Women, Perimenopause, and ADHD: Why Symptoms Often Get Worse

Jan 12

Hi again, I’m Nikki! A therapist and licensed clinical social worker (LCSW) with nearly 20 years of experience. In my online therapy practice, I support women in midlife and the struggles that come with it- perimenopause, anxiety and stress, ADHD and inattention, depression, grief and loss, and those unexpected life events that throw you off course.

Welcome back to my blog series on all things perimenopause! This is the fourth post of the series where we’ll explore the relationship between ADHD and perimenopause. In case you missed the first three posts:

MENTAL HEALTH CHANGES DURING PERIMENOPAUSE: SYMPTOMS, CAUSES, AND SUPPORT

DOES PERIMENOPAUSE CAUSE MOOD CHANGES AND DEPRESSION

DOES PERIMENOPAUSE CAUSE ANXIETY? UNDERSTANDING SYMPTOMS AND TRIGGERS

Ok, let’s get back to the question of the hour- why do ADHD symptoms often get worse during perimenopause? Hormonal fluctuations—especially fluctuating and declining estrogen levels—can affect ADHD symptoms: from intensified brain fog and memory issues, distractibility, disorganization, and emotional volatility. During perimenopause, these symptoms can be more noticeable and more difficult to manage.

How Hormones Affect Attention, Memory, and Focus

Estrogen directly influences neurotransmitters involved in ADHD. Estrogen:

Supports dopamine, which affects motivation, focus, and reward
Regulates norepinephrine, which helps with alertness and attention
Enhances working memory and cognitive flexibility

During perimenopause, fluctuating estrogen levels reduce the brain’s ability to regulate these systems, leading to worsened ADHD symptoms.

Emotional Regulation Challenges During Perimenopause

Emotional regulation is a core ADHD challenge—and perimenopause can amplify it. Women commonly report:

Increased irritability or emotional reactivity
Mood swings
Heightened anxiety
Feeling overwhelmed more easily
Lower stress tolerance

Hormonal changes can intensify emotional responses like those above while reducing the brain’s ability to self-regulate.

ADHD Symptoms During Perimenopause and Menopause

ADHD can look like:

Poor planning or time management
Disorganization and procrastination
Trouble remembering daily tasks
Losing focus or being easily distracted
Difficulty paying attention
Avoiding tasks that require focus
Problems with follow through, staying on task, or completing tasks
Trouble multitasking
Forgetfulness
Misplacing or losing things
Feelings of restlessness or always on the go
Impulsivity or low self-control
Low frustration tolerance and mood swings

How Does Perimenopause Affect ADHD Symptoms in Women?

Estrogen plays an important role in overall brain function, not just reproduction. It plays a role in various cognitive functions, including learning, memory, and mood regulation. Estrogen also plays a key role in brain systems that regulate focus, motivation, and emotional control.

As estrogen levels fluctuate during perimenopause, women may experience subjective cognitive challenges with: attention, memory, and executive function.

Executive function involves mental skills like planning, organizing, time management, self-control, focusing, and working memory. Executive function enables goal-directed behavior, such as starting and completing a project, managing daily tasks, regulating emotions, and solving problems. Key examples include creating a schedule (planning), paying bills (organization/time management), resisting cake (self-control), remembering a grocery list (working memory), and shifting focus from one activity to another (attention/flexibility).

These challenges in attention, memory, and executive function can mimic the core symptoms of ADHD. But women with ADHD- and those who may have undiagnosed or untreated ADHD- may experience more severe impairments in these areas.

Why Do Many Women Notice ADHD Later in Life?

Researchers have found that women often complain about increased ADHD symptoms and reduced efficacy of stimulant medication (e.g. Ritalin, Adderall, Vyvance) at points in their menstrual cycle when estrogen levels are lowest, the premenstrual period. Adding insult to injury, estrogen levels fluctuate more during perimenopause.

While we often assume ADHD is a disorder beginning in childhood, adults can be diagnosed with ADHD, too, often during perimenopause.

Common reasons include:

Girls and women are understudied when it comes to ADHD research
Girls are more likely to develop inattentive-type ADHD, which is more often overlooked
Given estrogen’s role in buffering ADHD symptoms when it was higher in their younger years, as it fluctuates and declines through perimenopause, symptoms may become more more obvious
Women may have previously developed coping strategies that no longer work as well when hormones begin to fluctuate in perimenopause
Perimenopause increases cognitive and emotional demands

It is important to note that perimenopause does not cause ADHD—but it can unmask or intensify existing symptoms.

ADHD and Perimenopause Management Strategies That Actually Help

Effective ADHD management during perimenopause often requires a multi-layered approach.

Lifestyle and Behavioral Strategies:

Limit distractions while completing tasks (adjust notification settings of your phone or smart watch) or limit access to distractions like social media (remove apps from your phone)
Break tasks into smaller steps and reduce multitasking
Make a daily or weekly plan and use external supports (lists, reminders, planners)
Prioritize sleep consistency and create a consistent sleep routine
Practice stress-reduction techniques like meditation, yoga, or walks in nature

Medical Support for Perimenopause:

ADHD medication or adjustments to current medications (under medical supervision)
Hormone therapy evaluation when appropriate

Therapeutic Support for ADHD:

Psychotherapy can help you to manage the symptoms of ADHD by supporting you in:

Building executive function skills
Managing emotional dysregulation
Reducing shame, self-criticism, and low self-esteem
Addressing any associated anxiety and depression
Improving communication and relationships
Nervous system regulation and stress management

Frequently Asked Questions About ADHD and Perimenopause (H2)

Can perimenopause make ADHD symptoms worse?

Yes. Perimenopause can worsen ADHD symptoms due to fluctuating estrogen levels, which affect dopamine and norepinephrine—key neurotransmitters involved in attention, focus, and emotional regulation. Many women notice increased distractibility, forgetfulness, and emotional reactivity during this stage.

Can perimenopause cause ADHD?

No. Perimenopause does not cause ADHD, but it can unmask or intensify symptoms that were previously mild or well compensated. Hormonal changes reduce the brain’s ability to compensate, making ADHD more noticeable in adulthood.

Why do many women get diagnosed with ADHD during perimenopause?

Women can be diagnosed with ADHD during perimenopause for several reasons. But when hormone fluctuations are to blame it may be because fluctuations reduce estrogen’s protective effect on attention and executive function. This can expose long-standing ADHD traits that were overlooked earlier in life, especially inattentive symptoms common in women.

Does menopause improve ADHD symptoms?

For some women, ADHD symptoms stabilize after menopause once hormone levels become more consistent. Others continue to experience challenges and benefit from ongoing ADHD-specific support. Symptom patterns vary depending on individual brain chemistry, lifestyle, and treatment approach.

How do hormones affect ADHD in women?

Estrogen supports dopamine and norepinephrine, which regulate focus, motivation, and emotional control. When estrogen fluctuates during perimenopause, these systems become less efficient, leading to increased ADHD symptoms such as brain fog, distractibility, and emotional dysregulation.

What helps manage ADHD symptoms during perimenopause?

Effective management often includes structured routines, sleep optimization, external organization tools, stress reduction, ADHD-informed therapy, and/or medical evaluation for medication or hormonal support. Many women benefit from adjusting the strategies that worked earlier in life.

Should I see a doctor if my ADHD symptoms worsen during perimenopause?

Yes. A healthcare professional can help determine whether symptoms are hormonally influenced, ADHD-related, or both. Early evaluation allows for personalized treatment adjustments and prevents unnecessary frustration or misdiagnosis.

How to Seek Mental Health Therapy During Perimenopause: For depression, anxiety, ADHD, and Emotional Changes

If you’re a woman looking for support in perimenopause, let’s connect for a FREE 15-minute call to talk through how I can support you! Located in Michgan and licensed to practice in CT, FL, IL, IN, MI, OH, SC, and WI.

Nikki Sewell