Growing up, Margaret Reed Roberts felt different from other children. She’d always been an extrovert—very active, expressive, and energetic. But she also silently struggled with retaining information at school, and she dealt with fatigue and low mood as a teenager.

“I felt very alone in my overactive, internal world,” says Reed Roberts, 51, a social worker in Cambridge, England, and mother of two. “I felt I was treated differently and sometimes felt very misunderstood.”

About five years ago, Reed Roberts entered perimenopause and faced a whole host of symptoms, including hot flashes, migraines, and sore breasts. At the same time, the constant thoughts that had always swirled in her head also increased. She became easily irritated and frustrated, and her battles with brain fog left her struggling to remember words and dates.

“Multitasking became a ginormous burden. It became an impossible feat for me,” she says. “I was always articulate and intelligent. I have two master’s degrees. But everything became very effort-full. I was unable to prioritize, so I shut down, just overwhelmed.”

Reed Roberts became so concerned about her own cognitive decline that, while working with dementia patients, she tested herself for early-onset dementia. Thankfully, she didn’t have dementia, but she was still left searching for answers as to what was happening. That was until a close friend suggested the possibility that she might have attention deficit hyperactivity disorder, or ADHD.

After seeing a psychiatrist at age 48, Reed Roberts was formally diagnosed with ADHD. “I felt a whole gamut of feelings. Forty-eight years of my life, I was living in a way where I didn’t have my needs understood,” she recalls.

As it turns out, noticing an uptick in ADHD symptoms during menopause is not uncommon. In a 2024 survey of 1,500 women (with diagnosed and undiagnosed ADHD) from the resource community ADDitude, 94 percent of women reported worsening ADHD symptoms during perimenopause and menopause. Seventy percent also said that brain fog and memory issues had a “life-altering impact” in their 40s and 50s. The average age of diagnosis for respondents to the survey was 43—meaning, like Reed Roberts, many had lived for decades with undiagnosed ADHD.

Why is this important? Well, women with ADHD are more likely to battle depression, and they have higher suicide rates than women without ADHD, per a January 2021 study in the Journal of Psychiatric Research¹. Women with undiagnosed ADHD are even more at risk, especially when you add on the mental, physical, and emotional symptoms that can come during perimenopause and menopause, says Ellen Littman, PhD, a clinical psychologist who works with women and girls with ADHD.

“These are serious public health concerns, and no one is acknowledging them,” says Littman, who co-authored the 2021 report ADHD in Females Across the Lifespan and the Role of Estrogen.

If any of this resonates with you, there is hope. Read on to learn more about the ADHD-menopause connection, symptoms of adult ADHD in menopausal women, and ways to treat both conditions to feel better mentally and physically.

The connection between ADHD and menopause

ADHD is marked by ongoing patterns of inattention and/or hyperactivity-impulsivity (either or both types of symptoms can be present) that interfere with functioning or development, per the National Institutes of Health (NIH). It’s unclear what exactly causes ADHD, but genetics are believed to play a large role, as ADHD often runs in families.

A quick Google search will show hundreds of articles and personal accounts about ADHD and menopause. But medical research on the topic is nearly nonexistent, says Jeannette Wasserstein, PhD, a clinical neuropsychologist and co-author of the report on the role of estrogen in ADHD.

“The closest thing we have to research is anecdotal evidence that, with ADHD, what was always there gets worse and can be more difficult to manage with medications,” Wasserstein says.

Physiologically, there are valid explanations as to why ADHD would worsen during perimenopause (the time right before menopause when estrogen and progesterone hormones begin to fluctuate) and menopause (defined as going one year without a menstrual period). People with ADHD already have low levels of dopamine, and in menopause, estrogen levels can drop as much as 65 percent, affecting the production of dopamine, serotonin, and other important neurotransmitters governing cognition, memory, and mood.

“Estrogen is an extraordinarily important hormone,” says Wasserstein. “It’s not only a sex hormone. Estrogen is a modulator of dopamine and serotonin, and is also good for the brain and helps neurons” function properly.

As estrogen drops, these neurotransmitter levels plummet further, leading to worsening symptoms, particularly focus and concentration—which many women with ADHD experience in perimenopause and menopause, according to a June 2021 study in Materia Sociomedica² on ADHD symptoms in females at different life stages. Not surprisingly, more than half of the women who responded to the ADDitude survey said menopause was the time when ADHD had the greatest overall impact on their lives.

The ADHD has likely always been there

It’s important to note that although many women receive late-in-life ADHD diagnoses, they aren’t newly developing ADHD, says Wasserstein. “ADHD is a neurodevelopmental disorder, meaning it occurs in the development of the nervous system,” she says. “If you never had ADHD and symptoms first came in your 40s, it’s not ADHD.”

Instead, for women who are undiagnosed in midlife, the decline of estrogen along with life changes (such as children leaving home and caring for aging parents) creates a perfect storm for worsening ADHD symptoms, says Littman.

“High-functioning women might now be struggling enough that they get diagnosed,” says Littman.

Reed Roberts says she also battled depression and self-inflicted “character assassination” before her ADHD diagnosis. “You see yourself as a flawed human being because you can’t do what other people do naturally,” she says.

Why ADHD can be difficult to diagnose during menopause

Because many cognitive and emotional symptoms of ADHD and menopause overlap, it can be difficult for women and even their doctors to know which is at play. Because ADHD is somewhat genetic, having family members with the condition can be one clue as to what might be causing your symptoms, says Wasserstein.

“ADHD is extremely inheritable,” Wasserstein says. “If no one in your family has ADHD, I would likely attribute symptoms to menopause. If ADHD runs in your family, I might say you were a borderline person who has shifted over the border.”

For many women, getting a proper diagnosis is complicated by the fact that, in general (but especially during menopause), their concerns aren’t always taken seriously by health care providers. Littman says many clinicians who treat ADHD aren’t aware of the connection between worsening symptoms and menopause.

“There is a gender bias and women often may be dismissed,” says Littman. “Clinicians see the most observable symptoms, so women can be misdiagnosed and given antidepressants.”

Roberts Reed says neither of the two male psychiatrists she saw after her diagnosis were familiar with the link between worsening ADHD and menopause. “I already knew about the perimenopause connection, but they didn’t discuss it until I brought it up,” she says. “It wasn’t included the assessment and menopause was not recognized or discussed as being part of it.”

“An added factor in late ADHD diagnosis is women’s natural tendency to feel guilty and even hide their struggles,” says Littman. “Women are supposed to be “superwomen” and put everyone else first and look good while doing it,” she says. “In my practice, I see high-IQ, ADHD women who were told they can’t have ADHD because they are high functioning, with no one knowing how much they struggle to look that way.”

The symptoms of ADHD during menopause

Not surprisingly, the bulk of research on ADHD has been done in males, and diagnostic criteria is based on symptoms in males, not females, says Littman. Females are more likely to have ADHD symptoms like inattention and overthinking, while men are more likely to be impulsive and hyperactive, according to 2020 research in PLOS One³.

It’s also well known that ADHD symptoms can change throughout someone’s lifetime. Women over 40 who responded to the ADDitude survey were more likely than their younger counterparts to have overwhelm, brain fog and memory issues, procrastination, and time-management difficulties.

Littman says common symptoms she sees in the women she treats with midlife ADHD include:

• Feeling overwhelmed, like you can’t possibly juggle everything
• Always being late and other challenges with time
• Putting off things you need to do, and doing nothing or scrolling on your phone instead
• Withdrawing from peers

Women should never feel guilty about any of these behaviors because it’s not something they can help, advises Littman. “You might think about things you have to do, but your ADHD brain says, “Sorry, that’s too boring. I’m not going to do this,”” she says. “You are actually trying desperately to get these things done, but your brain is not engaged.”

How to navigate ADHD during menopause

Stimulant and nonstimulant medications along with psychotherapy and behavioral therapy can all help improve ADHD symptoms and improve functioning, per the NIH. But ADHD menopausal women might also benefit from hormone replacement therapy (HRT) because it’s known to help with mood and cognitive function, though no research has been done on HRT’s specific effects on ADHD, says Wasserstein. HRT can help improve physical and emotional symptoms of menopause if started within 10 years of menopause and before the age of 60, per the Cleveland Clinic.

The catch-22 is that many psychiatrists who treat ADHD don’t prescribe HRT, say Wasserstein and Littman. Both experts recommend women with ADHD in perimenopause and menopause see a psychiatrist, and if they’re still facing difficulties after treatment? Seeing an OB/GYN with menopause training either in-person or virtually to discuss HRT.

Littman also suggests asking your clinician how many people in menopause they’ve worked with, and taking articles on ADHD and menopause to appointments. “You can manage symptoms, and lots of coping skills can be taught. You can turn things around, be successful, and have better relationships and a better life,” she says.

Other coping skills you can try at home for ADHD symptoms include the following, per ADDitude:

• Daily exercise
• Yoga, meditation, and deep breathing
• Cognitive behavioral therapy
• Setting daily, weekly, or monthly goals
• Making to-do lists
• Rewarding yourself for getting tasks done

With treatment, Reed Roberts is feeling much better, but still working on getting to where she needs to be. “With a combination of HRT and medications, I have definitely improved and moved forward,” she says. She also finds that support groups and engaging in ADHD activism (in the form of podcasts and other initiatives) help her along her ADHD journey.

She also encourages other women who have worsening ADHD symptoms, especially if undiagnosed, to seek help. Just getting a diagnosis was a huge relief because she realized her symptoms weren’t something she could help, but a product of her neurodivergence, she adds.

“ADHD is not an illness or a disease, but something I was born with,” Reed Roberts says. “Being diagnosed was empowering and freeing. There was less self-blame and I could reframe my life in a different way. Diagnosis is not a label. It’s a roadmap to yourself.”

—reviewed by Andrea Braden, MD, OB/GYN