ADHD in Women

Let’s Talk About Perimenopause and ADHD

Hormonal fluctuations in midlife can hit women with ADHD hard. Learn what perimenopause treatment options can help — and how to talk to your doctor about them.

By Lotta Borg Skoglund, M.D., Ph.D. Updated on May 7, 2025
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Perimenopausal women with ADHD feel abandoned by healthcare. Few clinicians are knowledgeable about female presentations of ADHD, so women are left to untangle a messy knot of hormones, ADHD symptoms, medications, and lifestyle factors on their own. And science offers little help. Fewer than one percent of all brain imaging studies focus on female-specific health factors, revealing little data on how hormonal shifts impact ADHD.

Even with so little research, we can help perimenopausal women with ADHD make sound medical decisions by arming them with vital information to share with their doctors. Start here.

ADHD and Low Estrogen

Estrogen regulates the effects of neurotransmitters implicated in ADHD. When estrogen is low, dopamine and serotonin are affected, which can have a negative impact on attention, memory, mood, decision-making, sleep, emotional regulation, and other executive functions. As estrogen vacillates wildly in perimenopause (the years leading up to menopause), many women find that their ADHD symptoms grow significantly worse.

Perimenopause Treatment Options

  • Selective Serotonin Reuptake Inhibitors (SSRIs): People with ADHD face an outsized risk for depression and anxiety disorders. While not a first-line treatment for ADHD, antidepressants including SSRIs and selective norepinephrine reuptake inhibitors (SNRIs) may have dual benefits for mood and ADHD symptoms in women with these comorbidities. There is also evidence that SSRIs effectively treat hot flashes as well.

[Read: How Changing Hormones Exacerbate ADHD Symptoms]

  • Hormone Replacement Therapy (HRT): The current medical consensus is that, for women without risk factors such as breast cancer, or complications from diabetes, the benefits of HRT are generally considered to outweigh the potential risks. Through HRT, estrogen is delivered transdermally (via a patch, spray, or gel) or orally through pills. Women who shouldn’t use estrogen taken as a pill, such as women with migraines with aura or risk for thrombosis, can in many cases still use transdermal estrogen.
    For women who have a uterus, systemic estrogen should always be combined with progestin via an IUD or pills every day, every month, or every three months, or as a fixed estrogen-progestin combination in patch or pill form. For women who can’t take systemic HRT because of contraindications, local estrogen can be taken to treat vaginal atrophy or urinary tract symptoms.
  • Alternative Options: A new treatment option for women who don’t tolerate hormonal therapy is Veozah, which targets hot flashes directly via the hypothalamus.
  • Adjusting ADHD Medication: Fluctuating and declining hormone levels may affect the efficacy of stimulant or non-stimulant ADHD medication; many perimenopausal women report that their tried-and-true ADHD medications fail to adequately manage their symptoms during this time. If you’ve noticed this, talk with your doctor about tailoring your ADHD medication dosage, possibly in conjunction with hormone therapy.

[Watch: A Patient’s Guide to Talking with Your Doctor About ADHD and Menopause]

Prepping for Your Appointment

To make the most of your doctor’s visit, arrive with the following information:

  • Menstrual Cycles and Symptoms: Track your cycle, and your ADHD and perimenopausal symptoms, ideally for two to three months, to help your doctor identify patterns. You can use this sample menstrual cycle tracker.
  • Medications: List prescription and nonprescription medications (including the ones you’ve recently discontinued), as well as vitamins and supplements.
  • Major Life Stressors or Changes: Note important life events on a timeline so your doctor has full context for your experience.
  • Questions: If you’re not sure where to begin, say: “I’ve noticed changes in my ADHD symptoms, and I suspect that this may be related to perimenopause. Can we talk about treatment options for both of these conditions?”

Perimenopause Treatment and ADHD: Next Steps

Lotta Borg Skoglund, M.D., Ph.D., is an associate professor at Uppsala University in the Department for Women’s and Children’s Health and leader of the pioneering research group GODDESS ADHD.

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