ADHD and Perimenopause, Part 2: The Emotional Side
Quick disclaimer before I get started: I'm a menopause specialist. I am not an ADHD specialist. An accurate ADHD diagnosis requires a comprehensive evaluation by a properly trained professional. This is not an attempt to diagnose, nor to advise readers on medication.
First, to recap Part 1. ADHD, or attention-deficit/hyperactivity disorder, is a condition that starts in childhood and affects focus, organization, time management, and follow-through. In adults, it often looks like trouble getting started, finishing tasks, remembering things, or feeling overwhelmed by a workload. During perimenopause, estrogen swings up and down, and dopamine can dip with it. For a brain already wired for ADHD, those dips can make symptoms much harder to manage. It also means that what feels like "just brain fog" may be something more. Perimenopause doesn't cause ADHD, but it can expose ADHD that was there all along. And because women have historically been underdiagnosed, this occurs more than you may think. Many women have managed their symptoms for years without knowing it – through lists, alarms, checking and rechecking, and working extra hard to feel put together. While it doesn't mean every woman with brain fog has ADHD, it's worth looking back at your history to see whether these patterns were there long before perimenopause.
ADHD Isn't Just About Focus
Now I want to talk about a side of ADHD that doesn't get nearly enough attention: the emotions that come with it. One study found that women diagnosed with ADHD have exacerbated perimenopause symptoms compared to women without ADHD (Smári et al., 2025). While this study was within a controlled population, it represents what clinically makes sense, ADHD symptoms and peri/menopause symptoms can mimic each other, making overall reactions more severe.
ADHD can also make it harder to manage your emotions (Shaw et al., 2014). Big feelings can come on faster, feel more intense, and take longer to settle. For many women with ADHD, mood swings, irritability, and acting on impulse become more noticeable during perimenopause. Here are some examples:
You get frustrated even more easily.
When too many things are happening at once, you feel even more overwhelmed.
You react strongly to something and later wonder why it bothered you so much.
Criticism is really hard to let go of, or you spend way too much time worrying that you've let someone down.
Some women describe the feeling as if they just don't have the same buffer they used to. This emotional side is one more reason ADHD can hide in plain sight. Because these feelings can be so intense, women with ADHD are often treated for anxiety or depression without anyone considering that ADHD may be part of the picture.
How Your Cycle Can Change Things
Estrogen swings affect your mood and stress levels, not just your focus. Many women with ADHD notice their symptoms get worse right before their period, when estrogen and progesterone both drop. Focus, planning, and managing emotions can all get harder, and ADHD medication may not work as well during this time.
Research suggests PMDD is more common in women with ADHD (Broughton et al., 2025). PMDD is a severe form of PMS that causes intense mood changes in the days before a period. PMDD isn't caused by abnormal hormone levels. Instead, some women's brains are extra sensitive to the normal rise and fall of hormones each month. If your mood takes a big dive every month, tell your clinician.
If you notice your ADHD symptoms (distraction, feeling overwhelmed, emotional swings), get worse at certain points in your cycle, track it. Write it down. It can be in an app or in a notebook. Whatever works best for you. If you still get your period, a period tracking app can make these patterns easier to see. Just noting when symptoms show up gives your clinician useful information to guide treatment. During perimenopause, as periods become irregular, these patterns can get harder to spot, which makes tracking even more valuable.
Sleep
Few factors affect your daily functioning as much as sleep does. Sleep problems are already common with ADHD, and bad news… perimenopause will likely make sleep even harder. Hot flashes and night sweats wake you up. ADHD medications affect sleep too, especially stimulants, so it's important that your menopause provider knows what you're taking and when. When you aren't sleeping well, everything gets harder: concentration, memory, emotional tolerance, motivation. This makes it difficult to determine what is ADHD, what is perimenopause, and what may simply be the result of not getting enough sleep. It's crucial to look at symptoms from every angle. Don't let this get you down. There are remedies to help get your sleep back on track, whether the culprit is ADHD, plain old insomnia, or perimenopause and menopause. If you suspect the latter, that's one more reason to see a menopause specialist. (And if you're a woman in midlife, regardless of symptoms, you've heard it from me before: consult with a menopause specialist!)
What About Treatment of ADHD during Perimenopause?
Currently, research looking at how to treat ADHD during perimenopause is limited. We know hormones can affect ADHD symptoms, but we don't have great data on exactly how ADHD treatment should change as hormones change. If you have ADHD, the ADHD needs to be treated. For some women that includes medication. For others, therapy and learning practical ways to manage focus, organization, and getting things done can make a big difference. For many women, it's a combination of both.
I'm a big believer in therapy. Medication can be a game changer, but it doesn't necessarily teach you how to manage feeling overwhelmed, organize your day, handle big emotions, or change the patterns you've developed over the course of years. A therapist who understands ADHD can give you the practical tools you need.
If you're already taking ADHD medication and it doesn't seem to be working as well as it used to, especially during perimenopause, talk with your prescriber. Sometimes the medication, dose, or even the timing may need to be adjusted.
MHT (menopause hormone therapy) can be very effective for a variety of menopause and perimenopause symptoms. If you're sleeping better, having fewer hot flashes, and generally feeling better, you may notice that you're thinking more clearly too. However, MHT is not a treatment for ADHD, and I do not endorse it being prescribed solely to improve focus or memory.
What About Testosterone?
I get asked this question all the time. I have patients who tell me that with testosterone, they feel sharper, have more energy, are more focused, or just feel better than they did before. (Note that each of my patients recieve individualized plans and dosage… one size doesn’t fit all.) We don't have enough research yet to know exactly what testosterone may be doing when it comes to focus, memory, mood, or ADHD. And just like estrogen and progesterone, I don't prescribe testosterone to treat ADHD, but if a woman is using testosterone appropriately for other reasons and tells me she's thinking more clearly, has more energy, or just feels better, that matters. While long term research is yet to be published on testosterone, the current results are promising. For more on the safety of testosterone treatment in perimenopausal and menopausal women, see this primary care guide to prescribing testosterone for women.
Don't Skip the Basics
This is likely not what you want to hear, but stick with me. Sleep, movement, regular meals, less alcohol, and managing stress really do matter. None of this will treat ADHD by itself, and it doesn't replace medication or therapy when those are needed. But it's really hard for any of us to think clearly, manage our emotions, or have sufficient energy when we're exhausted, not eating well, barely moving, and stressed all the time.
I also realize that telling someone with ADHD to "just take better care of yourself" isn't helpful. Some of the things I'm advising, like planning meals, exercising, and sticking with a routine, may be the very things that are harder when you have ADHD. So start small. Pick one or two things you know you can realistically do that day.
And give yourself some grace. You're not going to get it right every day, and that's okay.
Food doesn't have to be perfect. Keep a few easy things around that you know you'll actually eat, like eggs, Greek yogurt, nuts, frozen vegetables, canned beans or fish, and whole grain bread. Aim for protein and fiber when you can.
Exercise doesn't have to be complicated either. You don't have to spend an hour at the gym. Go for a walk, lift some weights, take the stairs, or get outside. Even a few minutes of moving during the day counts.
Stress matters too. Deadlines may be motivating, but the stress that comes with them will not make any of this easier. Keep using whatever helps you stay organized: lists, alarms, calendar reminders, sticky notes. You don't need to make things harder than they need to be.
How I Approach This With My Patients
I believe the best care is made possible through teamwork. Your menopause provider's role is to understand the physiological trends occurring in your body during midlife, including your hormones, sleep, mood, and more. Women struggling with focus, memory, or feeling overwhelmed during this stage of life should be asked whether some of these same patterns were present long before perimenopause. It's our job as menopause specialists to refer our patients for an ADHD evaluation when testing and clinic visits demonstrate a potential pathology outside our scope of practice.
In that same vein, it's important that women diagnosed with ADHD are asked by their providers (psychiatrist, PCP, etc.) about their hormones and menopause symptoms so they can be referred to a menopause specialist when appropriate.
How to Start the Conversation With Your Clinician
If you're having more trouble with focus, memory, organization, motivation, or your mood, and it's starting to affect various aspects of yout work and personal life, talk to your clinician and consider seeing a menopause specialist/provider.
Spend some time thinking about what has always been there and what feels new. Think back to childhood, school, college, work, and even how you manage things at home.
Were you always a procrastinator?
Did you lose things?
Was staying organized always harder for you?
Did you tend to wait until the last minute and then somehow pull everything together?
If you can, ask a parent or sibling what they remember about you growing up. ADHD doesn't suddenly start in perimenopause, so your history matters.
Then think about what has changed recently.
Are your periods changing?
Are you having hot flashes or night sweats?
How are you sleeping?
Are there certain times of the month when everything seems harder?
Has your mood or anxiety changed?
If you’ve made an appointment with a healthcare provider, bring any notes you've been keeping on your periods, sleep, mood, or symptoms. Mention if ADHD runs in your family, including in your children and mke sure your clinician knows everything you're taking, including ADHD medication, antidepressants, hormones, and supplements.
There isn't one test that will sort all of this out. As providers, its important to look at the whole picture, from various angles .
Speak Up for Yourself
If you think you might have ADHD, or you feel like your symptoms are being brushed off, you have every right to ask questions, ask for a referral, and ask about your treatment options. If you aren't getting the support you need, it's okay to try again or find someone else. You should be part of every decision about your care, including hearing the pros and cons of each option.
I hope these two articles have helped you understand a little more about why ADHD and perimenopause can be so hard to separate.
It is a lot to digest, so take some time to think about how any of these descriptions resonate in your life.
The medical community is still learning about the relationship between ADHD and hormones in women, but as providers and patients, the importnat questions are finally being asked. As a result, more women are getting the help they need and deserve. You can be one of them as well.
My Weekly Recommendation:
Too Sensitive: Rejection, Resilience, and the Science of Feeling Deeply by Dr. Sasha Hamdani.
“For anyone who has ever felt like they are too much, a groundbreaking guide to understanding emotional sensitivity.”
"A conversation that everyone deserves to hear. . . if you think ADHD is just about attention, let me tell you, Dr. Sasha Hamdani is gonna tell you that's only a third of the picture." ― Mel Robbins
Works Cited
Broughton, T., Lambert, E., Wertz, J., & Agnew-Blais, J. (2025). Increased risk of provisional premenstrual dysphoric disorder (PMDD) among females with attention-deficit hyperactivity disorder (ADHD): Cross-sectional survey study. The British Journal of Psychiatry, 226(6), 410–417. https://doi.org/10.1192/bjp.2025.104
Scott, A., & Newson, L. (2020). Should we be prescribing testosterone to perimenopausal and menopausal women? A guide to prescribing testosterone for women in primary care. British Journal of General Practice, 70(693), 203–204. https://doi.org/10.3399/bjgp20x709265
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966
Smári, U. J., Valdimarsdottir, U. A., Wynchank, D., De Jong, M., Aspelund, T., Hauksdottir, A., Thordardottir, E. B., Tomasson, G., Jakobsdottir, J., Lu, D., Nevriana, A., Larsson, H., Kooij, S., & Zoega, H. (2025). Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. European Psychiatry, 68(1), e133. https://doi.org/10.1192/j.eurpsy.2025.10101
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