Last Tuesday you forgot three separate Teams meetings. Forgot they existed. Yesterday you snapped at your daughter for breathing too loud. This morning you've stared at your to-do list for forty minutes. Haven't started a single thing.
Your ADHD medication isn't working like it used to. Or maybe you've managed without medication for years but suddenly everything's falling apart.
We see you. If you're in midlife and have ADHD, what you're experiencing might not be worsening ADHD. It might be perimenopause making your ADHD worse. Or both at once.
Dropping oestrogen levels affect the same brain pathways that already struggle with ADHD. That's why many women with ADHD say this time is one of the hardest of their lives.
Not because you're not coping. Because your brain chemistry is working against you.
What the Research Shows
A 2025 study from King's College London examined 656 women aged 45 to 60, including 245 with diagnosed ADHD.
The key finding: As ADHD symptom severity increases, menopausal difficulties increase too.
Women with more severe ADHD traits reported more difficulties with anxiety, depression, memory, and concentration during perimenopause.
(And we get why that probably sounds confusing when you're already struggling to work out what's causing what.)
A 2025 systematic review confirmed that hormonal changes are linked to ADHD symptom fluctuations in females. The relationship between sex hormones and ADHD requires urgent investigation.
The Brain Chemistry Connection
With ADHD, you have less:
- Dopamine
- Norepinephrine
These control:
- Focus
- Motivation
- Emotional regulation
- Impulse control
Your ADHD medication boosts these chemicals.
Here's what nobody tells you: oestrogen does the exact same thing.
Think of oestrogen as fuel for your brain's engine. It helps make dopamine and norepinephrine. It helps your brain actually use them properly. You've been running on less fuel than most people your entire life. But the oestrogen was helping. Compensating.
In perimenopause, oestrogen doesn't just drop. It crashes. Fast. Unpredictably. One week you might have enough, next week almost none.
Your ADHD brain was already struggling with low dopamine. Now the oestrogen that was supporting those dopamine systems? Gone.
It's like trying to run a car that's already low on fuel, then someone siphons out half of what's left.
What's happening in your brain:
Oestrogen sits in two key areas:
Prefrontal cortex (planning, decisions, impulse control)
Hippocampus (memory)
These areas already work differently with ADHD.
When oestrogen drops, they get hit twice. Once because oestrogen itself is gone. Twice because the dopamine systems oestrogen was supporting collapse further.
The result:
Less oestrogen + ADHD = executive function falls off a cliff.
A 2019 study found something important. Women often cope fine with early brain development challenges (trauma, neglect, childhood stress). Until hormones shift. Puberty. Pregnancy. Perimenopause.
That's when everything surfaces.
For women with ADHD, perimenopause is that moment. The moment when coping mechanisms built over decades stop working. Not because you're failing. Because your brain chemistry just fundamentally changed.
Why the Symptoms Overlap
ADHD symptoms and perimenopause symptoms look remarkably similar. We've noticed that women come to us convinced their ADHD has suddenly worsened, when actually they're experiencing perimenopause. Others think perimenopause is the problem, but they're dealing with previously undiagnosed ADHD that's being unmasked by hormonal changes.
Research examining ADHD across the female lifespan found that "hormonal fluctuations and transitional periods of life seem to influence the symptoms of ADHD more" in women. The research emphasises that perimenopause and menopause represent particularly vulnerable periods when ADHD symptoms may worsen or become newly apparent.
Both cause:
- Brain fog (thick mental cloudiness, can't find words)
- Executive dysfunction (can't start tasks, finish projects, organise)
- Emotional dysregulation (sudden rage, crying, overwhelm)
- Fatigue (exhausted despite sleeping)
- Anxiety (racing thoughts, catastrophising)
- Sleep problems (mind won't switch off, waking at 3am)
(We know you're probably worrying about whether you can trust your own perception. That's completely understandable when symptoms overlap this much.)
When Perimenopause Unmasks Hidden ADHD
Something we see time and again: women discovering they have ADHD for the first time during perimenopause. Not because ADHD appeared in their forties. It was always there. Hormonal changes just removed the coping mechanisms that had been working for decades.
Women are significantly more likely than men to have inattentive-type ADHD. You're not bouncing off walls. You're quietly struggling with internal chaos: racing thoughts, difficulty focusing, constantly losing things, chronic lateness, forgetting important details. This type goes undiagnosed because it doesn't match the stereotypical hyperactive boy presentation.
You've probably built elaborate systems. Excessive planning. Lists. Alarms. Sheer determination to compensate for executive function deficits. Your entire life organized around these systems.
Then perimenopause arrives. Cognitive load increases. Those systems suddenly aren't enough.
The not-knowing is often worse than having answers. You might spend months thinking you're failing, losing your mind, or developing early dementia. Actually? You've been managing undiagnosed ADHD through compensatory mechanisms that hormonal changes have now overwhelmed.
UK research shows that adults with diagnosed ADHD have reduced life expectancy. They're more likely to have mental health problems and might experience more difficulties accessing healthcare. Getting the right diagnosis matters. Not just for symptom management, but for long-term health outcomes.
Learn more about undiagnosed ADHD in women
What Gets Worse
If you already know you have ADHD, symptoms you'd learnt to manage have suddenly intensified:
Time blindness worsens: Lose track of hours, miss appointments despite reminders
Working memory deteriorates: Forget what you're doing whilst doing it, lose thread of conversations
Emotional regulation becomes harder: Strategies that worked stop working. Small frustrations trigger disproportionate reactions.
Task initiation becomes almost impossible: That executive function paralysis intensifies during perimenopause.
Medication might stop working as effectively: The same dose might suddenly feel inadequate. This isn't tolerance. It's hormonal changes affecting how your brain responds to dopamine and norepinephrine.
The Hot Flush Problem
Hot flushes interact with ADHD in ways that aren't immediately obvious.
If you're already struggling with attention regulation, sudden waves of heat completely derail whatever focus you'd managed to achieve.
The physical sensation triggers anxiety responses, especially in work meetings or social situations. That anxiety compounds existing ADHD-related anxiety.
Night sweats wake you multiple times. You're already at higher risk of sleep problems with ADHD. Poor sleep worsens every ADHD symptom.
HRT works best for managing hot flushes and night sweats. For women with ADHD, this isn't just about comfort. It's about maintaining baseline cognitive function.
Treatment That Actually Helps
We're passionate about helping you find what works for your unique situation. Because standard approaches (treating ADHD with medication alone, or treating perimenopause with HRT alone) often aren't enough when both conditions are present.
According to a 2024 study describing a female-specific ADHD treatment programme found that addressing hormonal cyclicity alongside ADHD symptoms in a group setting led to increased self-awareness, self-acceptance, and better symptom management. The research emphasised that "a lifespan approach increased self-understanding" and that participants "took their menstrual cycle more seriously, prioritising self-acceptance and self-care."
ADHD Medication Adjustments
Your existing medication might need adjusting:
Many women need higher doses during perimenopause. This isn't tolerance. It's hormonal changes affecting neurotransmitter pathways. Work with a psychiatrist or specialist who understands this interaction.
Some women may be advised to take it differently:
- Split once-daily dose
- Take daily instead of weekdays only
- Switch timing
Non-stimulant medications might work better: Some women find atomoxetine work differently on norepinephrine pathways and some women find these more effective during hormonal transitions. The medication choice might need revisiting based on how perimenopause is affecting your neurotransmitter systems.
What worked before might not work now. That's your brain navigating a major hormonal shift.
HRT Can Help ADHD Symptoms Too
Hormone replacement therapy restores oestrogen's support for dopamine and norepinephrine systems.
For many women with ADHD, HRT isn't optional. It's essential for maintaining baseline cognitive function.
Evidence shows oestrogen replacement can improve:
- Attention
- Working memory
- Executive function (how you plan, focus, and execute tasks)
The progesterone component matters: Natural progesterone (micronised progesterone) tends to be better tolerated for mood than synthetic progestogens.
Testosterone might help: Some women find it helps with motivation, energy, and cognitive function. Worth discussing if standard HRT plus ADHD medication isn't fully working.
Lifestyle Approaches
Sleep hygiene becomes non-negotiable: Dark room, cool temperature, consistent bedtime, no screens before bed.
Regular exercise: Walking, swimming, cycling all help regulate mood, improve sleep, support cognitive function.
Protein-rich breakfast: Stabilises blood sugar and supports dopamine production.
External systems: Calendar reminders, habit tracking apps, visual planning. Your brain's internal executive function is under siege. External structure compensates.
Finding the Right Support
Find a healthcare professional who understands both conditions.
Learn more about finding specialist support for ADHD and menopause - we've written a complete guide on finding the right menopause specialist who understands ADHD, including what to look for, what to ask, and how to get referrals.
What to say when booking:
"I have ADHD and I'm experiencing perimenopause symptoms. I need someone who understands how these conditions interact because treating just one isn't working."
If your GP dismisses the connection:
Bring research - the 2025 King's College study and systematic review demonstrate the connection between ADHD symptom severity and menopausal difficulties. Some GPs simply aren't aware of this research. Educating them helps you and future patients.
What Hope Looks Like
Understanding what's happening is genuinely therapeutic.
The relief of knowing your worsening symptoms have a neurobiological explanation (that you're not failing or losing your mind) cannot be overstated.
Many women with ADHD who start HRT report: Their brain "comes back online." Executive function improves, emotional regulation becomes easier, brain fog lifts.
You'll probably still need ADHD medication, but the combination can be transformative.
We've noticed that people who are kindest to themselves tend to see the best results. Your brain is managing significant neurological challenges. Be gentle with yourself whilst finding what works.
¹- Berkshire Healthcare NHS Foundation Trust. ADHD and Menopause Guide. https://www.berkshirehealthcare.nhs.uk/media/109514308/4-adhd-guide-menopause.pdf
²- Chapman L, Gupta K, Hunter MS, Dommett EJ. Examining the link between ADHD symptoms and menopausal experiences. Journal of Attention Disorders. 2025. https://doi.org/10.1177/10870547251355006
³- Osianlis E, Thomas EHX, Jenkins LM, Gurvich C. ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders. 2025;29(9):706-723. https://doi.org/10.1177/10870547251332319
⁴- Antoniou E, Rigas N, Orovou E, Papatrechas A, Sarella A. ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. Materia Socio-Medica. 2021;33(2):114-118. https://doi.org/10.5455/msm.2021.33.114-118
⁵- de Jong M, Wynchank DSMR, Michielsen M, Beekman ATF, Kooij JJS. A Female-Specific Treatment Group for ADHD. Journal of Clinical Medicine. 2024;13(7):2106. https://doi.org/10.3390/jcm13072106
⁶- Hodes GE, Epperson CN. Sex Differences in Vulnerability and Resilience to Stress Across the Life Span. Biological Psychiatry. 2019;86(6):421-432. https://doi.org/10.1016/j.biopsych.2019.04.028
⁷- NHS. Attention deficit hyperactivity disorder (ADHD) in adults. https://www.nhs.uk/conditions/adhd-adults/
⁸- NICE. Attention deficit hyperactivity disorder: diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87
⁹- NHS. Hormone replacement therapy (HRT). https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/
