Living with attention deficit hyperactivity disorder (ADHD) means you’ve probably built a system of habits, medication, or both to help you manage. But when menopause enters the picture, your once-reliable routine may seem to fail you.
You’re not alone: In a survey of more than 1,500 women with diagnosed or undiagnosed ADHD, 94 percent said their symptoms were at their most severe and impactful during perimenopause and menopause.1
It can be easy to feel overwhelmed or guilty when you’re struggling to manage tasks and habits that were once easily reined in. “That’s one major obstacle for patients—failing to realize that ADHD is not a function of character or willpower. It’s simply the way your brain is wired from genetics,” says psychiatrist David W. Goodman, M.D., assistant professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine.
During perimenopause, changing hormone levels can cause ADHD symptoms to flare up. To make matters worse, menopause symptoms like trouble sleeping can impair concentration, memory, and focus. But don’t let this stress you out more. A variety of solutions can help you once again make your ADHD more manageable in perimenopause and menopause.
About the Experts
David W. Goodman, M.D. is an adult psychiatrist, an assistant professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine, and the director of the Adult Attention Deficit Disorder Center of Maryland.
People with ADHD tend to be easily distracted or forget things, but it’s more than that. They also often interrupt people, blurt things out, feel restless, struggle to stay organized, and have an ever-growing list of tasks that they start but never complete. 2
These changes can intensify during perimenopause—the transition leading up to menopause, when you haven’t had a period for 12 consecutive months—when fluctuating hormones create a perfect storm for cognitive and emotional shifts.
During perimenopause, estrogen and progesterone levels shift from their normal rise and fall during the menstrual cycle to being an unpredictable roller coaster. You may experience this as annoying and uncomfortable physical symptoms like vaginal dryness, hot flashes, and changes in your period.
Other symptoms that arise during perimenopause can resemble those of ADHD, including irritability and other mood symptoms, memory problems, and difficulty focusing.3
For women who have ADHD, perimenopause can be like pouring gasoline on a fire. Symptoms that were manageable can become a hazard. “My everyday forgetfulness went from, ‘You know me, always 10 minutes late!’ to one day completely missing a very important, even life-changing meeting,” says Ann, a former editor in Indianapolis, Indiana, who was diagnosed with ADHD at age 50.
“Before perimenopause, feeling scatterbrained would cause me inconvenience—being a little disorganized, being late sometimes—but then it got to the point when it was a serious problem in daily life,” she says.
How hormone changes in menopause affect ADHD
Estrogen helps regulate the production of the brain chemical dopamine, low levels of which are associated with ADHD. Without enough estrogen, dopamine decreases further, exacerbating ADHD symptoms in people who have the condition.4
Erratic estrogen and progesterone levels also affect your production of serotonin, the “feel good” hormone that helps you feel stable and happy. 56 Add it all up, and “there’s a domino effect on concentration and memory,” says gynecologist and menopause practitioner Alyssa Dweck, M.D.
Menopause Symptoms Can Worsen ADHD Symptoms
Hormones get the brunt of the blame during perimenopause, but they may not be the only culprit in intensifying ADHD symptoms. Various menopause symptoms can also affect your mental health.
Lack of sleep affects concentration
Getting a good night’s rest can feel impossible. Low progesterone—a hormone that acts like a natural sedative—can make it difficult to doze off.7 When you finally do fall asleep, menopause symptoms like night sweats, anxiety, and frequent trips to the bathroom can keep you from staying there.
The overall effect of this menopausal insomnia is a sleep deficit that can impair your daytime concentration. You may wake up drowsy and continue to feel groggy throughout the day, experiencing brain fog, memory lapses, difficulty with focus, and trouble with concentration and decision-making, Dweck says,
Memory worsens
Sleep is also crucial for memory consolidation8. If you find yourself struggling to recall details, it may be because of those sleep disruptions.
Anxiety spikes
ADHD can bring on overstimulation and general anxiety. Throw in hormone fluctuations that influence your mood-regulating serotonin and dopamine production, plus stressors like fatigue or personal challenges that can occur in midlife (like caring for children and parents), and it’s no wonder that menopausal anxiety, rage, and depression can surface9. You may feel short-tempered, weepy, or stressed—or all of the above.
Work might feel overwhelming
Working during menopause can be very challenging. Some surveys suggest that 40 percent of menopausal women have symptoms that interfere with work, and up to 20 percent have considered leaving their jobs because of it. 10
The reasons are varied. Menopause can disrupt the motivation, multitasking, and follow-through that jobs demand. Brain fog can compound ADHD’s memory and attention problems. Hot flashes can make it hard to focus. And depression can sap your drive to be a high performer.
ADHD vs Menopause Symptoms: How to Tell Them Apart
Distinguishing what’s menopause from what’s ADHD may largely come down to timing, Goodman says. If you’re experiencing physical symptoms of perimenopause and your ADHD management strategies can’t keep your ADHD symptoms in check, declining estrogen is likely the culprit.
Still, if your symptoms are new or worsening, see a medical professional. Gynecologists, women’s health specialists, or providers well-versed in ADHD can help you determine what’s going on and discuss lifestyle changes or treatment options, says Dweck. In the meantime, the chart below may help you distinguish if your symptoms are ADHD or menopause.
Undiagnosed ADHD During Perimenopause
Though more people are aware of ADHD today, about 50 to 75 percent of women with ADHD are undiagnosed, according to a 2018 estimate.11 Newer research highlights that while boys are diagnosed about three times as often as girls in childhood, ADHD rates between men and women even out in adulthood. This suggests women go undiagnosed until they’re adults, despite ADHD being known to begin in childhood.
The reasons for this are varied and complex, but researchers point out that girls and women may be better at masking their symptoms. 12 But when perimenopause comes along, the hormonal upheaval can make ADHD apparent—and far more difficult to hide or manage. 13
If you think you have undiagnosed ADHD, see a provider who treats adults to discuss your symptoms and possible treatments.
How to Manage and Treat ADHD During Menopause
Managing ADHD during perimenopause calls for a well-rounded approach. “ADHD management is not simply ‘write a prescription and go about your life,’” Goodman says. It involves complementing the medicine with skills, activities, and habits that support you. This might include lifestyle changes and stress management techniques.
Lifestyle adjustments
Everyday actions like moving your body, eating well, and ensuring proper rest may help you feel better.
Be active
Physical activity may not be a top priority when you’re feeling irritable, tired, or down, but it’s likely to help you power through. “Regular exercise is important not only for health factors, but for sleep, cognition, and mood control,” Goodman says.
Larger, more controlled research is needed to understand any specific benefit to people with ADHD. Some studies suggest that exercise can decrease some but not all ADHD symptoms, while other studies have found that exercise may do nothing for ADHD symptoms. 14
Eat a healthy diet
Although research on diet and ADHD is mixed, eating a generally healthy diet may help improve symptoms, especially in perimenopause and menopause. According to a 2023 study in Nutrients, balanced nutrition during this time can help ease menopausal symptoms that make your ADHD worse. 15
Aim to incorporate plenty of fruits and vegetables, healthy fats, low-fat dairy, and lean proteins into your meals while limiting or avoiding ultra-processed and refined foods. 16
Get a good night’s sleep
Quality sleep improves almost every aspect of health. Even though perimenopausal symptoms can be bothersome at bedtime, habits for good sleep hygiene can help. Try cutting back on screens before bed, keeping your room dark and cool, and sticking to the same wake/sleep schedule all seven days of the week. 17
Stress management
It’s understandable if you feel stressed during perimenopause. Many women in their 40s and 50s are already pulling triple duty: raising kids, caring for aging parents, and working at the peak of their careers. Perimenopause adds one more thing to manage, and then there’s the mood swings. Consider the following to help feel more in control.
Psychotherapy
“Psychotherapy can help you gain a different perspective or a broader range of skills to manage stress,” says Goodman, who recommends focusing less on the specific type or modality of therapy and more on finding a provider who can help you identify and accomplish your goals.
According to Goodman, psychotherapy for ADHD in menopause can be tailored to accommodate your specific challenges, with goals such as:
Improving emotional reactivity: The emotional dysregulation of ADHD—and perimenopause—can affect your social engagement. So, for example, “if you tend to be low in frustration tolerance and quick to react, psychotherapy can address your ability to contain that emotional reactivity,” Goodman explains.
Reducing cognitive distortions: Cognitive-behavioral therapy (CBT) can help quiet or change automatic negative thoughts that may affect your feelings, mood, and behavior.
Improving family relationships: In family-based treatment (FBT), family members who aren’t as familiar with ADHD or menopause learn more about it. That helps neutralize how they understand your behavior, so they aren’t continually frustrated if you act differently than they’d expect you to, Goodman explains.
Meditation and yoga
Many people find that meditation and yoga are useful practices for managing stress, containing emotional reactivity, and encouraging a sense of calm. While there’s a lack of conclusive evidence about whether these can help people with ADHD specifically, some people may experience benefits if they can commit to either or both.
Some research suggests that yoga may not improve cognition or mood in women with adult ADHD. 1819At the same time, a recent review of 10 randomized controlled studies found that yoga appears to improve sleep and reduce stress, anxiety, and depression in perimenopausal women. 20
While meditation is sometimes challenging for people with ADHD, it may have similar benefits. According to a meta review published in 2022, regular practice can help improve self-compassion, quality of life, wellbeing, depression, and anxiety, though the benefits for ADHD symptoms such as executive dysfunction and emotional dysregulation are less certain. 21
Hormone replacement therapy
Addressing the hormonal factors aggravating your ADHD may help you feel better. Research suggests that taking estrogen or estrogen with progesterone can help decrease depression in menopause and improve sleep quality. 22 “To be clear,” Dweck says, “menopause hormone therapy is not in and of itself indicated for the treatment of ADHD, but it may be a helpful adjunct to other treatments.”
ADHD medication
Evidence-based medication for ADHD may also help you take on worsening ADHD symptoms. “Increasing the ADHD medication isn’t going to have any effect on the physiologic symptoms of perimenopause [like hot flashes and irregular periods],” Goodman says, but it may often help with brain fog, difficulty concentrating, and other cognitive challenges.
Be sure to talk to your healthcare provider about any possible interactions that could occur between any medications or supplements you take, whether they’re for ADHD, menopause, or other conditions.
The Bottom Line
Menopause can make ADHD worse because as estrogen decreases, so does dopamine, an important chemical in your brain that helps regulate ADHD symptoms. What’s more, shared symptoms of ADHD and menopause—such as anxiety, memory problems, and mood swings—can compound each other. Following a healthy lifestyle, including trying stress-management techniques, as well as medication for ADHD and menopausal symptoms may help make this transition easier.
Amanda Doyle is a Boston-based editor and writer who as created content for organizations such as Healthline, Boston Medical Center, and Everyday Health. Her priority is making health information accessible while decreasing stigma or shame around the human experience.
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