ADHD, interoception and perimenopause: why hormonal changes can worsen symptoms and affect metabolic health
For many women with ADHD, perimenopause brings a noticeable change in how their body and brain feel. Long standing challenges with regulation, energy, focus and emotions can feel amplified. Sometimes this builds gradually. Sometimes it feels as though everything becomes harder almost overnight.
It is easy for this to be attributed to stress, getting older, or simply not coping well enough. Yet research increasingly suggests that there are identifiable neurobiological and hormonal mechanisms involved.
One important piece of the puzzle is interoception.
Understanding interoception helps explain why ADHD symptoms often intensify during perimenopause. It also offers insight into why blood sugar instability, fatigue and metabolic concerns can become more noticeable during the years when hormones are changing most significantly.
What is interoception?
Interoception is the brain’s ability to sense, interpret and respond to internal bodily signals. These include hunger, thirst, temperature, fatigue, heart rate, pain, breathing, and the physical sensations that underpin emotional experience.
It plays a central role in self regulation, emotional awareness, decision making and physiological stability (Khalsa et al., 2018).
When internal signals are detected accurately and interpreted correctly, the body can respond early and appropriately. When those signals are delayed, inconsistent or misread, regulation becomes much harder.
Interoception and ADHD
Emerging research suggests that interoceptive processing is altered in ADHD. Differences have been observed in how bodily signals are detected, prioritised and integrated with emotional and cognitive processes (Quadt et al., 2018).
In everyday life this can affect:
• Eating and hydration
• Recognising fatigue
• Emotional regulation
• Identifying early signs of stress or overwhelm
• Responding appropriately to physical needs
Reduced or inconsistent interoceptive awareness may lead to:
• Missing early hunger or thirst cues
• Not recognising fatigue until exhaustion is pronounced
• Difficulty identifying emotions until they escalate
• Misinterpreting sensations such as anxiety, low blood sugar or overheating
• Delayed responses to physical needs
Neuroimaging studies highlight the role of the insula, a brain region central to interoception, emotional awareness and autonomic regulation. Functional differences in this area have been implicated across ADHD, anxiety and mood regulation research (Khalsa et al., 2018; Paulus et al., 2021).
These are measurable differences in how the nervous system processes internal information.
The impact of perimenopause on interoception and ADHD symptoms
Perimenopause is characterised by fluctuating and gradually declining oestrogen levels. Oestrogen has wide ranging effects on the brain. It influences dopamine signalling, autonomic nervous system regulation, sensory processing and glucose metabolism. It also contributes to how internal bodily signals are perceived and interpreted (Brinton et al., 2015).
During perimenopause, internal signals can become less predictable. Hunger, temperature regulation, sleepiness, emotional responses and stress reactions may feel inconsistent or exaggerated.
For women with ADHD, who may already experience interoceptive differences, this layering effect can significantly increase the regulatory load on the nervous system.
Research suggests that hormonal changes across the female lifespan can amplify difficulties with emotional regulation, attention and physiological stability in neurodivergent women (Osborne et al., 2021). This helps explain why many women report worsening ADHD symptoms during perimenopause.
What this means for blood sugar, insulin sensitivity and diabetes risk
Interoception is central to recognising changes in blood glucose levels.
Early symptoms of low or high blood glucose include hunger, shakiness, palpitations, sweating, dizziness, cognitive fog and irritability. These sensations are interoceptive signals. If awareness of these signals is inconsistent, early warning signs may not be recognised promptly, delaying appropriate responses such as eating, resting or seeking medical support (Herbert et al., 2019; Paulus et al., 2021).
This is particularly relevant during perimenopause, when insulin sensitivity and glucose regulation may fluctuate.
Population based studies show higher rates of metabolic conditions, including type 2 diabetes, in adults with ADHD. Proposed mechanisms include executive function differences, altered reward processing, disrupted routines, stress related physiological changes and interoceptive processing differences (Chen et al., 2018; Instanes et al., 2018).
For women with ADHD during perimenopause, this may increase vulnerability to:
• Irregular eating patterns that destabilise blood glucose
• Delayed recognition of low blood sugar symptoms
• Emotional dysregulation linked to glucose fluctuations
• Increased fatigue and cognitive fog
• Longer term metabolic risk
This reinforces the importance of viewing ADHD in perimenopause through both a neurological and metabolic lens.
Supporting interoception in women with ADHD during perimenopause
If internal signals are inconsistent or harder to interpret, relying on instinct alone is often not enough.
Evidence informed support may include:
• Regular, predictable meal timing to support glucose stability
• External reminders for eating, hydration and rest
• Gentle body based awareness practices to improve signal recognition
• Explicitly linking emotional changes with physical sensations
• Neurodiversity informed support that understands both ADHD and hormonal change
External structure is not a weakness. It is a practical adaptation to how the nervous system is functioning during this stage of life.
Understanding the interaction between ADHD, interoception and perimenopause provides a biologically grounded explanation for symptom changes. It also highlights why physical health, including metabolic and glucose regulation, deserves greater attention in women with ADHD as hormones fluctuate.
As research continues to develop, integrating neurodiversity informed and hormone aware approaches will be essential in improving care and support for women navigating ADHD during perimenopause and menopause.
References
Brinton, R. D., Yao, J., Yin, F., Mack, W. J. and Cadenas, E. (2015) Perimenopause as a neurological transition state. Endocrine Reviews, 36(3), pp. 1 to 25.
Chen, Q., Hartman, C. A., Haavik, J., Harro, J., Klungsøyr, K., Hegvik, T. A., Wanders, R., Ottosen, C., Dalsgaard, S. and Larsson, H. (2018) Common psychiatric and metabolic comorbidity of attention deficit hyperactivity disorder, a population based study. PLoS ONE, 13(9), e0204516.
Herbert, B. M., Pollatos, O. and Schandry, R. (2019) Interoceptive sensitivity and glucose regulation. Psychophysiology, 56(7), e13323.
Instanes, J. T., Klungsøyr, K., Halmøy, A., Fasmer, O. B. and Haavik, J. (2018) Adult ADHD and comorbid somatic disease, a systematic review. Journal of Attention Disorders, 22(3), pp. 203 to 228.
Khalsa, S. S., Adolphs, R., Cameron, O. G., Critchley, H. D., Davenport, P. W., Feinstein, J. S., Garfinkel, S. N., Lane, R. D., Mehling, W. E., Paulus, M. P. and Stein, M. B. (2018) Interoception and mental health, a roadmap. Biological Psychiatry, 84(9), pp. 660 to 668.
Osborne, S., Kornelsen, J., Smith, P. J. and McKay, A. (2021) Hormonal influences on ADHD symptoms and brain function across the female lifespan. Frontiers in Global Women’s Health, 2, 596234.
Paulus, M. P., Feinstein, J. S. and Khalsa, S. S. (2021) Neural mechanisms of interoceptive dysfunction in mental health disorders. The Lancet Psychiatry, 8(9), pp. 761 to 773.
Quadt, L., Critchley, H. D. and Garfinkel, S. N. (2018) The neurobiology of interoception in health and disease. Annals of the New York Academy of Sciences, 1428(1), pp. 112 to 128.