Does perimenopause make ADHD worse?

What women in one survey reported

The headline figure is striking, and it’s worth stating precisely what it is and isn’t.

Osianlis and colleagues surveyed 600 female participants who reported having an ADHD diagnosis, using an online survey run between June and November 2023. Asked about perceived symptom change at different hormonal life stages, 97.5% perceived a worsening of ADHD symptoms during menopause. The same sample reported 70.4% perceiving worsening in the postpartum period.

That’s a large number, and it needs its limits attached. This was a cross-sectional online survey. Participants self-reported an ADHD diagnosis and symptoms, and were recruited online, so the sample selects for people already identified and engaged with the topic. They were asked to report perceived change, which is retrospective and shaped by what people expect to be true. It’s evidence about what these participants reported, not a population rate and not a measurement of symptom change.

Qualitative work points the same way. Johansson and Hogg interviewed twelve women, neurodivergent and neurotypical, about the psychological impacts of the menopausal transition, and constructed themes including evolving expressions of neurodivergence and unmasking. Twelve participants describe a texture rather than a rate.

What the measurements found

Here the picture gets more complicated, so both studies are laid out below.

Boyd and colleagues surveyed 602 women in total, but the menopause measure went only to the 218 participants (36.2%) who reported being peri- or postmenopausal—148 in the ADHD group, 70 without. Using the Greene Climacteric Scale, the ADHD group showed greater menopausal symptom severity (t = 9.61, p < .001). The paper notes that these two groups were not fully age-matched: the non-ADHD group was older, mean 51.41 against 48.26, t(216) = 3.0, p = .003. The study is cross-sectional, ADHD status is self-reported, and recruitment ran through ADHD support groups and social media.

Chapman and colleagues recruited 656 women aged 45 to 60, 245 with an existing ADHD diagnosis, and assessed menopausal experience with four validated instruments: the Women’s Health Questionnaire, the Menopause-Specific Quality of Life Questionnaire, the Hot Flush Rating Scale, and the Hot Flush Related Daily Interference Scale. After analysis of covariance with a false discovery rate correction, they found no significant effects of ADHD diagnosis and no interaction between diagnosis and menopause stage. Adding medication status—no ADHD, ADHD medicated, ADHD unmedicated—produced no main effects either. Their conclusion was that women with ADHD did not report greater menopausal complaints than women without, at any stage.

Two studies, opposite headline results, on samples of different sizes and composition.

Why they might disagree

Not something either paper settles, but the differences are visible and worth knowing.

Who was compared. Chapman recruited 656 women aged 45 to 60, the window in which the transition happens. Boyd’s menopause comparison rests on a smaller subgroup—218 people—and the paper reports that its two groups were not fully age-matched, with the non-ADHD comparison group about three years older on average.

Statistical approach. Chapman used analysis of covariance with a false discovery rate correction, which adjusts for the number of comparisons run. Boyd reported group comparisons without that adjustment. The two approaches answer slightly different questions, and this page doesn’t try to rule between them.

How ADHD was established. Chapman required an existing diagnosis. Boyd used self-report.

What was measured. Chapman measured menopausal complaints—hot flushes, quality of life, general menopausal symptoms. Whether ADHD symptoms specifically worsen is a related but different question, and one that Chapman’s design wasn’t built to answer.

That last point matters. It’s coherent for both to be true: that women with ADHD don’t report worse menopausal symptoms while still experiencing their ADHD as harder to manage. The studies may be measuring different things.

The attribution problem

Chapman’s paper raises an idea that is interesting rather than dismissive, and it may be the most useful one in this literature.

Across all their participants, ADHD symptoms and menopausal complaints were significantly correlated. But at group level the association was less prominent among the women with ADHD—which the authors suggest could indicate a different attribution of symptoms in that group.

In plain terms: everyone in the transition reports some difficulty concentrating, some forgetfulness, some overwhelm. Women without ADHD may file those under “menopause.” Women with ADHD, who have a lifetime of experience with exactly those difficulties, may file the same experiences under “my ADHD is worse.”

That would produce precisely the pattern in the data: high rates of reported ADHD worsening in a survey, without a matching rise on menopause questionnaires.

It’s a hypothesis the authors offer, not a finding they demonstrate, and it doesn’t mean the experience is imaginary. If the same cognitive load lands on a system that was already working near capacity, it can cost more even if the questionnaire score looks the same.

The mechanism, and what status it has

You’ll see a confident explanation repeated widely: oestrogen boosts dopamine, ADHD involves dopamine, so falling oestrogen worsens ADHD. It’s worth knowing what kind of claim that is.

The 2025 review by Kooij and colleagues for the Eunethydis Special Interest Group on Female ADHD examines the interplay of oestrogen and progesterone with dopaminergic pathways, and proposes that periods of lower oestrogen may affect cognition. That’s a mechanism proposed in a narrative review synthesising existing literature and self-reported experience—not a demonstrated causal pathway from hormone level to ADHD symptom severity in this population.

The same review states its own gap plainly: hormonal transitions are described as exacerbating symptoms, pharmacological research and tailored treatments are lacking, and longitudinal sex-specific studies incorporating hormonal status are needed.

So the mechanism is plausible and it is not established. Treat anyone stating it as settled fact with the caution you’d apply to any tidy story about a complicated system.

What this means if you’re in it

The research being unsettled doesn’t leave you with nothing.

Your experience is not unusual. Whatever the mechanism turns out to be, the survey figures mean you are describing something many other women with ADHD describe too.

If strategies that used to work have stopped working, that’s information regardless of cause. Rebuilding support around what’s difficult now doesn’t require knowing why it got difficult.

If you’re wondering whether you’ve had ADHD all along, that’s a reasonable question at this stage of life and a common point of first assessment. It would be recognition rather than onset—ADHD requires childhood onset—and our page on whether an assessment is worth it as an adult covers what changes with one.

And it’s worth tracking what you notice, with dates. Given how thin the longitudinal evidence is, your own record over months is more informative about you than any of the studies above.

Medication and hormone questions

These come up constantly on this topic and they belong with a clinician, so this page will be brief and unhelpful on purpose.

Whether your ADHD medication should change, whether hormone therapy might affect your symptoms, and how the two interact are individualised clinical decisions that depend on your history, your other health conditions, and what you’re taking. Reviews in this area note that pharmacological research tailored to this life stage is lacking—which is a reason to have the conversation with your prescriber, not a reason to make changes on your own.

What you can usefully bring to that conversation is a specific record: what changed, when, and what it’s costing you. That’s the same thing this page recommends for everything else, and for the same reason—it’s the part nobody else can supply.