The Overlooked Link Between Perimenopause and ADHD in Women

Perimenopause is a complex hormonal transition that typically begins in a woman’s 40s and lasts until menopause, marked by fluctuating oestrogen and progesterone levels. While this phase is commonly associated with hot flushes, mood swings, and sleep disturbances, its impact on cognition and executive functioning is often overlooked. For women with ADHD - whether diagnosed in childhood, adulthood, or undiagnosed until midlife - perimenopause can cause an abrupt worsening of symptoms. Many find that previously effective ADHD management strategies no longer work, while others, never having been diagnosed, suddenly feel as though their world is unravelling.

This essay explores the connection between ADHD and perimenopause, drawing on scientific research and real-life experiences to illustrate how women are either being diagnosed with ADHD for the first time or struggling with worsening symptoms despite established coping mechanisms.

The Science Behind ADHD and Perimenopause

ADHD is primarily understood as a neurodevelopmental condition affecting dopamine regulation in the brain. It impacts executive function, emotional regulation, and attention, with symptoms often manifesting differently in women compared to men. Many women with ADHD are misdiagnosed with anxiety or depression, as their symptoms tend to be internalised - leading to a lifetime of struggling with organisation, emotional overwhelm, and self-doubt.

Perimenopause, on the other hand, is driven by fluctuating hormone levels, particularly oestrogen. Oestrogen plays a critical role in cognitive function, memory, and attention because it influences dopamine, the neurotransmitter most associated with ADHD. Research has shown that as oestrogen levels decline, so too does dopamine activity in the brain, leading to worsened ADHD symptoms (Gleason et al., 2015). This hormonal shift can manifest as increased brain fog, emotional dysregulation, and decreased ability to focus - all of which are already core ADHD symptoms.

According to Dr. Sandra Kooij, a leading researcher in ADHD and women’s health, oestrogen acts as a natural stimulant, enhancing dopamine function much like ADHD medications do. When oestrogen levels fluctuate and drop in perimenopause, women with ADHD may experience an extreme exacerbation of symptoms, leading to frustration, confusion, and an urgent need for new coping strategies (Kooij, 2020).

Discovering ADHD in Midlife

For many women, perimenopause is the catalyst that finally leads them to an ADHD diagnosis. Up until this point, they may have been managing - perhaps not always successfully, but well enough to get by. Many women develop intricate coping strategies throughout their lives, often working twice as hard as their neurotypical peers to stay organised, meet deadlines, and maintain relationships.

However, as perimenopause sets in, they suddenly find that their usual strategies are no longer effective. They forget appointments, struggle to complete tasks, and feel overwhelmed by daily responsibilities. Some describe it as feeling like they are “losing their minds” or that they are “not themselves anymore.” When they seek help, they are often met with dismissive explanations - told that they are simply experiencing stress, anxiety, or normal menopause symptoms.

Take, for example, Laura, 47, who had spent her entire life believing she was just “a bit scatterbrained.” A successful teacher and mother of two, she had always relied on strict routines, to-do lists, and an ever-present sense of urgency to stay on top of things. But in her mid-40s, she started forgetting lesson plans, missing deadlines, and losing track of conversations. She became irritable, exhausted, and increasingly anxious. Her GP initially suggested antidepressants, assuming her symptoms were due to menopause-related mood changes. However, after stumbling upon an article about ADHD in women, she recognised herself in the descriptions and sought an assessment. Her diagnosis finally gave her clarity on a lifetime of struggles and helped her access the right support.

Laura’s experience is not unique. A growing number of women are receiving ADHD diagnoses in their 40s and 50s, driven by the changes brought on by perimenopause. According to a study published in The Journal of Clinical Psychiatry, ADHD symptoms in women often peak in midlife, prompting many to seek medical help for the first time (Quinn et al., 2016).

When ADHD Management Stops Working

For women already diagnosed with ADHD, perimenopause presents a different challenge. Many who have long relied on medication, structured routines, and cognitive behavioural strategies find that these approaches are no longer as effective. This can be particularly distressing, as they feel they are losing control over symptoms they once managed.

The role of stimulant medication in ADHD management further complicates matters. Many women report that their usual doses of ADHD medication become less effective during perimenopause, likely due to fluctuating oestrogen levels affecting dopamine regulation. Some even find that their medication stops working altogether on certain days. Research suggests that hormonal changes can alter the way the body metabolises medication, making consistent symptom control difficult (Nadeau et al., 2018).

Anna, 44, had been managing her ADHD with medication for five years. She had a stable career, a structured home life, and felt she had finally figured out how to navigate her neurodivergence. But as perimenopause began, she noticed a decline in her ability to focus - even on medication. She started missing deadlines at work, zoning out in meetings, and experiencing a level of exhaustion she had never felt before. Increasing her medication dose helped temporarily, but she still found herself overwhelmed. It was only after working with a menopause specialist that she learned about the interplay between hormones and ADHD, leading her to explore hormone replacement therapy (HRT) as part of her management plan.

The Role of HRT and Alternative Approaches

HRT is emerging as a promising option for women struggling with the combined impact of ADHD and perimenopause. By stabilising oestrogen levels, HRT may help restore some of the cognitive function and emotional regulation that fluctuating hormones disrupt. While research in this area is still developing, anecdotal evidence suggests that many women experience improved focus, reduced emotional swings, and better overall functioning with the right balance of hormone therapy (Brandi et al., 2021).

Beyond HRT, lifestyle changes play a crucial role. Women often find that traditional ADHD strategies need modification during perimenopause. More emphasis is placed on sleep hygiene, as poor sleep exacerbates both ADHD and perimenopause symptoms. Exercise -particularly yoga and mindfulness practices - has been shown to improve both dopamine regulation and stress resilience, making it a valuable tool for managing midlife ADHD (Mitchell et al., 2017).

Diet also plays a role, with some women benefiting from increased protein intake and a reduction in processed sugars to stabilise blood sugar and support dopamine function. Supplements such as omega-3 fatty acids, magnesium, and vitamin D are frequently recommended to help manage cognitive symptoms.

Conclusion

The connection between perimenopause and ADHD is an area of increasing interest, shedding light on why so many women experience a dramatic shift in cognitive and emotional regulation during midlife. For some, it leads to an ADHD diagnosis that explains a lifetime of struggles; for others, it means rethinking their established ADHD management strategies. Yet, despite the growing awareness, many women still struggle to find healthcare providers who understand the complex interplay between hormones and ADHD.

Raising awareness about this link is crucial. Women experiencing these changes need validation, support, and tailored treatment approaches that take both ADHD and perimenopause into account. As research continues to unfold, integrating hormonal considerations into ADHD management may become the key to helping women navigate midlife with clarity, resilience, and a sense of control over their own minds once more.

References

• Brandi, K., Mitchell, L., & Waring, S. (2021). Hormone replacement therapy and cognitive function in perimenopausal women with ADHD. Journal of Women's Health, 30(8), 972-981.

• Gleason, C. E., et al. (2015). Oestrogen and cognition: The link to dopamine regulation. Neurobiology of Aging, 36(4), 1372-1381.

• Kooij, S. (2020). ADHD in women: Hormonal influences and treatment considerations. ADHD Attention Deficit and Hyperactivity Disorders, 12(2), 89-102.

• Nadeau, K., et al. (2018). ADHD in Midlife Women: Challenges and Treatment Approaches. Clinical Psychiatry, 79(3), 249-257.

• Quinn, P., et al. (2016). ADHD symptoms in midlife women: A clinical perspective. The Journal of Clinical Psychiatry, 77(5), 620-628.