Editor's note: Dr. Hair's observations and the findings she reports here are of critical importance to women with ADD for two reasons.
First, women with ADD who are entering menopause may encounter a worsening of their ADD symptoms (poor memory, word retrieval, and/or executive functioning). At that time they may need to reassess the effectiveness of the medications taken to treat their ADD symptoms and in addition discuss hormone replacement therapy as an adjunct to their present medication regime. Perhaps some women are incorrectly concluding that their medications are no longer effective when in fact hormonal changes are responsible.
Second, it may be that many women who are experiencing memory loss, lack of concentration, irritability, and various other symptoms as a result of menopause and changing hormone levels are being inappropriately labeled ADD, or worse yet, given other psychiatric diagnoses. Women need to be aware of the various manifestations of the perimenopausal and menopausal state and seek out appropriate support and guidance. P.O.Q.
One of the most common complaints that I hear from women in their mid-forties and older is of memory loss. Women come in for their yearly examinations and complain that they can no longer remember things -common names, words that they use frequently in their daily routines, or where they have placed things such as their car keys or even their cars! This can be very frightening to these women, especially if they have a family history of Alzheimer's disease. On further questioning, many women relate that they can not focus on their tasks or concentrate as well. I often found myself thinking that these women were all describing an adult form of ADD.
Because I heard this complaint from almost every woman who came in to discuss menopause or the perimenopause (those years preceding menopause when a woman's estrogen is diminishing), I realized that there had to be a connection between estrogen and cognitive functioning, including memory.
There was not much known at that time, but during the past decade, especially during the last five years, more evidence points to the fact that estrogen does indeed have an effect on the brain, and therefore, cognition and memory. These cognitive changes commonly reported as a difficulty in remembering and concentrating are a major concern to women, but relatively few studies have looked at cognitive functioning in the postmenopausal woman. What studies we do have reveal that estrogen affects cognition in three ways. The hormone increases brain cell function, increases growth, and enhances protective mechanisms in parts of the brain that involve cognition and memory. These portions of the brain have been found to have estrogen receptor sites and are therefore sensitive to estrogen. These areas have also been implicated in affective disorders such as depression and anxiety and are noted to decrease with age. Over the last several years studies of women using 1.25 mg of estrogen and a placebo have reported a subjective improvement in memory in the women taking the estrogen. Other studies using more objective psychometric tests have shown higher scores in women taking estrogen. These studies further reveal that estrogen exerts a specific rather than a global effect on cognition and enhances or maintains aspects of verbal memory but has no effect on spatial memory.
So what does all this have to do with healthy perimenopausal or menopausal women? Well it is rather exciting to know that along with estrogen's role in protection against heart disease, vasomotor symptoms (such as hot flashes), and osteoporosis we can add the all important role of protection for the mind to maintain cognitive functioning and improved memory. And a women does not have to wait until she is menopausal, or completely without menses, to help herself if she exhibits a decline in her memory. The exciting news now is that women in their forties entering the transition, or perimenopausal years can also receive help. For the past several years, it has been medically acceptable to treat nonsmoking women in that age group with a low dose oral contraceptive to increase her own natural estrogen level and subsequently offer protection to her heart, bones, and mind. All of these benefits must, of course, be balanced against the possible increased risk of breast cancer. Every woman is different, and therefore, should discuss her individual situation with her physician.
Perhaps now, the equation regarding the benefits and risks of hormone replacement therapy can be recalibrated. Estrogen has now been shown to have an effect on cognition and memory as well as on dementia. I will continue to share my belief that maintaining a good mind is just as important as maintaining a healthy heart and strong bones when discussing the controversy surrounding hormone replacement therapy with my patients.
* Re-posted with permission from www.addvance.com a site dedicated to women and girls with ADHD.
** Dr. Hair is an obstetrician-gynecologist with a private practice in Falls Church, Virginia. She is married and has two children.