Three months ago you could hold it together. Now you're forgetting meetings you literally just scheduled. You walked into the kitchen this morning and stood there for five full minutes trying to remember why. Your ADHD medication doesn't seem to work anymore. Last week you cried in the Tesco car park because you couldn't find your keys (they were in your hand). You've had ADHD your whole life. You know what your brain does. But this feels different. Worse. Like someone turned up the dial on every symptom you've ever managed.
We see you. And we know you're probably Googling "early dementia" at 2am, terrified that something's seriously wrong.
Why Your ADHD Feels Impossible Right Now
You're not losing your mind.
Your hormones are changing, and they're taking your ADHD symptoms along for the ride.
Here's what's happening. Your ovaries are producing less oestrogen as you approach menopause. This usually starts in your early to mid-40s, though it can begin earlier. When oestrogen drops, it directly impacts the neurotransmitters in your brain. Specifically dopamine and norepinephrine.
These are the exact same neurotransmitters that are already lower in people with ADHD.
So perimenopause creates what researchers call a perfect storm. You already have less dopamine than other people. Now your falling oestrogen is reducing it even further. Your brain is trying to function with even less of the chemicals it needs for attention, working memory, emotional regulation, and impulse control.
Frustrating, right?
In a recent study of over 1,500 women with ADHD, 94% said their symptoms got worse during perimenopause and menopause. For more than half, this was the time in their lives when ADHD had the greatest impact. More than their 20s. More than their 30s. More than any other decade.
You're not imagining this.
The Hormone Connection Nobody Warned You About
Oestrogen doesn't just affect your periods. It plays a crucial role in brain function.
When oestrogen levels are high, dopamine works more effectively in your brain. This is why some women with ADHD notice their symptoms are better during certain parts of their menstrual cycle. When oestrogen is low (like during PMS or perimenopause), dopamine becomes less available and less effective.
Think of oestrogen as the volume knob for dopamine. When it's turned up, your dopamine works better. When it's turned down, everything gets harder.
During perimenopause, your oestrogen levels fluctuate wildly before eventually declining. One week you might have high oestrogen. The next week it crashes. Your brain never knows what it's getting. This unpredictability makes managing ADHD symptoms incredibly difficult.
And we know you're probably worrying about whether this is just perimenopause or if something else is wrong. The not-knowing does your head in.
How to Tell If It's ADHD, Menopause, or Both
This is where it gets tricky.
ADHD symptoms and menopause symptoms overlap significantly. Brain fog, difficulty concentrating, memory problems, mood swings, sleep issues, emotional dysregulation. All of these can be ADHD. All of these can be menopause. Sometimes it's both.
Here's what helps distinguish them.
Timing matters. If these difficulties appeared suddenly in your 40s or 50s alongside other perimenopausal symptoms (hot flushes, irregular periods, night sweats), hormone fluctuations are likely playing a role. If you've always struggled with focus and organization but it's dramatically worse now, perimenopause is probably amplifying existing ADHD.
ADHD symptoms persist throughout life. Even if they've been mild or well-managed until now. Menopause symptoms come and go with hormonal changes.
Response to treatment differs. HRT and lifestyle changes can improve brain fog from menopause. ADHD symptoms often need ADHD-specific medications and strategies.
Many women discover they have ADHD for the first time during perimenopause. They've masked and managed symptoms their whole lives. Then perimenopause unmasks everything. Suddenly the coping strategies that worked for decades don't work anymore.
Research shows ADHD is significantly under-recognized in women. You're less likely to be referred for assessment. You're more likely to have undiagnosed ADHD. You're more likely to receive an incorrect diagnosis of anxiety or depression instead.
If you're reading this and thinking "wait, could this be me?" - talk to a specialist about assessment.
What Actually Happens to Your Brain
Let's talk about the science bit. (We know you want all the details.)
Your brain relies on neurotransmitters to send messages between nerve cells. Dopamine is one of the most important for ADHD. It's involved in motivation, reward, attention, working memory, and impulse control. When dopamine levels drop, all of these functions become harder.
Norepinephrine is another key neurotransmitter affected by oestrogen. It helps with alertness, attention, and stress response. When it's low, you feel foggy and struggle to focus.
Oestrogen influences how your brain produces, uses, and breaks down these neurotransmitters. When oestrogen is stable and adequate, your neurotransmitter systems work more efficiently. When oestrogen crashes or fluctuates, your neurotransmitter systems struggle.
This is why many women with ADHD report that their symptoms vary with their menstrual cycle. High oestrogen days are better. Low oestrogen days are worse.
During perimenopause, you're basically stuck on low oestrogen days more often. Your brain is trying to function with inconsistent and declining hormone levels. If you already have ADHD (which means lower baseline dopamine), this hormonal shift hits you particularly hard.
The combination creates what feels like your ADHD symptoms on steroids. Executive function difficulties intensify. Emotional regulation becomes harder. Time management feels impossible. Your brain fog is dense and persistent.
And we get why you're probably worrying about whether this is permanent. It's not.
Your Treatment Options Work Together
Here's the reassuring bit.
You don't have to choose between treating ADHD and treating menopause. You can address both. In fact, you should address both.
HRT stabilizes your hormones. It replaces the oestrogen and progesterone your ovaries are producing less of. For many women with ADHD, HRT reduces brain fog, improves concentration, and helps emotional regulation. It won't fix ADHD, but it can reduce how much hormonal fluctuations are making your ADHD worse.
ADHD medication targets your brain's neurotransmitter systems. It helps increase dopamine and norepinephrine availability. During perimenopause and menopause, you might need to adjust your dose or change medications because hormone changes affect how your body processes and responds to ADHD medication.
The two treatments complement each other. HRT provides hormonal stability. ADHD medication provides symptom management. Together, they can help you feel more like yourself again.
Some women find that once they start HRT, their ADHD medication works better. The stable hormone environment allows the ADHD treatment to be more effective. Others need to increase their ADHD medication dose temporarily during the perimenopause transition.
This is why you need a specialist who understands both conditions.
Finding the Right Specialist in the UK
This is crucial. You need someone who gets the intersection of ADHD and hormones.
Menopause specialists are your first choice. Not general GPs. Menopause specialists have specific training in how hormones affect brain function and mood. Many now specialize in managing ADHD alongside hormonal transitions. They understand that your ADHD symptoms worsen with hormone changes and can prescribe both HRT and coordinate with your ADHD treatment.
Look for specialists with ADHD expertise. Not all menopause specialists understand ADHD deeply. When searching for a specialist, ask if they have experience treating women with ADHD. Some clinics explicitly advertise ADHD-menopause expertise.
NHS options exist. The South London and Maudsley NHS Trust runs a national Female Hormone Clinic that specializes in women with neurodevelopmental disorders including ADHD affected by hormonal fluctuations. You can be referred from anywhere in England. Your GP can refer you, or you can ask your ADHD specialist to refer you.
Private specialists are available. If NHS waiting lists are long or you can't access specialist NHS services easily, private menopause clinics often have shorter wait times. Many have doctors with specific ADHD training. Costs typically start around 150 to 200 pounds for initial consultations.
You don't need a separate ADHD assessment. If you're already diagnosed with ADHD and established on ADHD medication, you don't need to go through another ADHD assessment. A menopause specialist who understands ADHD can work with your existing diagnosis and treatment. They'll coordinate with your psychiatrist or ADHD specialist if needed.
Your ADHD specialist might not know enough about hormones. Most ADHD specialists aren't trained in menopause management. They can adjust your ADHD medication, but they typically can't prescribe HRT or fully address the hormonal side of what you're experiencing. This is why you need someone who specializes in both areas or can coordinate care between specialties.
What to Say When You Book
Make your situation clear from the start.
Say: "I have ADHD and I'm experiencing perimenopause symptoms. I need someone who understands how hormonal changes affect ADHD symptoms and can manage both HRT and ADHD medication."
If the receptionist or booking system doesn't acknowledge ADHD expertise, ask directly: "Does this specialist have experience treating women with ADHD during menopause?"
Bring your ADHD medication list to your appointment. Include doses and how long you've been on each medication. Bring information about when your symptoms worsened and whether you've noticed any patterns with your menstrual cycle.
Tell them about your current struggles. Be specific. "My ADHD medication doesn't seem to work as well" or "I'm having breakthrough symptoms I haven't had in years" or "My emotional regulation has completely fallen apart."
A good specialist will listen, validate your experience, and explain how they plan to address both the hormonal and ADHD aspects of what you're experiencing.
What to Do Right Now
You don't have to wait for a specialist appointment to start helping yourself.
Track your symptoms. Note when your ADHD symptoms are worse and whether they correlate with your menstrual cycle, sleep quality, or stress levels. This information helps your specialist understand your patterns.
Don't stop your ADHD medication. Even if it feels less effective, keep taking it as prescribed. Stopping abruptly can make things worse. Your specialist can adjust it once you're in their care.
Consider your current GP. While most GPs aren't specialists in this area, yours might be willing to refer you to appropriate services. Ask them about referral to a menopause specialist who works with ADHD patients or to the South London and Maudsley Female Hormone Clinic.
Look after the basics. Sleep, regular meals, and exercise all support both ADHD and hormonal health. When you're struggling with executive function, these can feel impossible to maintain. Do what you can. Even small improvements help.
Join support communities. Other women with ADHD going through perimenopause understand what you're experiencing. Online communities can provide practical advice and emotional support while you wait for specialist care.
Remember this is temporary. Perimenopause eventually ends. Your hormones will stabilize again (though at a lower level). With the right treatment and support, you can manage both your ADHD and your menopausal transition effectively.
You're not failing. You're not broken. Your brain is dealing with a significant biological transition while managing a neurodevelopmental condition. That's genuinely hard. You deserve specialist support to navigate it.
Book that appointment. Tell them what you need. Get the help that's specifically designed for exactly what you're going through.
¹- NHS Berkshire Healthcare. ADHD and the Menopause. https://www.berkshirehealthcare.nhs.uk/media/109514308/4-adhd-guide-menopause.pdf
²- Kooij JJS, de Jong M, Agnew-Blais J, et al. (2025). Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women's Health. https://doi.org/10.3389/fgwh.2025.1613628
³- de Jong M, Wynchank DSMR, Michielsen M, et al. (2024). A Female-Specific Treatment Group for ADHD-Description of the Programme and Qualitative Analysis of First Experiences. Journal of Clinical Medicine. https://doi.org/10.3390/jcm13072106
⁴- NHS. ADHD in adults. https://www.nhs.uk/conditions/adhd-adults/
⁵- South London and Maudsley NHS Trust. Female Hormone Clinic. https://slam.nhs.uk/service-detail/service/female-hormone-clinic-241/
⁶- NICE. Attention deficit hyperactivity disorder: diagnosis and management (NG87). https://www.nice.org.uk/guidance/ng87
