Women are forced to learn to manage this time in their life, and all its unexpected and unwanted symptoms, whether they like it or not. Unfortunately, women with ADHD find themselves even more at the mercy of their body’s changes during perimenopause, a time when hormonal fluctuations can intensify the symptoms of ADHD and add another layer of complexity to daily life.
How ADHD Makes Perimenopause Even More Challenging
“For women already managing ADHD, the hormonal shifts that accompany perimenopause can exacerbate existing symptoms and introduce new challenges,” says Dr. Michael Green, an OB/GYN and co-founder of Winona, an anti-aging wellness center. He explains that estrogen and progesterone levels decline during this time, affecting chemicals in the brain that help regulate mood and focus. For women with ADHD, this often leads to:
- Severe fluctuation in hormone levels
- Heightened emotional sensitivity
- Increased impulsivity
- Difficulty concentrating
“The result is often a perfect storm of cognitive and emotional challenges that can disrupt work, relationships and daily routines,” says Green.
Emma Laing, Ph.D., a registered dietitian nutritionist, a national spokesperson for the Academy of Nutrition and Dietetics and director of dietetics at the University of Georgia, agrees.
Laing was 48 when she was diagnosed with ADHD and almost 50 at the onset of perimenopause symptoms. Though she struggled with attention and concentration for most of her life, “I figured I was one of those who thrived in chaos and worked best under pressure,” she says. “It wasn’t until one of my children was being tested for ADHD when I noticed that the answers I circled on their psychologist’s intake form applied almost identically to me.”
Laing decided to seek testing for herself, was diagnosed with ADHD, and started a helpful medication regimen. Then everything began to change when perimenopause appeared.
Her inability to manage the internet browser tabs open on her computer or work through her to-do lists were just a couple of the problems. Many ADHD symptoms in women follow this trajectory, along with disorganization, forgetfulness, not listening, not following through and being easily distracted.
Is It Perimenopause or Is It ADHD?
There is overlap between the symptoms of perimenopause and the symptoms of ADHD. Trying to separate them can feel impossible, especially when in the throes of experiencing these feelings and bodily shifts.
“Perimenopause can feel like a total breakdown — mentally, emotionally, physically and even sexually,” says May Allen, co-founder and CEO of Interlude, a virtual clinic that helps women in perimenopause and menopause manage hormonal changes. Allen herself is in perimenopause and has ADHD.
Allen says her mood and attention are severely impacted by hormonal fluctuations. Laing, too, noticed an intense level of distraction and disorganization even though she hadn’t changed her ADHD medication.
“I couldn’t decipher if ADHD was to blame for my difficulty in prioritizing tasks, or if I was trying to balance life as a working mom at the start of the school year,” she says.
Turns out it was neither. Enter perimenopause.
Erratic menstrual cycles, decreasing reproductive hormone levels, lack of sleep. It was more than a few hot flashes for Laing — it was perimenopause plus ADHD. Laing was prescribed hormone replacement therapy to take every few months to initiate periods that did not start on their own. Then her menstrual cycles stopped and bloodwork showed that she was completely in menopause.
“It was validating to learn that symptoms of ADHD can be similar to those experienced with perimenopause — or even amplified, as drops in estrogen have been shown to negatively impact mood, memory and executive functioning,” Laing says.
But what Laing says she found most discouraging: learning that little is known in the scientific and medical communities about how best to manage neurological symptoms when perimenopause and ADHD coexist.
Understanding ADHD Treatment During Perimenopause
There is no magic formula for managing ADHD plus perimenopause.
Allen’s most powerful tools to deal with both conditions are diet and exercise. She runs to help her mood, practices intermittent fasting to help her focus, and sets short, actionable goals weekly. This holistic route can work for some people. Others need medical intervention to make a difference with the changes in their body and mind.
When ovarian function decreases in perimenopause, so do estrogen and progesterone levels. Estrogen especially affects dopamine, which has a major role in attention and mood regulation. All of that can mean difficulty concentrating, reduced emotional control and impulsivity.
And women with ADHD often experience more severe mood swings than those without ADHD. In short, these estrogen drops can lead to new or worsened ADHD symptoms, something that can be incredibly confusing and overwhelming to a woman with this dual diagnosis.
“Understanding hormonal influences is crucial for women with ADHD navigating perimenopause,” Green says. “Working closely with healthcare providers and specialists who can provide tailored strategies and support — including medication adjustments, cognitive behavioral therapy, and lifestyle modifications — is essential.”
Your doctor may need to adjust the dosage of your ADHD medication or change the prescription entirely.
“By addressing the unique intersection of perimenopause and ADHD, women can better manage their symptoms and navigate this life stage with resilience and success,” Green says.