The perimenopause and ADHD connection

For decades, the conversation around attention-deficit/hyperactivity disorder (ADHD) focused almost exclusively on school-aged boys. But that’s starting to change.

More attention is now being paid to women in their 40s and 50s, as data shows a rise in adult ADHD diagnoses around the time of perimenopause.

This has led many to ask: why now? 

Is this a "new" diagnosis, or are the hormonal shifts experienced during perimenopause making long-standing ADHD traits harder to manage and therefore more visible?

This is why we’re looking deeper into the data. While our current collaboration with researchers at Queen Mary University of London focuses on how ADHD traits fluctuate across the menstrual cycle, these findings could help better understand the more permanent hormonal shifts of perimenopause. 

To help us connect these dots, we spoke with Eve Lepage, MSN, RN, Clue’s resident reproductive health specialist and fertility nurse. In this Q&A, she breaks down the link between perimenopause and ADHD and gives science-based tips on how people can manage both.

Key takeaways: 

• The ADHD and perimenopause link: Midlife diagnoses are often not "new" ADHD, but long-standing traits becoming harder to manage as estrogen declines

• The diagnostic gap: ADHD has historically been underdiagnosed in women, leading many to be identified later in life

• Managing ADHD and perimenopause: Support often includes a combination of clinical care and practical lifestyle adjustments

• Ongoing research: Clue is collaborating with researchers at Queen Mary University of London to investigate how focus, attention, and motivation fluctuate with hormonal changes. 

1. Why are ADHD diagnoses spiking during perimenopause and menopause? 

From a reproductive health perspective, the rise in ADHD diagnoses around perimenopause and menopause isn’t necessarily about ADHD suddenly “appearing.” It’s more often that long-standing traits become harder to manage and therefore more visible.

Estrogen plays an important role in brain function, particularly in regulating dopamine, which is key for attention, motivation, and executive function. During perimenopause, estrogen levels fluctuate and eventually decline, which can disrupt these systems and amplify ADHD-related challenges.

We’re also starting to see more research exploring how attention and executive function may shift in response to hormonal changes. For example, Clue has partnered with researchers at Queen Mary University of London to investigate whether focus, motivation, and distractibility vary across the menstrual cycle in people with and without ADHD.

The hypothesis is that while many people experience some fluctuation in these cognitive symptoms, those with ADHD may experience both higher overall levels of difficulty and more pronounced changes.

Perimenopause can bring underlying ADHD traits to the surface. Many people have spent years compensating through coping strategies, but hormonal changes can intensify symptoms and make those strategies less effective.

As a result, challenges that have been present for a long time may become more noticeable and harder to manage. This can prompt people to seek answers, and in some cases, a diagnosis for the first time. 

Women with ADHD are also more likely to experience co-occurring conditions such as anxiety, depression, and eating disorders. These can complicate the picture and delay diagnosis, meaning ADHD is sometimes only identified later in life, often at a point when symptoms become harder to ignore. 

There’s also emerging evidence that perimenopause may begin earlier in people with ADHD, which could mean this amplification happens sooner and feels more abrupt or unexpected. 

At the same time, this life stage often comes with increased cognitive and emotional demands, such as career pressure, caregiving, or health changes, which can further strain coping mechanisms.

Taken together, these factors could help explain why more women are seeking assessment and receiving diagnoses during this time. 

2. Why is this becoming such a big conversation now?

I think there are several reasons why the topic of ADHD and perimenopause is gaining more attention. 

ADHD has historically been underdiagnosed in women. Much of the early research and diagnostic criteria were based on how ADHD presents in boys, which means many girls and women were missed. As a result, many people are only now being identified in adulthood. 

ADHD can also present differently in women, often showing up as inattentiveness, internal restlessness, or feeling overwhelmed, rather than the more visible hyperactivity traditionally associated with the condition. Because of this, many women are only now recognizing these patterns in themselves. 

At the same time, there’s increasing recognition that reproductive hormones affect not just physical health, but also cognition, mood, and mental health.

Perimenopause is a life stage marked by significant hormonal changes, which can make these effects more noticeable. 

There’s also significant overlap in ADHD and perimenopause symptoms. Perimenopause can cause brain fog, forgetfulness, low motivation, and mood changes, all of which can also be seen in ADHD. For some people, this leads to a new diagnosis, and for others, it highlights how hormonal changes can exacerbate underlying neurodivergent traits. 

The link is likely multifactorial: hormonal fluctuations can intensify ADHD symptoms, while underlying ADHD can shape how someone experiences and copes with perimenopause. At the same time, a cultural shift towards greater openness around menopause and neurodiversity is making it easier for people to connect with experiences and talk about them. 

3. How can you manage ADHD during perimenopause?

Support during this life stage often needs to be flexible. What worked in your 20s or 30s may not work in the same way during perimenopause. 

If possible, speak to a healthcare provider who can look at the full picture. For some people, adjusting ADHD treatment is helpful; for others, it may be more about addressing menopausal symptoms. Often, it’s about finding the right balance between the two. 

In everyday life, small practical adjustments can help: 

• Externalizing tasks by writing things down

• Setting reminders

• Breaking tasks into smaller steps 

These can help reduce the pressure on working memory and make things feel more manageable

Sleep, nutrition, and stress also play a big role in how symptoms show up.

• Sleep: Aim for consistent sleep and wake time, even on weekends. If sleep is disrupted (which is common in perimenopause), try limiting caffeine later in the day, keeping your bedroom cool and dark, and having a wind-down routine that signals to your brain it’s time to sleep. If sleep issues persist, it’s worth discussing them with a healthcare provider, as treating sleep issues can significantly improve mood and focus. 

• Nutrition: Regular meals can help stabilize energy and concentration. Including protein, fiber, and healthy fats can support more sustained energy levels, which may help with attention and reduce crashes. Skipping meals or relying on quick sugar spikes can make symptoms feel more intense.

• Stress: Chronic stress can worsen both ADHD and perimenopause symptoms. Gentle, consistent strategies, like moving your body, spending time outside, or even a few minutes of structured downtime, can help regulate stress without adding extra pressure. Other techniques, like practicing mindfulness or breathing exercises, can also help regulate your nervous system. 

Finally, it’s important to update expectations. If something that used to work no longer does, that’s useful information.

Adjusting your approach is part of responding to a changing physiological landscape, not a sign that you’re doing something wrong.

The bottom line

ADHD and perimenopause can intersect in ways that make symptoms more noticeable and harder to manage, but this doesn't mean something new is wrong. For many, it’s about long-standing patterns becoming more viable during a time of hormonal and life change. 

Understanding this connection and seeking the right kind of support can make a meaningful difference.