How HRT Can Support Perimenopausal Women – Especially Those with ADHD
Perimenopause is a time of profound hormonal, physical, and neurological change. For many women, especially those with ADHD, this phase of life can feel overwhelming, disorienting, and emotionally destabilising. It’s not just hot flushes and night sweats — it’s brain fog, emotional dysregulation, sleep disruption, and a sharp dip in mental clarity.
Hormone replacement therapy (HRT) offers a scientifically backed way to support the body and brain during this time of transition. For neurodivergent women, especially those with ADHD, it may also play a key role in supporting cognitive function, mood stability, and even the effectiveness of ADHD medications.
Let’s take a closer look at what’s happening in the brain and body during perimenopause, how HRT helps, and why this matters for women with ADHD.
What Happens to the Body and Brain During Perimenopause?
Perimenopause is the phase leading up to menopause, often starting in a woman’s 40s, but sometimes earlier. During this time, levels of oestrogen, progesterone, and testosterone begin to fluctuate and gradually decline.
These hormonal changes can affect:
Cognitive function – including memory, attention, and processing speed
Emotional regulation – with increases in anxiety, irritability, and mood swings
Sleep – due to night sweats, anxiety, and disruption of melatonin production
Sensory sensitivity and executive functioning – particularly relevant for autistic and ADHD brains
Oestrogen, in particular, plays a key role in dopamine regulation in the brain. Dopamine is a neurotransmitter that is already dysregulated in ADHD, meaning that this hormonal drop can significantly worsen existing symptoms.
“Oestrogen modulates dopaminergic activity in the prefrontal cortex, a region crucial to executive function and attention.”
— Jacobs & D’Esposito (2011), Frontiers in Neuroscience
How HRT Works
HRT works by replacing the hormones your body is no longer producing in adequate amounts. In the UK, body-identical (also called bioidentical) HRT is commonly prescribed and includes regulated forms of:
Oestradiol (e.g., Oestrogel, Estradot, Evorel)
Micronised progesterone (e.g., Utrogestan)
Testosterone (off-label, e.g., Testogel, Androfeme – used under specialist supervision)
These hormones are chemically identical to the ones your body naturally makes.
Key benefits of HRT in perimenopause include:
Stabilisation of mood and reduction in emotional reactivity
Improvement in cognitive function, including memory and clarity
Better sleep quality
Reduction in anxiety and irritability
Support for libido, energy, and overall wellbeing
“Oestradiol replacement has been shown to improve verbal memory and processing speed in perimenopausal and postmenopausal women.”
— Sherwin (2003), Climacteric Journal
Why This Matters for Women with ADHD
Women with ADHD are more likely to be sensitive to hormonal fluctuations, particularly oestrogen and progesterone. Many report a sudden worsening of ADHD symptoms during perimenopause — including loss of focus, emotional dysregulation, and memory issues.
This is not imagined. It’s biological.
Oestrogen helps:
Enhance dopamine activity in the brain
Improve attention, motivation, and emotional regulation
Support the effectiveness of stimulant medications (which rely on dopamine availability)
“The decline in oestrogen during menopause can reduce the effectiveness of ADHD medications, leading to a return of symptoms that were previously well managed.”
— Quinn, P. O. (2015), ADHD and the Female Patient, The Journal of Clinical Psychiatry
Progesterone, when taken in its body-identical form (micronised progesterone such as Utrogestan), may also support sleep and reduce anxiety, without the negative emotional side effects sometimes associated with synthetic versions.
“Micronised progesterone appears to be better tolerated than medroxyprogesterone acetate in terms of mood symptoms.”
— Panay et al. (2017), British Menopause Society consensus statement
Testosterone, though used off-label in women in the UK, can support energy, motivation, libido, and focus. It is increasingly being prescribed for women who continue to struggle with cognitive and motivational issues even after optimising oestrogen and progesterone levels.
“Testosterone may play a critical role in female sexual health and cognitive vitality and is well-tolerated when prescribed appropriately.”
— Davis et al. (2019), The Lancet Diabetes & Endocrinology
Is HRT Right for Every Neurodivergent Woman?
Not all women choose to take HRT. However, for those who do, the body-identical forms are generally preferred, particularly among neurodivergent women who may be more sensitive to synthetic alternatives.
It’s important to work with a knowledgeable clinician to tailor the type, dose, and delivery method of HRT to your individual needs.
For women who are unable or unwilling to take HRT, other options — including cognitive behavioural therapy, nutrition, exercise, supplements, and ADHD coaching — may also offer support.
Clinical References
Brinton, R. D. (2008). Estrogen regulation of glucose metabolism and mitochondrial function: therapeutic implications for prevention of Alzheimer’s disease. Advanced Drug Delivery Reviews.
Jacobs, E., & D’Esposito, M. (2011). Estrogen shapes dopamine-dependent cognitive processes. Frontiers in Neuroscience.
Sherwin, B. B. (2003). Estrogen and cognitive functioning in women. Climacteric.
Quinn, P. O. (2015). ADHD and the Female Patient: Recognition, Diagnosis, and Management. The Journal of Clinical Psychiatry.
Panay, N., et al. (2017). The 2017 British Menopause Society consensus statement on hormone replacement therapy in menopausal women. Post Reproductive Health.
Davis, S. R., et al. (2019). Global consensus position statement on the use of testosterone therapy for women. The Lancet Diabetes & Endocrinology.
NICE Menopause Guidelines [NG23]. Available at: https://www.nice.org.uk/guidance/ng23
Newson Health Menopause Society: https://www.newsonhealth.co.uk
If you’re navigating perimenopause and noticing a shift in your ADHD symptoms, you’re not alone. Understanding the link between hormones and neurodivergence is the first step toward getting the support you need. Whether that includes HRT, coaching, or lifestyle changes, there are options that can help you thrive during this transition.