ADHD and perimenopause: understanding the overlap

Hi, I’m Dr Katie Hodgkinson, a GP and lifestyle medicine doctor and owner of Hampshire Health and Hormones. I advise my clients on managing hormonal health and lifestyle related disease. 

There is a potential link between perimenopause and exacerbation of symptoms of ADHD. In addition, it is not uncommon for the possibility of ADHD to be suggested or diagnosed at the time of perimenopause or menopause.

I have shared some frequently asked questions on how ADHD symptoms can change or intensify during perimenopause and what to expect.  

What are the hormonal changes at perimenopause? 

Perimenopause is the time leading up to menopause (when periods have stopped as the follicle function of the ovaries ceases). It can last on average 4-5 years, and in some cases 10 years or more before menopause. 

It is characterised by a decline in progesterone, and fluctuating and declining oestrogen levels. Testosterone declines from around the 30s onwards. 

What are symptoms of perimenopause?

There are many different potential symptoms of perimenopause as result of hormonal changes, including changes in periods, reduced concentration and memory, fatigue, low mood, anxiety, sleep problems, loss of confidence, weight gain and lots more. Each person’s experience of perimenopause is different and symptoms and severity can vary. 

Changes in hormones can result in cyclical symptoms - symptoms are often worse in the days before a period, and Pre-Menstrual Syndrome (PMS) can start or worsen as a result. As hormones (especially oestrogen) can significantly fluctuate in the perimenopause there may not be an obvious cyclical pattern, in particular if periods are changing. 

What is the link with our hormones and neurotransmitters?

Oestrogen and progesterone are involved in the uptake of dopamine and neurotransmitters such as serotonin and gaba. Dopamine is involved in mood, attention, motivation and movement, and serotonin and gaba help to regulate mood. 

Changes in hormone levels throughout the menstrual cycle can then impact the levels of these neurotransmitters, and can affect factors such as mental health, focus, and energy. When hormones are out of balance or significantly changing such as at perimenopause, this can have more of an impact on symptoms, including those as a result of changes to neurotransmitter levels. 

What are some of the symptoms of ADHD? 

Attention deficit hyperactivity disorder (ADHD) affects around 3-4 percent of adults. Symptoms may include inattention, intense emotions, hyperactivity, mood swings, reduced verbal and non-verbal working memory/self awareness/self-regulation, impulsivity, disorganisation with reduced planning and problem solving or difficulty in relationships.

What is the link with ADHD and hormonal change in particular at perimenopause? 

ADHD may be linked to a dysfunction of dopamine, and also maybe lowered levels of serotonin. As changes in hormones can affect levels of dopamine and serotonin, if levels are already potentially out of balance in ADHD, then people with ADHD can be more sensitive to hormonal changes.

As an example research has shown that ADHD symptoms tend to be better at times when oestrogen is higher such as around ovulation, and worse when oestrogen is lower such as the days before a period. When oestrogen declines in the peri-menopause, then a decline in neurotransmitters can occur which can exacerbate and result in significant ADHD symptoms such as worsening concentration, and memory and further reduced executive functioning, as well as deterioration in mood and anxiety. This can be especially challenging for those that already have significant emotional regulation problems. 

Many women with ADHD already suffer from sleep problems. If sleep is affected during the peri-menopause/menopause then this can further impact on ADHD symptoms and a worsening cycle can occur. 

In a survey of nearly 5,000 women with ADHD by ADDitude (1), 63 percent of those aged 45 and above mentioned that the time of their lives in which ADHD had the greatest impact was at perimenopause and menopause, and 93 percent had noticed a difference in the severity of their symptoms at this time. Symptoms in particular that were significant included overwhelm, brain fog, procrastination, inattention and poor time management. 

What other factors can affect hormones and ADHD symptoms?

Factors such as diet, lifestyle and stress can also impact hormones and ADHD symptoms. Gut health is closely clinked to our hormones and can also impact on mental health symptoms. Having a healthy balanced diet, plenty of sleep and exercising regularly is important. 

While most cases of ADHD are diagnosed in childhood, a large percentage of adults, especially women, remain undiagnosed due to attributing symptoms to other causes such as stress or mood disorders. Women are more likely to present with inattentive symptoms rather than hyperactivity which may be less easily noticed. As perimenopause and menopause can sometimes result in worsening symptoms which may impact on quality of life, this may then prompt consulting with a health professional. 

If you or someone you know is experiencing ADHD symptoms it is important to seek professional help with a possible diagnosis and further management. In addition, addressing hormonal deficiencies or imbalances as well as lifestyle factors such as diet/sleep/stress may help with management of ADHD symptoms.

About the author

Dr Katie Hodgkinson is a GP and lifestyle medicine doctor and owner of Hampshire Health and Hormones - managing hormonal health and lifestyle-related disease.