ADHD and Perimenopause
Why Does Everything Suddenly Feel Harder?
You’ve managed your ADHD for years. You’ve found strategies that work, figured out how to organise your life, and perhaps found medication that helps. Then, somewhere around your 40s, everything seems to start falling apart.
You’re more forgetful. Your executive functioning has gone AWOL. You’re struggling to regulate your emotions. Your sleep is terrible. Tasks that used to be manageable suddenly feel impossible.
If this sounds familiar, perimenopause could be part of the picture.
ADHD and hormones: what’s the connection?
We’ve known for some time that ADHD symptoms can fluctuate alongside hormonal changes. For example, anecdotally, women with ADHD report their medication not working as well when they are premenstrual. However, robust research into the relationship between ADHD and hormones in women has been surprisingly limited.
A 2025 systematic review found that the existing research generally suggests a relationship between hormonal changes and ADHD symptoms, particularly around the menstrual cycle [1]. However, the researchers also highlighted just how limited the evidence is, with only 11 studies meeting their criteria and considerable differences between the studies. They specifically called for more research into ADHD and menopause.
And that research is now beginning to emerge.
A recent population-based cohort study compared 535 women with ADHD with 4,857 women without ADHD. Women with ADHD had higher overall perimenopausal symptom scores, and the difference was particularly noticeable among younger women. Most strikingly, 54.2% of women with ADHD experienced severe perimenopausal symptoms, compared with 30.1% of women without ADHD.
That's a substantial difference.
What IS perimenopause?
Perimenopause is the transition towards menopause, during which oestrogen and progesterone fluctuate and eventually decline. It’s difficult to ascertain when perimenopause starts. For example, some doctors will tell you that a regular period means you’re not perimenopausal, others would say “you’re 44, you’re definitely perimenopausal”.
Perimenopause can bring a whole range of symptoms, including changes in sleep, mood, memory and concentration.Many of these symptoms overlap with ADHD.
So is it actually your ADHD getting worse, or are you experiencing the cognitive and emotional effects of perimenopause?
It may be both.
Why might this happen?
We don't know yet.
One possibility is that changes in oestrogen may affect brain systems involved in attention, motivation and executive functioning, including dopamine pathways. This is biologically plausible, but the evidence is not yet strong enough to say that declining oestrogen directly causes ADHD symptoms to worsen. The researchers behind the 2025 systematic review emphasise that much more research is needed.
There is another complication: perimenopause itself can cause difficulties that look a lot like ADHD.
Brain fog, poor concentration, forgetfulness, disrupted sleep, irritability and emotional changes can all occur during perimenopause. For someone who already has ADHD, these additional challenges may make existing difficulties much harder to manage.
In other words, you may not suddenly have "worse ADHD". Your brain may simply be dealing with more things at once.
You're not failing
Perhaps the most important thing to know is that struggling more during perimenopause doesn't mean you've somehow lost the skills you've developed. The strategies that worked when your hormonal environment was relatively stable may not work as well when that environment changes. And if you're suddenly thinking, "Why can't I cope with things I used to manage?", you're certainly not alone.
Research into ADHD and peri/menopause is still in its early stages, but it is beginning to validate what many women have been reporting for years: the experience of ADHD can change across hormonal life stages.
We still have a lot to learn about why this happens and what the most effective treatments are. In the meantime, recognising the possibility of a hormonal contribution can be an important first step towards understanding what's changed—and finding the right support.
Your next steps
If this is you, the Sea Spray psychologists recommend getting an excellent GP with experience in women’s health to talk through your symptoms and see what they can offer.
ADHD and Sex Hormones in Females: A Systematic Review https://pubmed.ncbi.nlm.nih.gov/40251875/
Perimenopausal symptoms in women with and without ADHD: A population-based cohort study https://pubmed.ncbi.nlm.nih.gov/40903825/
