopausal transition is WHO we are, WHAT’s important to us and HOW we want to relate to ourselves and others. The word ‘transition’ is significant because it captures the reality of the limbo that we’re in (and stay in for some time). We aren’t quite who we used to be, but we also aren’t quite yet finished with ‘becoming’. And that ‘becoming’, well if you speak to women who are well and truly postmenopausal they will often tell you that they have become ‘the most themself’ they ever have. 

It’s really hard being in limbo for so long. It’s overwhelming, confusing and tiring; we need a lot of support and rest. It’s also really hard to grow into the fullest and truest version of who we are. Letting go of the ‘ways of being’ that don’t serve us sounds good, but these lifelong patterns take time to recognise from afar let alone catch and change in the moment. And let's not forget that doing so disrupts the status quo in ALL our relationships; with partners, children, siblings, parents, friends and colleagues. They aren’t always so quick to come on board with this ‘new’ you. And this is where therapy shines. 

ADHD and Health Coaching

Coaching is a powerful partnership designed to help individuals achieve their personal and professional goals. It’s a collaborative process where a coach guides you through self-discovery, goal setting, and action planning. Unlike therapy, which often delves into past issues, coaching is future-focused in that it emphasises actionable strategies that move you forward. 

Coaches provide a supportive, non-judgmental space for you to explore your strengths, identify challenges, and develop tailored solutions. Whether it’s ADHD or health coaching, the coaching relationship not only helps you navigate specific challenges but also fosters a deeper understanding of yourself. By leveraging the expertise and support of a coach, you can make meaningful progress toward your goals.

When it comes to ADHD coaching one of the ongoing priorities is to understand your unique brain, embrace your strengths, identify your goals and create the roadmap for achieving them. Together you’ll create and implement strategies that help you manage the challenges that drive you, the most mad! You’ll be supported to develop systems and routines in areas that you decide are important but can include time management, organisation or procrastination. 

One of the fundamental premises of any coaching is accountability and as such, your coach will help you navigate the obstacles that you will inevitably face in trying to make these changes. Because, all humans struggle to change. Even when changing is for the better. Through the process of implementing strategies successfully, your self-confidence will grow and you will feel less overwhelmed. 

Health coaching for menopause rests on the same overarching coaching principles; identify the challenges and the goals, create the roadmap, develop the strategies that move you towards the goals and address the barriers to change so you can take the action you want. Health coaching takes a broad approach, looking at your physical and emotional health. Whether you are focused on improving your sleep or nutrition, reducing your stress, moving your body more, you identify what your goals are. Your health coach is there to guide you towards a deeper understanding of you, your health  ‘problem’ and the strategies you can implement to help you reach your goals. 

Whether you’re seeking to manage ADHD or navigate menopause with more ease, coaching offers a supportive partnership to help you achieve your goals and live your best life.

Lifestyle Modifications

Navigating the challenges of ADHD and perimenopause simultaneously can be tough, but adopting the right lifestyle approaches can make a world of difference. And to be blunt, chronic stress, crappy sleep, poor nutrition, a sedentary life and too much alcohol … well ADHD medication or MHT can’t counter those. I will add though that for many women, those medications do help them find the energy and motivation that's required to make lifestyle changes. But let's assume that it IS possible to make some lifestyle changes (however that’s come about). Because once it’s possible, these changes (made incrementally over time) will make a huge difference to how you feel in your day to day life AND your long term health. 

First, focus on nutrition. Think of food as your fuel, powering both your brain and body. A balanced diet rich in colourful vegetables, lean proteins, and healthy fats like avocados and nuts can make a significant impact. Omega-3-rich choices, such as salmon or chia seeds, help sharpen your mind and stabilise hormonal fluctuations. Reducing sugar and caffeine can prevent spikes and crashes that exacerbate symptoms. And don’t shoot the messenger, but perimenopause in particular is a time where alcohol just wreaks havoc with you. 

Movement is another key player. Whether it’s a brisk walk, a dance class, or a yoga session, regular physical activity boosts mood, improves focus, and alleviates perimenopausal discomforts. Find ways to move your body that you enjoy and make them a regular part of your routine.

Speaking of routines, having a structured day can be immensely helpful. Whether you start your day with some deep belly breaths, jump in the shower, get dressed and have your breakfast OR get out of bed and go for a walk or to the gym and then get yourself showered, dressed and fed, you do you! The point is to start your day in a way that lifts your mood and perspective and do it on repeat. A consistent schedule can keep ADHD symptoms in check and provide stability during hormonal changes.

Stress management is crucial but geez it’s hard in this day and age. I do really understand that. But do you best. Start with small changes. Maybe it’s as simple (and based on principles of habit stacking) that every time you go to the bathroom, you’ll take a few deep breaths. Perhaps it is getting up and doing some stretches, having a glass of water, or listening to a favourite song a few times each day. Incorporate moments of calm into your day, like a quiet walk, deep breathing exercises, or reading a book. One thing we don’t often think of but has an enormous body of research to support it’s benefits for stress reduction and that is play. Yes. Adults can really benefit from playing. What is something you can do (maybe thinking about what you used to do when your life was simpler) that brings you joy. That the experience itself is what makes you feel good, not the outcome. For me, that’s singing. It’s always singing. Whether it’s about creating a sense of calm or fun / joy, these practices help reduce anxiety and soothe your mind.

 This one is a kicker. We all crave it but for many ADHDers AND perimenopausal women, it’s so elusive. And that is quality sleep. Hands up who fantasises about a long, deeply restful sleep. Me! I do. Well, there are quite a few things that we can do to maximise the chance of getting a good night’s sleep. Often referred to as ‘sleep hygiene’ (terrible phrase really) this approach hinges on some key principles; (1) create a sleep-friendly environment with a cool, dark, and quiet bedroom (2) create an association that your bed is for sex and sleep only, which means just use your bed for sex and sleep (3) create and stick to an evening routine that helps you wind down like reading on the couch, having a herbal tea, cleaning your teeth and having a warm shower and heading to bed. I want to mention that when I say routine, it’s about doing the same things, in the same order and generally at the same time. Good sleep rejuvenates your body, sharpens your mind, helps the highly active ADHD brain settle and balances your hormones.

Hydration is another simple yet powerful tool. Keeping a water bottle handy helps manage hot flashes and supports overall cognitive function. Pair this with self-care routines like skincare to nurture both body and soul.

Finally, connect with others going through similar experiences. We know that the health impacts of loneliness are dire. And you can have many people around you, and feel lonely. What I’m talking about is connecting meaningfully with others. You don't have to have a huge number of people you’re close to, but we all need a few. It’s how we are wired. We don’t survive with some meaningful relationships. When it comes to being an ADHDer and going through the menopausal transition, it can be even more important to be around people who understand your experience - because they’re going through it too. So joining communities where ‘your kinda people’ hang out can be incredibly reassuring.

By adopting these practical lifestyle approaches, you can better manage the overlapping challenges of ADHD and perimenopause. Small, meaningful changes can help you feel more in control and empowered. Embrace this journey with self-compassion and confidence, knowing that you have the tools to thrive.

Final Words

By adopting a holistic and personalised approach to treatment, perimenopausal women with ADHD can navigate this transitional period with greater ease and empowerment. Embracing a neurodiversity paradigm ensures that treatment pathways are affirming, supportive, and truly reflective of each individual's unique journey. Oh and if there is ever a time to develop self-compassion AND give yourself permission to focus on yourself, it’s now. Do it. You’ll be better for it.

Raising awareness and deepening the understanding of perimenopause and ADHD is crucial—not just important—for timely and effective support. If you suspect you might be one of the many perimenopausal women with ADHD, check out the other articles in this ADHD and Perimenopause Series www.allabouthercentre.com.au and/or seek out a healthcare provider who knows this space well. Feel free to reach out to me via www.allabouhercentre.com.au if you need guidance as to how to go about being assessed or ongoing support.