What’s the connection between perimenopause and ADHD symptoms?
Perimenopause and ADHD share symptoms like brain fog, mood swings, forgetfulness, and executive function issues, but hormonal changes during perimenopause (especially decreasing estrogen) worsen ADHD symptoms. Estrogen helps produce and regulate dopamine. As estrogen drops during perimenopause, dopamine levels fall, worsening inattention, poor memory, and emotional dysregulation. Women may complain more of focus/memory struggles, disorganization, procrastination, fatigue, sleep problems, irritability, and anxiety. Stimulant medications that women are taking may feel less effective due to the lack of estrogen.
You may be thinking, “I never even considered having ADHD before this!” Perimenopause often acts as a "tipping point" for women with undiagnosed ADHD. Declining estrogen levels worsen executive dysfunction, leading to new diagnoses in midlife. Symptoms like brain fog, memory loss, and emotional instability significantly worsen, prompting many to first seek help in their 40s. Often, these women have functioned well their entire life. Those with high-functioning ADHD have utilized routines, high effort, and strict organization to mask their ADHD symptoms (without knowing it.) When perimenopausal burnout and cognitive decline occur, these systems fail, revealing the underlying ADHD.
As said earlier, there is considerable symptom overlap between perimenopause and ADHD. Symptoms of perimenopause (hot flashes, insomnia, anxiety) and ADHD (feeling scattered, inattention, forgetfulness, difficulty with word-finding, cognitive fatigue) often look similar, making it hard to distinguish between them without a thorough evaluation. It’s crucial to seek out a provider familiar with both ADHD and the hormonal health of women to differentiate between diagnoses.
What can we do about it? It’s important to note that women with ADHD in perimenopause are at greater risk of experiencing higher levels of stress and burnout. For that reason, women benefit from consulting with a provider skilled in assessing for ADHD symptoms during perimenopause. Adjustments in current ADHD medication (or adjuncts to the medication) might need to be made in order to account for low estrogen. Some women may benefit from starting an ADHD medication for the first time in their 40’s. Medications that provide your body with the hormone estrogen may also help in improving cognitive function. Lastly, a skilled provider should take a detailed look at your nutrition, sleep, physical activity level, and stress management to devise a tailored plan that will enhance executive functioning.