ADHD and Perimenopause: Why Your ADHD Symptoms May Feel Worse

You’ve had ADHD for years. You know how to manage it. So why does it suddenly seem much harder?

You’re struggling to concentrate. Getting started on a task takes more effort. You’re forgetting things, losing your train of thought or becoming overwhelmed by things you would normally manage.

If this is happening during your 40s or 50s, peri-menopause could be contributing to the change.

It doesn't mean that you have suddenly developed ADHD. Rather, hormonal changes during peri-menopause may make existing ADHD symptoms more difficult to manage.

What does oestrogen have to do with ADHD?

ADHD is associated with differences in the brain's regulation of neurotransmitters including dopamine and noradrenaline, which are involved in attention, motivation, focus and executive function.

Oestrogen also interacts with these systems.

During peri-menopause, oestrogen levels can fluctuate considerably. Eventually, they settle at a lower level after menopause. For some women with ADHD, these hormonal changes can make familiar symptoms more noticeable.

Things that you have previously found manageable may suddenly require considerably more effort.

What might you notice?

The changes aren't necessarily dramatic. They can show up as a gradual increase in everyday frustrations.

• Concentration: Staying focused on a meeting, reading or a work task becomes harder.

• Executive function: Planning, prioritising and getting started can take much more effort.

• Working memory: You forget what you were about to do, lose your train of thought or struggle to retrieve a word.

• Emotional regulation: You may become more easily frustrated or overwhelmed.

• Impulsivity: You might notice changes in things such as interrupting, spending or eating.

• Sleep: ADHD can already be associated with sleep difficulties, while peri-menopause can bring night sweats, disrupted sleep and insomnia. Poor sleep can then make concentration and emotional regulation even more difficult the following day.

It can become a bit of a feedback loop: hormonal changes affect sleep and concentration, poor sleep makes ADHD symptoms harder to manage, and the resulting stress makes everything feel more difficult again.

What can you do?

If you've noticed a significant change in your ADHD symptoms during perimenopause, it's worth discussing it with your GP, ADHD clinician or another appropriately qualified healthcare professional.

Your ADHD treatment may need reviewing, and if you're experiencing other menopause symptoms, you can discuss those too.

There are also some practical things worth looking at.

• Sleep: If you're waking repeatedly because of night sweats or struggling to switch off, addressing your sleep may make a noticeable difference to your concentration the following day.

• Exercise: Regular physical activity is useful for general physical and mental health, and maintaining an exercise routine can be particularly valuable during midlife.

• Strength training: Maintaining muscle becomes increasingly important as we age. Two or three well-structured strength sessions each week can support muscle mass, strength and physical function.

• External reminders: Calendars, lists, alarms and routines can reduce the amount you need to keep in your head. There's no prize for remembering everything without them.

• Regular meals: Long gaps between meals, lots of caffeine and grabbing whatever is available when you're already hungry aren't particularly helpful when you're trying to manage concentration, energy and appetite.

• And look at the overall load you're carrying. Work, family, poor sleep, training, menopause symptoms and ADHD can all compete for the same limited mental bandwidth. Sometimes the answer is reducing the load in the first place.

It may be time to change your approach

If strategies that worked well for you for years are no longer working, it makes sense to review them rather than simply trying harder.

For women with ADHD, peri-menopause can be a useful point to look at the whole picture: ADHD management, menopause symptoms, sleep, exercise, nutrition and stress.

That's also how I approach my Midlife Fit Programme. The focus is on practical, sustainable changes around strength, fitness, nutrition and recovery that fit into real life – rather than another restrictive diet or an unrealistic exercise plan.