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Take Our QuizIf your focus has fallen apart in your 40s, if the coping strategies that worked for decades suddenly stopped working and you feel more overwhelmed, forgetful, impulsive, or emotionally dysregulated than ever before, you are not imagining it. It may be ADHD.
The relationship between attention deficit/hyperactivity disorder and the menopause transition is a frequently asked about topic. Women with diagnosed ADHD who observe an increase in symptoms during perimenopause want to know if there’s a connection. And others who experience new struggles with focusing, excessive restlessness, forgetfulness, and more near the menopausal transition want to know if hormonal changes have caused ADHD. There is limited science exploring the link, but the research that exists suggests that hormones most certainly play a role.
The Evolving Understanding of ADHD in Females
Attention-deficit/hyperactivity disorder, commonly known by the acronym ADHD, is a neurological condition associated with disruptive patterns of behavior. ADHD is often associated with symptoms of hyperactivity and impulsiveness, and has historically been considered a male disorder. However, girls and women are also affected by ADHD, and their symptoms may be different than what is typically seen in boys and men. These symptoms can include difficulty paying attention, low self esteem, anxiety, depression, and feelings of underachievement. Because of this difference, girls and women with ADHD may initially receive an incorrect diagnosis.
How Hormones Play a Role
It’s well established that hormones affect brain function, and estrogens specifically impact the release of the neurotransmitters serotonin and dopamine. Estrogen plays a critical role in dopamine signaling, particularly in brain regions responsible for attention, motivation, and executive function. These are some of the same circuits that are implicated in ADHD.
During perimenopause, estrogen does not gently decline. It fluctuates wildly, which can alter levels of these key neurotransmitters and contribute to mood changes and cognitive difficulties. A decline in dopamine is related to ADHD, whereas lower serotonin is related to depression. Lower estradiol levels predict worsening ADHD symptoms the very next day, including inattention and emotional dysregulation.1
Those fluctuations can potentially unmask underlying ADHD or dramatically worsen existing symptoms. This is why so many women are first diagnosed with ADHD in midlife, with 43% of women diagnosed between the ages of 41 and 50.2 And why so many are told it is anxiety, depression, or “stress.”
In individuals without ADHD, less dopamine can lead to difficulties with concentration, focus, and task completion, and contribute to increased feeling of “brain fog.” In individuals with ADHD, this change in the brain’s biochemistry can make these same symptoms (among others) more severe.
Researchers studying perimenopausal symptoms in women with and without ADHD
found that women with ADHD are more likely to experience severe perimenopause symptoms and at an earlier age (up to 10 years earlier) than women who don’t have it. At the same time, the study found that women with ADHD also experience severe ADHD symptoms during perimenopause.3 In one position paper, nearly 70% of women with ADHD describe midlife as severely altering, with increased procrastination, working memory failure, overwhelm, and emotional dysregulation.4
Seeking Symptom Improvement in Menopause
In both ADHD and menopause, symptoms may arise as a result of changes to neurotransmitters. And improvements may be seen if neurotransmitter levels can be normalized.
Most patients who come in complaining of changes to executive function, including focus, emotions, and memory, experience improvement when they start menopausal hormone therapy (MHT). It’s likely that replacing estrogen with hormone therapy may help increase levels of serotonin or dopamine, thereby reducing symptoms. MHT also manages symptoms of perimenopause and menopause that can disrupt sleep, which plays a pivotal role in attention, memory, executive function, and emotional regulation.5
If you are not a candidate for MHT, you may want to talk to your doctor about ADHD medications.
Two recent articles looked at treating women who presented with executive function deficits in menopause with ADHD meds. The first article, published in the journal Neuropsychopharmacology6, looked at the use of the stimulant lisdexamfetamine (LDX) in healthy menopausal women with noted cognitive difficulties. The second, appearing in Menopause, studied the use of the non-stimulant drug atomoxetine (brand name: Strattera) in perimenopausal and menopausal women without a history of ADHD who had reported difficulties in memory, concentration, and attention.7
In both cases, the study participants reported a noticeable improvement in their symptoms.
The Plain Truth About ADHD and Menopause
A recent review published in Frontiers in Global Women’s Health identified the need for more targeted research on women in different life stages and ADHD, as well as diagnostic intervention.8
One thing we know for sure already: If you’re perimenopausal and you’ve noticed an increase in cognitive difficulties, whether you have diagnosed ADHD or not, you are not imagining things. This is not a personal failure. This is neuroendocrinology. What you are experiencing has a biological explanation and evidence behind it. If your symptoms are disruptive and negatively impacting your quality of life, you will want to discuss treatment options with your doctor as soon as possible.
