‘I fell off a cliff’: Perimenopause worsened Natalie Imbruglia’s ADHD symptoms – here’s why & how to cope

When Natalie Imbruglia first sang about lying naked on the floor in the iconic song Torn, we don’t think she was referencing menopausal hot flushes. Neither was she giving a nod to the common perimenopause symptom of insomnia with the line ‘I’m wide awake and I can see the perfect sky is torn’.

But perhaps now when she performs the anthem, she’s got these experiences in mind. What we do know is that on her upcoming album, Algorithm, there will indeed be lyrics inspired by the 51-year-old singer’s experience of hormonal transition – which, at least at first, was not remotely enjoyable.

‘Let’s just say it was a grieving process,’ Natalie told The Times. ‘I was really angry. I fell off a cliff. It felt like someone had taken some of my personality.’

The singer, who dabbled in acting with a role in Johnny English, explained in the interview that she’s hugely grateful to women like Davina McCall for being honest about what perimenopause and menopause can truly be like. ‘It’s really important that we speak up and stop going, “Oh, I just breezed through it”,’ Natalie said. ‘How is that helping anyone? Beware, women, if you start saying, “I just don’t feel like myself”. I said that for a year before I addressed anything.’

Natalie shared that her main symptoms were anxiety and anger, and that perimenopause exacerbated her ADHD, with which she was diagnosed in midlife. The singer and mum says that she doesn’t see her ADHD as a ‘negative’, but instead as her ‘superpower’. However, she notes, ‘There’s a particular thing about my neurodiversity that’s hard for me to accept, which is how I get when I’m nervous before a show.’ She added: ‘Perimenopause made it worse.’

This is far from an uncommon experience. The number of midlife women receiving a diagnosis of ADHD has risen in recent years, and research suggests that many experience a worsening of ADHD symptoms during menopause. This makes sense when you consider how hormones generally interact with neurodevelopmental disorders. A review of studies suggested that there’s a significant association between women’s sex hormones and ADHD, with some reporting struggles at specific points of their menstrual cycle – but it’s an under-researched area that needs far more attention.

What we do know is that the drop in oestrogen levels that happens during perimenopause is likely to be to blame. ‘Oestrogen has a significant impact on regulating transmitters such as dopamine and norepinephrine,’ Dr Lori Bohn, a psychiatric mental health nurse practitioner and medical director at Voyager Recovery Center, tells Good Housekeeping. ‘These transmitters are central to focusing your attention (attention), motivating you to do things (motivation), remembering what happened before (working memory) and performing tasks that require problem solving (executive functioning). The fluctuations in oestrogen levels as well as eventual decline in oestrogen during perimenopause can lead to decreased efficiency in how efficiently brain systems process information. This means people whose ADHD symptoms have been present since birth will experience the effects of those symptoms much more severely than previously experienced.’

Perimenopause doesn’t cause ADHD, says Dr Robert Davies, a psychiatrist specialising in ADHD, mood disorders and women’s mental health. But it can make symptoms that have previously gone under the radar become more apparent, prompting the pursuit of a diagnosis.

To further complicate matters, there’s some crossover between perimenopause and ADHD symptoms that can be hard to untangle. Bonnie Lambert, a psychiatric mental health nurse and counsellor, tells us that some common perimenopause symptoms she sees in patients are: ‘brain fog, slow thinking, decreased working memory, mood swings, irritability and difficulty doing multiple things at once’. She adds: ‘The cognitive difficulties experienced by many postmenopausal women are similar to those related to ADHD’.

Plus, ADHD symptoms can make it harder to manage perimenopause symptoms. Think about it: treatments that can benefit perimenopause and menopause symptoms include medications, hormone replacement therapy, physical activity and lifestyle adjustments. ADHD can make implementing any of these things a challenge, having an impact on everything from the organisation required to take medication on time to the motivation needed to get up and take helpful actions. What’s more, says Bonnie, ‘Individuals with ADHD often experience emotional swings that can intensify feelings of stress as a result of hot flushes, sleep loss and mood changes, which makes these symptoms more difficult to tolerate.’

In short, it’s all a big, complicated mess. But there is good news: help is available. If you suspect perimenopause and ADHD are having an effect on you, experts recommend taking these steps.

Recognise that you’re not imagining or exaggerating things

The first step is knowing that if you’re struggling, you don’t just have to grin and bear it. There’s been a great deal of improvement in recent years, but the stigma around both ADHD and perimenopause symptoms remains – and it can be difficult to unpick.

Know that you are not alone, you’re not being dramatic and you deserve to feel better. Simply understanding the science – and hearing or reading a doctor validating your experience – is a vital component of the path forward. With that in mind, let’s hear from Dr Bohn again: ‘The combined effect of hormonal fluctuations from perimenopause and the emotional instability associated with ADHD can create overwhelming amounts of stress, which can exacerbate feelings of being unable to cope with the demands of daily life.’

Speak to a doctor

As we mentioned, it can be incredibly tricky to unpick what’s behind a symptom you’re experiencing. For example, perhaps you’re finding it impossible to focus. That could be down to ADHD’s impact on executive function and attention, but it could also be the brain fog common to perimenopause. Or perhaps this is a symptom you’ve been putting up with as just ‘part of ageing’.

‘Brain fogginess, mental exhaustion, forgetfulness, and an inability to organise can be misdiagnosed as either the typical signs of aging or just from being stressed,’ notes Dr Davies. ‘However, brain fogginess, mental exhaustion, forgetfulness and an inability to organise could also be related to the combination of the changes in hormone levels that women experience during their menstrual cycle and the pre-existing neurological development problems that women with ADHD have.’

The answer to starting to untangle this? Speaking to a professional. ‘A full clinical evaluation is needed,’ says Dr Davies.

Consider medication

There’s a cultural resistance to taking medication. That’s something we need to overcome. Medications such as Ritalin and Elvanse (both stimulants) can be life-changing for those with ADHD, enabling them to focus and get the basics of life, which neurotypical people may take for granted, done. HRT, meanwhile, can make a huge difference to the symptoms of both perimenopause and menopause. It’s not ‘weak’ to take medication. Getting help is not taking ‘the easy route’. This is how you survive and thrive.

‘The best way to handle this condition is through a multi-disciplined and individualised treatment plan,’ says Bonnie. ‘By optimising the ADHD medication regimen; establishing a regular sleep schedule; participating in some form of physical exercise each day; utilising stress reduction techniques (such as yoga); developing and adhering to a daily routine; and consulting with a medical doctor about the use of menopausal specific therapy, [a woman] may be able to significantly improve her memory, mental stability and quality of life.’