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The wild hormonal swings of perimenopause and marked estrogen drop of menopause correlate to more severe and sometimes new symptoms of ADHD in women. As they enter perimenopause around age 47, women will begin to experience irregular, extreme, and worsening drops in total estrogen and progesterone levels. Levels of follicle-stimulating hormone (FSH), which stimulate the ovaries to produce estrogen; and luteinizing hormone (LH), which triggers ovulation, also vary considerably. These fluctuating estrogen levels help explain the sometimes extreme mood and cognitive problems that many women, ADHD or not, experience in the lead up to menopause.1 These symptoms also happen to overlap with and mimic the symptoms of ADHD. By menopause (average age, 51), estrogen levels have dropped about 65%. The loss of estrogen leads to a decrease in serotonin and dopamine levels in the brain. During the menopausal transition, women report moodiness, sadness, irritability, fatigue, fuzzy thinking, and memory lapses. A study published on April 30, 2024 reports that women in perimenopause are 40% more likely to experience depression than are premenopausal women. No research has determined whether menstruating individuals with ADHD are more affected, or differently affected, by the transition, but current evidence — and an abundance of anecdotal reports — suggest that women with ADHD are likely more vulnerable to challenges during perimenopause and after menopause.2 3 Indeed, in an ADDitude survey of nearly 5,000 women with ADHD, 63% of respondents aged 45 and older said ADHD had the greatest impact on their lives during perimenopause and menopause. (In contrast, less than 6% said ADHD had the biggest impact before age 20.) More than 93% said they noticed a difference in the severity of some ADHD symptoms during perimenopause and/or menopause. More than half of survey respondents said the following symptoms had a "life-altering impact" from ages 40 to 59: These symptoms are in addition to those more commonly associated with menopause: hot flashes, sleep problems, weight gain, anxiety, and loss of libido to name a few. Research suggests that ADHD medications may help women without ADHD manage typical executive function difficulties associated with the onset of menopause. A series of studies conducted on healthy women aged 45 to 60 without ADHD found that treatment with ADHD medications improved their executive functions — namely, organization, focus, emotional regulation, and memory. "These studies showed that some women report mid-life onset of some executive functions similar to ADHD symptoms during menopause and/or in their post-menopausal functioning," wrote study co-author Thomas E. Brown, Ph.D., "and that those symptoms may respond to treatment with medications approved for treatment of ADHD, specifically atomoxetine and lisdexamphetamine (i.e., Vyvanse)."4 Essentially, we know nothing about ADHD and the menopausal transition. Most women who live to 60 will experience perimenopause and menopause, yet no formal medical research exists on climacteric women with ADHD. "How do the hormonal changes of menopause uniquely affect women who have ADHD? The science, unfortunately, is simply not there," wrote Jeanette Wasserstein, Ph.D., in the article "Menopause, Hormones, & ADHD." "Despite increased and hugely warranted interest, there are no studies that specifically examine menopause in females with ADHD. And that is a serious medical problem." No research exists on ADHD symptoms in perimenopausal and menopausal women, which means we are lacking answers to all of the following questions (and many more): Women with ADHD describe perimenopause and menopause as the most challenging phases of their lives. They are desperate for information and solutions to improve their quality of mid-life, yet a lack of scientific research leaves the medical community unable to provide diagnosis, guidance, or treatment during this pivotal time. "What areas of research would most significantly impact your life as a woman with ADHD?" In a recent survey of 703 women with ADHD, the most common answer to this question was this: How the hormonal changes of perimenopause and menopause affect ADHD symptoms. From brain fog to emotionality and poor memory to disorganization, the symptoms of ADHD grow markedly worse and largely unmanageable in perimenopause and menopause. Nearly half of ADDitude readers call this the most challenging time of life for them. Yet no formal research exists on menopause and ADHD, so a significant population of patients is left without answers or solutions in their years of greatest need. They report feeling medically gaslit and abandoned - their bona fide ADHD symptoms often dismissed as regular symptoms of perimenopause - and their long-term health outcomes suffer as a result. To ignore what women are telling us about the extreme and debilitating nature of ADHD symptoms in their 40s and 50s is medically irresponsible and inexcusable. Dedicated research is needed to help women understand the impact of hormonal changes on their ADHD symptoms, to reveal the early warning signs of undiagnosed ADHD in midlife, to uncover treatment strategies fine-tuned to women experiencing the hormonal fluctuations of perimenopause, to determine the safety and efficacy of HRT in managing ADHD in midlife, and much more. Women almost unanimously report that their ADHD symptoms were most debilitating and life-altering during perimenopause and menopause, when executive dysfunction and emotional dysregulation grew beyond their capacity to manage them effectively. "Everything flared up in perimenopause. I feel the worst I have ever felt, and my life is in disarray," wrote one respondent to ADDitude's 2022 menopause survey. "I am unemployed, without a fixed address, lonely, anxious, depressed, and can't think straight. I've turned my life, which appeared to be running well enough, into a blazing dumpster fire." "I somehow managed to mask and manage my ADHD all my life," wrote another survey respondent, "but by perimenopause, the hormone changes affected my energy and my physical ability to recover from sport. By exercising less, my energy levels dropped further. My emotions were more dysregulated. My brain fog got really bad, and my anxiety skyrocketed. I had daily heart palpitations and could not stay focused if my life depended on it. It got so bad that I eventually was laid off from my job… The worst part was that I had no idea it was ADHD until my daughter was diagnosed. I went through 10 years of hell before I knew." "My procrastination, attention, and distractibility all got markedly worse in perimenopause," wrote a 53-year-old woman diagnosed with ADHD at age 43. "The worst, by far, though was the emotional stuff. That got way, way worse - and then made the other issues worse because I was either super upset or depressed about why I couldn't get my work done." "In perimenopause, the brain fog and memory, inattention, distractibility, perfectionism, hyperactivity, and restlessness issues become progressively worse," wrote a 52-year-old woman diagnosed with ADHD at age 50. "I have always had these symptoms, but I was able to manage them with systems that I created for myself. My ability to manage them has declined significantly, and this makes these symptoms seems like they are the worst they have ever been." Research into menopause and ADHD is imperative — and long overdue. "Whether it's ADHD or perimenopause or ADHD and perimenopause, the impact of perimenopause and menopause on presentation of ADHD symptoms is an enormously unrecognized and important topic in global female health," said Jeanette Wasserstein, Ph.D., during her 2023 ADDitude webinar titled, "Hormonal Fluctuations and ADHD." "We're half the world, and this is a significant issue, and it should be recognized and addressed." "It's critical that we examine the connection between the rise of ADHD symptoms and the onset of perimenopause and menopause in women," said Sharon Saline, Psy.D., "and how estrogen and progesterone affect the dopamine and norepinephrine receptors and pathways in the brain." Intro: Top 10 Research Priorities ADDitude is dedicated to honoring gender diversity and fluidity. For the purposes of this reporting, we use the terms "girls" and "women" to refer to individuals assigned female at birth and/or who identify as female. 1 Weber, M. T., Maki, P. M., & McDermott, M. P. (2014). Cognition and mood in perimenopause: a systematic review and meta-analysis. The Journal of steroid biochemistry and molecular biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001 2 Weber, M. T., Maki, P. M., & McDermott, M. P. (2014). Cognition and Mood in Perimenopause: A Systematic Review and Meta-Analysis. The Journal of steroid biochemistry and molecular biology, 142, 90-98. https://doi.org/10.1016/j.jsbmb.2013.06.001 3 Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. Published online December 3, 2020. doi:10.1016/j.jpsychires.2020.12.005 4 https://www.additudemag.com/menopause-memory-loss-women-adhd-medication/What We Know
What We Don't Know
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What ADDitude Readers Tell Us
What ADHD Experts Say
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Perimenopause and Menopause Impact ADHD Symptoms: Related Reading
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