Hormones and ADHD: Why things can feel so much harder during perimenopause
One of the things I talk about a lot with the women I support is the relationship between hormones and ADHD. It's something many of us were never taught about, and yet for those of us navigating perimenopause or menopause with ADHD, it can be one of the most important pieces of the puzzle.
Hormone levels change across your life, of course, but perimenopause brings a whole new level of fluctuation, not just month to month but even hour to hour. And if you’re already living with ADHD, these shifts can make things feel even more unpredictable, overwhelming, and exhausting (Newson Health Menopause Society, 2023).
Women with ADHD often describe a noticeable change in their symptoms around hormonal transitions – whether that’s puberty, the menstrual cycle, after childbirth, or now, during perimenopause (Quinn & Madhoo, 2014). There’s a growing body of research exploring how changes in oestrogen affect cognitive function, mood, and ADHD traits (Jacobs & D’Esposito, 2011). Oestrogen plays a role in dopamine production and regulation, and dopamine, as many of us know all too well, is one of the core neurotransmitters affected in ADHD (Barkley, 2020).
During the menstrual cycle, symptoms are usually most manageable during the follicular phase, which is when oestrogen levels are rising, and many women report feeling more clear-headed, motivated, and emotionally stable. But then comes the luteal phase, where oestrogen drops sharply and progesterone rises. That’s when a lot of us experience the worst of our ADHD symptoms: irritability, mood swings, fatigue, brain fog, and emotional sensitivity (Rydell et al., 2018; Jacobs & D’Esposito, 2011). Sound familiar?
For some women, these premenstrual symptoms go beyond the usual impact of daily life.
Premenstrual dysphoric disorder (PMDD) – a more severe, hormone-linked mood disorder – appears to be more common in women with ADHD (Wynchank et al., 2016). That tells us something important: for neurodivergent women, hormonal changes aren’t just a bit uncomfortable. They can be completely dysregulating.
Then, when perimenopause arrives, the pattern changes again – and often not for the better. Oestrogen becomes more erratic and eventually declines altogether. If the natural monthly dip in oestrogen causes a flare-up in symptoms, you can imagine what happens when levels start dropping more drastically over time (Newson Health Menopause Society, 2023). For many women, this is when ADHD symptoms seem to suddenly get worse. For others, it’s when they’re first noticed at all (Quinn & Madhoo, 2014).
I’ve worked with so many women who’ve said, “I was managing fine and then perimenopause hit, and everything fell apart.” The hormonal shifts in perimenopause can strip away the coping strategies that were just about holding things together (Rydell et al., 2018).
That’s why understanding this link matters so much. It helps us make sense of what’s happening in our bodies and brains and it gives us a foundation for finding the right support, whether that’s HRT, ADHD coaching, medical treatment, or simply knowing we’re not alone.
If you’re starting to notice changes in your focus, memory, energy, or mood, especially around midlife, it might be time to look at hormones as part of the picture. You deserve support that takes the full picture of your health into account. ADHD and hormones aren’t separate issues. For many of us, they’re deeply connected.
References
Barkley, R. A. (2020). ADHD: A Handbook for Diagnosis and Treatment (5th ed.). Guilford Press.
Jacobs, E., & D’Esposito, M. (2011). Estrogen shapes dopamine-dependent cognitive processes: Implications for prefrontal cortex function in women. Frontiers in Neuroscience, 5, 62. https://doi.org/10.3389/fnins.2011.00062
Newson Health Menopause Society (2023). Hormonal health and neurodiversity. https://www.newsonhealth.co.uk
Quinn, P. O., & Madhoo, M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01596
Rydell, M., Lundström, S., Gillberg, C., Lichtenstein, P., & Larsson, H. (2018). Has the Association Between ADHD and Female Hormonal Events Been Underestimated? European Child & Adolescent Psychiatry, 27, 1369–1378. https://doi.org/10.1007/s00787-018-1137-3
Wynchank, D., Bijlenga, D., Beekman, A. T., Kooij, J. J., & Penninx, B. W. (2016). Adult Attention-Deficit Hyperactivity Disorder and the Pre-Menstrual Syndrome in a Population-Based Sample. European Psychiatry, 35, 47–52. https://doi.org/10.1016/j.eurpsy.2016.02.005