You’ve been juggling for years. Work, family, the washing, the to do list that never ends. You’ve not always found it easy, but you’ve managed. Now your anxiety’s through the roof, you’re snapping at people over nothing and you can’t remember the last time you slept properly.
If you’ve got ADHD and you’re in perimenopause, it really helps to understand two systems in your brain and body that your hormones affect. A lot of the research on hormones and the brain’s calming system comes from studies of premenstrual dysphoric disorder (PMDD), a severe form of PMS where mood changes before a period can be really disabling. We’re still learning how it applies to perimenopause, but the same systems are involved.
What is GABA, and how do your hormones affect it?
Imagine your brain is a classroom full of children all shouting at once. Someone’s crying in the corner, someone’s banging on the desk, and you can’t hear yourself think. Then a teacher walks in and says, “Right, everyone settle down, inside voices.” The noise drops and everyone can breathe again.
That teacher is GABA, your brain’s main calming chemical messenger. When they’re doing their job, you can think, sleep and feel OK. When they’re not, it’s as if they never show up. The classroom stays chaotic, and that can look like anxiety, not being able to switch off, emotional overwhelm and poor sleep.
Oestrogen and progesterone both help keep the balance in your brain between calming signals and stimulating ones. When they fluctuate in perimenopause, that balance gets thrown off, affecting not just GABA but other chemical messengers too, including serotonin and dopamine (Fidecicchi et al., 2024). Serotonin affects mood, and dopamine is so important for focus and motivation in ADHD. So when oestrogen fluctuates and drops, the teacher gets less effective and the classroom gets louder.
Progesterone plays its part too. Your body turns some of it into a substance called allopregnanolone, which works directly on GABA and helps them do their job (Hantsoo and Epperson, 2020). It’s a bit like handing the teacher a megaphone. Its effect on mood seems to follow a curve, though, so in some women, levels that are lower or higher than usual can both bring stronger emotional changes (Gao et al., 2023). In women with PMDD, the GABA system doesn’t seem to adjust well as allopregnanolone fluctuates across the cycle, and that can show up as anxiety, irritability and low mood (Hantsoo and Epperson, 2020).
The HPA axis: your body’s smoke alarm
Your body also has a stress system called the HPA axis, which works like a smoke alarm. It has three parts.
The hypothalamus in your brain spots danger and sets off the alarm.
The pituitary gland gets the message and calls for backup.
Your adrenal glands respond by releasing cortisol, your stress hormone, to help you deal with the danger.
That’s perfect for real emergencies. For many of us with ADHD, though, it can feel like the smoke alarm is oversensitive. It goes off when someone burns the toast and takes ages to settle afterwards, and that feeling is all too familiar. In perimenopause, oestrogen fluctuates and drops, and research suggests this can make the stress system more reactive (Liu et al., 2026). So the alarm trips even more easily and takes even longer to reset.
The calming system and the stress system don’t work separately. Allopregnanolone and GABA help keep the alarm in check, and research in PMDD suggests that when this calming control isn’t working well, the alarm is easier to set off in the second half of the cycle (Hantsoo and Epperson, 2020). So when the teacher can’t keep order, the smoke alarm goes off more easily, and when the alarm keeps going off, the classroom gets even louder. For those of us with ADHD in perimenopause, both can be disrupted at the same time. That might be why so many of us say, “I don’t know why everything suddenly feels impossible.”
Are women with ADHD more affected by hormone changes?
A UK survey of over 700 women aged 18 to 34 found that around 31% of women with an ADHD diagnosis met the criteria for provisional PMDD, compared with about 10% of women without ADHD. The risk was highest in women who also had depression or anxiety (Broughton et al., 2025). It was a one off survey based on what women reported, and the women were much younger than those in perimenopause, so it can’t tell us everything. It does add to a growing picture that hormonal changes may have a bigger impact on women with ADHD. If your classroom was already noisier than most, hormonal changes can turn the volume right up.
It’s often the way your hormones fluctuate that causes the most trouble, rather than the amount you have. In perimenopause, oestrogen and progesterone can fluctuate wildly from day to day, which is why a single blood test often doesn’t tell you much. NICE doesn’t recommend blood tests to diagnose perimenopause in women over 45 for exactly this reason (National Institute for Health and Care Excellence, 2024).
Why symptoms are so often mistaken for anxiety or depression
Think about what a noisy classroom and a smoke alarm that won’t stop going off actually look like from the outside. Anxiety, overthinking, not sleeping, feeling low, being irritable, struggling to cope with things you’ve always managed. On paper, that looks a lot like anxiety or depression, and that’s often what we end up being treated for.
So many women I speak to have been prescribed anti anxiety medication or antidepressants, and found they’re not really helping. If your hormones are a big part of what’s driving how you feel, treating the anxiety or low mood on its own may not get to the root of it. That doesn’t mean these medications are wrong for everyone, and please don’t stop any medication without speaking to your prescriber first. What it does mean is that your hormones need to be part of the conversation.
The same goes for talking therapies like CBT. They can be really helpful, but if the person you’re working with doesn’t have a deep understanding of the neurodivergent brain, they may end up treating something different from what’s actually going on. Strategies designed for a neurotypical brain don’t always fit an ADHD one, and that can leave you feeling like you’ve failed at therapy too, when really it just wasn’t the right fit for how your brain works.
When you’re living with anxiety or low mood, it’s so important to step back and look at the bigger picture. What else might be going on? Could it be neurodivergence, your hormones, what’s happening in the rest of your life, or a mix of all of these? Understanding what’s really driving how you feel is what helps you get the right support.
The NICE menopause guideline recognises that low mood and depressive symptoms can come with the menopause, and that HRT can be considered to help with them (National Institute for Health and Care Excellence, 2024). Understanding what’s happening with your hormones doesn’t mean anxiety and depression aren’t real or don’t need support. It means the cause might be different from what you’ve been told, and that can change what support looks like.
What can help
Start by tracking how you feel. Keep a daily note of your mood, sleep, anxiety and focus for at least two cycles, or a couple of months if your periods have stopped or become irregular. Daily tracking across two cycles is how PMDD is properly picked up, and it tells you far more than a single blood test (Broughton et al., 2025). Look for patterns. Do things get worse at certain times in your cycle, easing once your period starts? Have they changed over the last few months or years? Patterns are much easier to spot written down than from memory in a ten minute appointment, so take your notes with you, and mention your ADHD too.
HRT can make a real difference for many women. By replacing the hormones that are fluctuating and falling, it can help settle some of the noise in the classroom and calm the smoke alarm. NICE recommends HRT as the first treatment for menopause symptoms, and cognitive behavioural therapy (CBT) can also be considered for low mood and sleep problems linked to the menopause, either alongside HRT or for women who can’t or would rather not take it (National Institute for Health and Care Excellence, 2024). If you do try CBT or another talking therapy, look for someone who understands ADHD, so it’s adapted to how your brain works. It’s really important to find clinicians who understand both ADHD and the menopause, so the whole picture gets looked at together.
Lifestyle changes can help too. Getting as much sleep as you can, building some regular movement into your week, getting outside, and making time for things that help you relax can all make a difference. They won’t fix everything on their own, but alongside the right support, they can really help.
Be kind to yourself. What you’re feeling is real. Symptoms like anxiety, exhaustion and overwhelm are your brain and body responding to changes in your hormones, and this isn’t your fault.
Back to the classroom
So the next time your classroom feels like it’s in uproar and nobody’s coming to calm it down, I hope you can remember that it’s not you failing. It’s your teacher and your smoke alarm struggling at the same time, and you deserve support that understands that.
References
Broughton, T., Lambert, E., Wertz, J. and Agnew-Blais, J. (2025) ‘Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): cross-sectional survey study’, British Journal of Psychiatry, 226(6), pp. 410–417.
Fidecicchi, T., Giannini, A., Chedraui, P. et al. (2024) ‘Neuroendocrine mechanisms of mood disorders during menopause transition: a narrative review and future perspectives’, Maturitas, 188, 108087.
Gao, Q., Sun, W., Wang, Y.-R. et al. (2023) ‘Role of allopregnanolone-mediated γ-aminobutyric acid A receptor sensitivity in the pathogenesis of premenstrual dysphoric disorder: toward precise targets for translational medicine and drug development’, Frontiers in Psychiatry, 14, 1140796.
Hantsoo, L. and Epperson, C.N. (2020) ‘Allopregnanolone in premenstrual dysphoric disorder (PMDD): evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle’, Neurobiology of Stress, 12, 100213.
Liu, Y., Fu, X., Guan, B., Cui, R. and Yang, W. (2026) ‘The role and mechanism of estrogen in perimenopausal depression’, Current Neuropharmacology, 24(1), pp. 36–57.
National Institute for Health and Care Excellence (2024) Menopause: identification and management (NICE guideline NG23). London: NICE.
