ADHD in women can come with more inattention and overthinking than hyperactivity, which is more common in men. However, the hormonal shifts women experience during perimenopause can significantly worsen ADHD symptoms and increase their severity.
I’ve helped many women navigate ADHD symptoms while undergoing hormonal changes like those in perimenopause. The good news is that it’s all manageable. I’ll break down how perimenopause affects women with ADHD, and ways to manage your symptoms.
How Does Perimenopause Affect Women with ADHD?
Perimenopause can worsen ADHD symptoms because declining estrogen levels affect dopamine, serotonin, and other neurotransmitters involved in attention, memory, and emotional regulation. Many women report increased brain fog, forgetfulness, procrastination, and emotional overwhelm during the transition to menopause.
One survey found that 94% of women with ADHD agreed that their symptoms worsened during perimenopause and menopause. This is a stark contrast to the 17% who felt they had severe symptoms in their 20s and 30s.
For example, women with ADHD and perimenopause may experience more intense:
- Brain fog: 70% of women with ADHD undergoing perimenopause felt that their brain fog symptoms had a “life-altering” impact.
- Forgetfulness: Memory issues were a top symptom that women with ADHD felt exacerbated during perimenopause.
- Trouble following through: 63% of women with ADHD found that procrastination and time management struggles were notably worse with perimenopause.
But how do hormones affect ADHD symptoms? Estrogen drops during perimenopause, but that’s the same hormone that regulates neurotransmitters affected by ADHD.
Low estrogen contributes to a subsequent drop in happy, feel-good hormones like dopamine and serotonin. And it’s these hormone drops that cause changes in physical and emotional health, like sleep, memory, mood, and emotional sensitivity.
These shifts can significantly worsen ADHD symptoms.
“Women with known ADHD often find that their symptoms worsen within the perimenopause to menopause transition,” says Heather Hirsch, MD.
But what’s interesting about perimenopause is that it also sparks more prominent symptoms in women who haven’t received a diagnosis.
On the onset of perimenopause, women who may have been able to cope with ADHD symptoms previously can’t any longer. This is because before, they were able to mask their symptoms. Masking becomes increasingly more difficult.
“They can’t keep on track, they can’t finish reading a book, they can’t finish dishes, and it’s really affecting their quality of life,” says Hirsch.
Why Does ADHD Often Feel Worse During Perimenopause?
ADHD symptoms can increase during perimenopause because estrogen helps regulate dopamine, a neurotransmitter involved in attention, motivation, and executive functioning. As estrogen levels fluctuate and decline, many women notice increased brain fog, forgetfulness, emotional sensitivity, and difficulty concentrating.
For many women, perimenopause is the first time ADHD symptoms become difficult to ignore. While ADHD has been present throughout life, hormonal changes can make previously manageable symptoms feel much more disruptive.
One of the primary reasons is the relationship between estrogen and dopamine. Estrogen helps support dopamine activity in the brain, and dopamine plays a major role in attention, motivation, memory, emotional regulation, and executive functioning. When estrogen levels begin fluctuating during perimenopause, dopamine regulation can become less stable as well.
As a result, women may notice symptoms such as:
- Increased brain fog
- Difficulty concentrating
- More frequent forgetfulness
- Greater emotional sensitivity
- Trouble organizing tasks and managing time
- Reduced motivation and follow-through
These changes can be particularly frustrating because they often appear during a stage of life when responsibilities are already increasing. Many women in their 40s and 50s are balancing careers, children, aging parents, household management, and other demands that place additional pressure on executive functioning skills.
For women who have unknowingly lived with ADHD for years, perimenopause can also make masking significantly more difficult. Many develop coping strategies throughout adulthood that help compensate for symptoms such as forgetfulness, disorganization, or inattention. However, hormonal changes can reduce the effectiveness of those strategies, making symptoms more noticeable.
This is one reason many women first seek an ADHD assessment during perimenopause. What appears to be a sudden onset of symptoms is often an existing pattern that has become harder to manage due to hormonal changes.
Many women find that symptoms they were previously able to compensate for begin affecting their quality of life during the perimenopause transition. Understanding this connection can help women recognize that these challenges are not a personal failing but rather the result of complex interactions between hormones, brain function, and ADHD.
What’s the Difference Between Perimenopause and Menopause in Women with ADHD?
Perimenopause is the transition period leading up to menopause, while menopause begins after 12 months without a menstrual period. Both stages can worsen ADHD symptoms due to hormonal changes, though many women find the unpredictability of perimenopause particularly challenging.
Both perimenopause and menopause result in more intense ADHD symptoms for women. Here are the main differentiators between the two, and how they affect ADHD.
Perimenopause symptoms most commonly start between the ages 40 and 50, when women experience irregular or stopped periods. Symptoms might also include mood swings and brain fog as your body adjusts to an unpredictable shift in body and mind.
Menopause marks the official end of a woman’s menstrual years, and an even more significant drop in the estrogen hormone. Women experience menopause after 12 months without a period.
Since perimenopause feels so new and unpredictable, it can worsen symptoms like overthinking, trouble concentrating, and anxiety in women with ADHD. While menopause continues to worsen ADHD symptoms, its overall symptoms might feel more manageable to women because they’re familiar with them.
Navigating ADHD During Perimenopause: Tips for Symptom Management
Managing ADHD during perimenopause often requires a combination of strategies that address both hormonal changes and ADHD symptoms. Treatment may include medication, therapy, hormone replacement therapy, lifestyle adjustments, structured routines, and support from healthcare professionals.
Many of the women I work with who have ADHD are in the age range for perimenopause and menopause. Here’s how I’d advise them to approach ADHD symptoms during perimenopause:
- Write down your symptoms: Spend 5 minutes a day writing down your symptoms to keep track of patterns and shifts.
- Find out if you have ADHD: One survey found that 25% of adults suspect they have ADHD, but haven’t received a diagnosis. Start with a free online ADHD assessment. Then, verify the results. You can only know for certain that you have ADHD with a mental health practitioner’s diagnosis.
- Find out if you’re in perimenopause: Perimenopause is the transition stage from regular menstrual cycles to menopause. You might have perimenopause if you notice irregular periods, mood swings, and hot flashes around your 40s and early 50s.
- Ask your physician about hormone replacement therapy (HRT): HRT is a common treatment for women undergoing perimenopause and menopause. While studies are limited on its effects on women with ADHD, MD Hirsch has seen promising results with HRT among patients with ADHD going through perimenopause.
- Managing perimenopause: Talk to your physician to understand your perimenopause symptoms and see if they’d recommend treatment. Some physicians recommend HRT; others focus on more holistic healing. Regardless of the treatment, mitigating perimenopause can alleviate some of the worsened symptoms of ADHD.
- Maintain a structured routine: Brain fog and trouble concentrating get worse with ADHD and perimenopause. Use calendars, to-do lists, alarms, and weekly reviews to keep yourself on track with your personal and work obligations.
- Review your diet: Perimenopause can contribute to weight gain as your metabolism slows down. Medical experts call for dietary changes that focus on fiber, calcium, and omega-3 fatty acids. Sleep is also an important consideration to manage perimenopause symptoms.
- Find your community: Whether it’s family, friends, or a perimenopause support group, talking to others in a safe space can help you make sense of your symptoms and alleviate feelings of overwhelm.
- Talk to a mental health professional: Our ADHD experts support women with ADHD daily, many of whom also struggle with perimenopause and menopause.
Living Well with ADHD During Perimenopause
ADHD in women can feel overwhelming when paired with the hormonal shifts that come with perimenopause. However, I’ve seen many women successfully manage these challenges with the right treatment plan and support.
Our nurse practitioners support women with ADHD every day, including many navigating perimenopause and menopause. They can assess ADHD, provide diagnoses, and prescribe ADHD medication when appropriate while working alongside your broader healthcare team to help you find the right treatment approach for your symptoms and stage of life.
FAQs
Q: Do ADHD symptoms get worse in your 40s?
A: ADHD symptoms can get worse in your 40s as your cognitive load and responsibilities increase. While some symptoms may worsen, others may improve. For example, symptoms of inattention can worsen with age, whereas symptoms of hyperactivity can improve.
Q: How does perimenopause affect ADHD?
A: Perimenopause affects ADHD because the drop in estrogen can worsen symptoms like brain fog, trouble concentrating, irritability, inattentiveness, and memory issues.
Q: Can perimenopause bring on ADHD?
A: Perimenopause doesn’t cause ADHD on its own; however, it can unmask previously masked symptoms. This leads many to assume that perimenopause causes ADHD, but it only reveals it. Some women with ADHD aren’t diagnosed for years, and they find ways to mask their symptoms.
Q: How do you manage ADHD in perimenopause?
A: You can manage ADHD while in perimenopause with a combination of therapy, medication, diet changes, strict routines, and support groups. Some health experts also recommend intentionally reducing stress to manage symptoms. One common approach is meditation.
Q: Does ADHD get worse at menopause?
A: Yes, multiple studies demonstrate that ADHD symptoms can get worse at menopause because the hormonal changes can affect mood and memory.
Q: Why was my ADHD manageable before perimenopause?
A: Many women develop coping strategies that help manage ADHD symptoms. Hormonal changes during perimenopause can make those strategies less effective.
Q: Can hormone replacement therapy help ADHD symptoms?
A: Some women report improvements in focus, memory, and emotional regulation while using HRT, though research is still emerging.
Resources
- Survey about ADHD and menopause
- Video about perimenopause and ADHD from an MD
- Medical review about perimenopause
- Medical review about menopause
- Study about adults with undiagnosed ADHD
- Medical study about nutrition and ADHD
- Medical review about ADHD in adults
- Survey about ADHD and menopause
- Summary of perimenopause and ADHD causes