Why does ADHD in women seem to change throughout the month—or suddenly get worse in your 30s and 40s? It turns out that hormones and ADHD in women are more closely connected than we’ve long understood.
In this video, I break down the powerful connection between women, ADHD, and hormones—and why this piece of the puzzle has been overlooked for so long.
Hang on—if estrogen directly modulates dopamine, AND dopamine is essential to executive function—like emotional regulation, impulse control, motivation, and thinking—AND for women, estrogen looks like this across their lifespan, then why has it taken us so long to just start understanding the impact of hormones on women with ADHD?!
I’m back with posters! And I’m a little worked up!
ADHD in Women is Misunderstood and Underdiagnosed
Everyone knows that women’s emotions can be affected by their menstrual cycle. But here’s the thing: researchers are just now beginning to understand that for women with ADHD those fluctuations in estrogen levels have a magnified effect.
And we’re not talking that women with ADHD are a little more cranky. Look at this. The research shows that women with ADHD…
- Were almost twice as likely to experience severe PMS, aka PMDD 1
- Five times as likely to have postpartum depression 2
- And nearly 4 standard deviations 3 from the norm with perimenopausal symptoms. (In English that means perimenopause really, really sucks for ADHDers.)
Now, I was officially diagnosed with ADHD at age 41. And even then, a quarter of the way into the 21st century, no one told me that one of the reasons my emotions were so unpredictable and difficult to manage was because my ADHD is affected by my estrogen.
And why didn’t they tell me? It’s because medical training and research have been built around male bodies.
When women’s symptoms didn’t line up with the ADHD research, they were often dismissed as “in your head” or just anxiety. That dismissal meant that hormone research was misinterpreted or stalled for decades. We are literally decades behind where the science should be.
As a result, ADHD in girls and women is underdiagnosed, under-researched, and undertreated, despite the massive impact ADHD has on their mental and physical health.
Thankfully, we are just now getting the first stages of research to understand how hormones impact ADHD symptoms, and what that means for treatment options.
So in this video we’re going to explore the research on how hormones interact with ADHD across the lifespan, from puberty and the menstrual cycle, through pregnancy, and of course through perimenopause and menopause. We’ll also look at how fluctuating hormones change the way that ADHD meds get metabolized in the brain.
This is seriously life-changing. Ladies, as I read this research my mind was blown—so many things make sense for me now. So let’s look at what we do know and some things you can do to get your ADHD brain to work with your hormonal body, not against it.
How ADHD Women Hormones Connect: Estrogen
OK, so first, let’s explore what’s going on here. Why do hormonal shifts impact ADHD symptoms and contribute to so many other linked conditions like mood disorders, depression, anxiety, and substance abuse? Short answer: “Estrogen modulates dopamine, its synthesis, maintenance, and …degradation.” 3
Because of the research on male subjects, we already know that people with ADHD struggle with attention, motivation, executive function, memory, impulse control, and emotional regulation. Dopamine is a key neurotransmitter for those regulating functions, and ADHDers have lower or dysregulated levels of dopamine in their brain.
What we’re learning now is that Estrogen helps the dopamine signaling in the brain work more smoothly. So estrogen supports our ability to think things through, and use our braking system, and sort through multiple thoughts or tasks at once.
Check out my other video on ADHD and Emotional regulation to learn about the key role of executive function on emotion management.
Higher estrogen is linked to better attention and executive function, and this is true whether you have ADHD or not.
But when estrogen is low, or variable, that undermines the brain’s ability to efficiently use dopamine which leads to worse attention, memory, impulse control, and emotional regulation.
It’s one reason why when estrogen levels drop in perimenopause, women often experience brain fog.
So estrogen is really important to our ability to manage our lives and our emotions. But women don’t just have lifetime variations in our estrogen levels, it also varies every 28 days with our menstrual cycle. It even fluctuates between morning and nighttime.
Estrogen peaks during the second week of the menstrual cycle. Even neurotypical women were more hyperactive post ovulation. The study says that when estrogen levels drop in the second half of a woman’s monthly cycle, women experience worse attention, impulsivity and emotional regulation. These seem to have compounding effects for women with ADHD.3
Estrogen is also usually highest in the morning and decreases as the day goes on, which impacts ADHD symptoms and meds—we’ll come back to this.
OK, so ADHD makes your dopamine kinda weird, and estrogen levels make it even weirder. Great.
ADHD and Hormones: Lifelong Impacts
Let’s step back and see how ADHD affects female health throughout her lifespan.
Childhood
Let’s start with childhood.
Children with ADHD experience delayed development in their brain’s cortical thickness. Studies show that female children and adults with ADHD may experience more challenges with vocabulary, intellectual abilities, and visuospatial reasoning” while “…boys and men show worse response inhibition, cognitive flexibility, slower processing speed, and more deficits in motor functioning than girls and women. And because “most studies have been male-dominated”, the girls’ symptoms tend to be missed as ADHD.3
Not only are their symptoms different, but girls with ADHD are more likely to mask their symptoms and be more socially compliant. Masking their symptoms leads to girls with ADHD being diagnosed less frequently and later in life than males. And, get this, even when they are diagnosed, females are less likely to receive ADHD meds than boys.
On top of girls not receiving the same support for their ADHD as the boys get, without a diagnosis it can harm how they feel about themselves. They wonder, “What’s the matter with me?” or they feel bad, broken, stupid, lazy, etc. This helps explain why women have higher risks of co-occurring mental health diagnoses like depression and anxiety with their ADHD.3
Puberty
Moving on to puberty.
I really wish we had some good research about ADHD and the onset of female puberty (menarche). I found exactly two studies on this, one of which suggests that neurodiverse females start puberty later than their neurotypical friends. That study wasn’t ADHD specific, and the other study showed no difference between the two groups. Again, we need more research on our half of the population.
I started my period super late, but that was probably because I was exercising like four hours a day to manage my hyperactivity without meds or a diagnosis. And look, I still think my hyperactivity is a gift, but it would have been nice to have a name for it back then.
Regardless of when a girl begins puberty, once she does, it can really affect both ADHD symptoms and medication efficacy.
There are limited studies indicating that stimulant medication works better for some girls right before ovulation. This means girls might benefit from tailoring stimulant dosing to a monthly cycle instead of a static dose.4
And ADDitude magazine summarized another study:
“Compared to boys, girls report a stronger effect from short-acting methylphenidate earlier in the day, but it also wears off much sooner… Atomoxetine also appears to produce a greater effect on girls’ emotional regulation, hyperactivity, and impulsivity compared to boys.” 5
So, as girls move into puberty, the way their estrogen levels change daily and monthly directly impacts their ADHD symptoms and their ability to metabolize ADHD meds.
Also, when we look at stimulant medication during puberty, girls have different and more frequent adverse side effects, but we don’t know why or much about it.
This seems kinda important. We really need more research in this area.
Now let’s talk about sexual health
Sexual Health
“Women with ADHD are more likely to engage in risky sexual behaviours compared to non-ADHD women.” 3
There’s increased likelihood of…
- Earlier sexual activity
- Multiple or risky sexual partners
- Less frequent use of contraception
- Higher rates of STDs
- Unplanned and teen pregnancies. Women with ADHD are 6 times as likely to become mothers before age 20 than neurotypicals.
Why is this? Some risk factors include impulsivity and executive function deficits, like planning and thinking things through, as well as increased substance use.
On a separate note, females with ADHD have a higher likelihood of being victims of sexual abuse. And they’re also more likely to identify as gay or transgender than their non-ADHD peers. 3
Birth Control
Birth control for girls and women with ADHD is another important topic. IUDs may be better options for women with ADHD than pills. Not only do IUDs not require you to remember to take your pill every day, but oral contraceptives increase the risk of depression up to 5 times in women with ADHD.6
That would have been good for me to know a decade ago. Maybe doctors should start telling women about this!!!!!!!.
When I started birth control, I was crazy for the first week. Like, I was just crying for a week straight. I ended up changing to something else.
Pregnancy, Birth, and Postpartum
There are very few studies—4 to be exact—but they indicate that during pregnancy, women with ADHD experience more stress, depression, anxiety, and less social support than neurotypicals. They are more likely to continue smoking and drinking during pregnancy. They’re more likely to have birth complications including preeclampsia, c-sections, and premature births as well.
“Mothers with ADHD have a significantly higher risk (5–6 times) of developing postpartum depression and anxiety disorders.” 3 There are also mixed studies about the safety of using ADHD medication during pregnancy—so more research is needed!
Women with ADHD may experience elevated rates of polycystic ovarian syndrome (PCOS) (now called PMOS) and possibly premature (or primary) ovarian insufficiency (POI). Women with endometriosis have an increased risk of a later diagnosis of ADHD.
It might have to do with inflammation.
But we don’t really know how the uterus and ADHD are connected, because…more studies are needed.
Ok folks, now we’re onto the part many of you have been waiting for….drumroll please…perimenopause!!!
Perimenopause, Menopause and ADHD
When women go through perimenopause, the estrogen levels plummet. Many women experience memory and attention issues, sleep issues, mood swings, “brain fog”, difficulty making words, poorer cognitive functioning.
When estrogen decreases, the brain seems to also shrink in volume. And all of this seems to compound with the already present symptoms of ADHD in women.
While 30% of women in the general population experience debilitating perimenopause symptoms, that number is 54.2% for women with ADHD. 7
But these issues don’t wait until your late 40’s or 50’s. For people with ADHD, the most severe symptoms came TEN years earlier—between the ages of 35 to 39! 7
ADDitude magazine did a survey of nearly 4,000 women with ADHD to ask about the impact of perimenopause. More than 93% said they noticed a difference in the severity of some ADHD symptoms during perimenopause and/or menopause.
“70% of women said ADHD had a ‘life-altering’ impact in their 40s and 50s, with 50% of women calling their ADHD ‘extremely severe’. The most debilitating symptoms were procrastination and time management (79%), working memory problems (74%), feelings of being overwhelmed (72%), and greater disorganisation (70%).” 3
In contrast, less than 6% said ADHD had the biggest impact before age 20.
Interestingly, a lot of women who were never diagnosed previously get diagnosed during perimenopause.
One woman who was surveyed said:
“Everything flared up in perimenopause. I feel the worst I have ever felt, and my life is in disarray. I am unemployed, without a fixed address, lonely, anxious, depressed, and can’t think straight. I’ve turned my life, which appeared to be running well enough, into a blazing dumpster fire.” 7
A 52-year-old who was diagnosed with ADHD at age 50 said:
“In perimenopause, the brain fog and memory, inattention, distractibility, perfectionism, hyperactivity, and restlessness issues become progressively worse. I have always had these symptoms, but I was able to manage them with systems that I created for myself. My ability to manage them has declined significantly, and this makes these symptoms seem like they are the worst they have ever been.” 7
And not only are there biological changes contributing to your ability to function, but it’s also one of the most mentally heavy periods in a woman’s life because it’s when women are often managing their home and family, their career, their marriage, or their aging parents or in-laws.
It’s easy to see how ADHD plus menopause plus mental load often lead to the straw that breaks the camel’s back.
Treatment Options for ADHD in Women
OK, so what can we do about it? What options do we have?
Well, I’ll say this one more time: we need more research. But there are a few pieces of hope so far.
What about hormone replacement therapy for women with ADHD?
“While not for everyone, hormone replacement therapy (HRT) was the beginning of getting my life back. It gave my brain the biochemical support it needed to function again. As estrogen was restored and my nervous system began to calm, so did the touch aversion. The person who loved warmth and physical connection was not gone. Sleep, exercise, a protein-rich diet, and avoiding highly stimulating environments where possible are all meaningful supports alongside medical treatment.” 9
Biologically, it makes sense that estrogen supplementation could help ADHD symptoms. What about progesterone?
For some people, progesterone helps decrease anxiety and hyperactivity; for others it increases brain fog, fatigue, and procrastination symptoms. Progesterone alone is not shown to improve ADHD symptoms, but it may help sleep or anxiety in some cases. Estrogen supplementation has much more evidence of cognitive benefits.
Look, I am not a doctor, but if you’re a woman over 35 with possible ADHD, I encourage you to speak with a menopause-informed doctor.
What about tailoring medication for women with ADHD?
What about menstruating women with ADHD?
We know that PMS can be much worse than average for women with ADHD. What can we do about that?
- Start by tracking your menstrual cycle and your symptoms. You can use paper or a phone app to do this. Watch and note when ADHD is hardest. (Many people see a pattern in the luteal phase). I use Apple’s Health app and it gives me a little reminder about 5 days before my period starts. This helps me keep in mind that I might start to feel terrible about myself and everyone around me, and to be patient with myself.
- Consider adjusting your work or social calendar around your menstrual cycle. You might find that you’re able to do more mentally laborious work during the first half of your cycle, and need a bit more rest/gentleness towards the last week of your cycle.
- Adjust expectations of yourself (not just effort). If your brain is slower that week, pushing harder often backfires. Instead, simplify, reduce your load, and lower friction.
- Externalize executive function more during your luteal phase: more reminders, smaller steps, body-based activation.
- Plan demanding tasks earlier in the cycle. Use the follicular phase for big decisions, creative work, and complex planning.
As you track your cycle and gain more awareness of your cycle and your brain’s needs, you’ll find it’s easier to be compassionate towards yourself, and I think this can really help decrease some of the lows that come with ADHD and women hormones.
We Need More Research for Managing ADHD and Hormones
So hormones, and especially estrogen, really impact executive function and ADHD symptoms. We can’t treat women with a male-based ADHD model. We need more research focusing on understanding women and their needs, and we need to tailor treatment plans to our female bodies.
I’m happy to see that the tide is turning and a lot of new research is starting to come out. Also, some caution is needed.
There’s a growing trend online to blame everything on “low hormones”. That’s too simplistic.
- ADHD is primarily a neurodevelopmental dopamine condition.
- Hormones modulate it—they don’t cause or cure it.
- When we understand the unique way that estrogen impacts ADHD in women, we can get better at tailoring interventions like medication, hormone replacement, and behavioral strategies to really get women the specific help they need.
We don’t need to change women with ADHD. Instead the goal is to understand your brain in context and work with its patterns. And when you do that, it can make things a lot better.
I hope you found this helpful. I’ll link the studies and articles below, and if you’d like more support and education about how to manage your emotions, check out my membership. I’ve created a course there with 31 lessons and a workbook that will help you learn skills to process your emotions.
Sources
[1] Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. (2021) 133:10–5. doi: 10.1016/j.jpsychires.2020.12.005. https://www.sciencedirect.com/science/article/abs/pii/S0022395620311134?via%3Dihub ↩
[2] Andersson A, Garcia-Argibay M, Viktorin A, Ghirardi L, Butwicka A, Skoglund C, et al. Depression and anxiety disorders during the postpartum period in women diagnosed with attention deficit hyperactivity disorder. J Affect Disord. (2023) 325:817–23. doi: 10.1016/j.jad.2023.01.069. https://www.sciencedirect.com/science/article/pii/S016503272300085X?via%3Dihub ↩
[3] Kooij, J. J. S., de Jong, M., Agnew-Blais, J., Amoretti, S., Madsen, K. B., Barclay, I., Bölte, S., Skoglund, C. B., Broughton, T., Carucci, S., van Dijken, D. K. E., Ernst, J., French, B., Frick, M. A., Galera, C., Groenman, A. P., Kallner, H. K., Koerner, J. K. A., Kittel-Schneider, S., … Wynchank, D. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health, 6, Article 1613628. https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628/full
[4] 3 de Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: Premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194 ↩
[6] Lundin C, Wikman A, Wikman P, Kallner H, Sundström-Poromaa I, Skoglund C. Hormonal contraceptive use and risk of depression among young women with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. (2023) 62(6):665–74. 10.1016/j.jaac.2022.07.847 https://pubmed.ncbi.nlm.nih.gov/36332846/ ↩
[7] Wolkoff Wachsman, M. (2026, March 31). Study: Perimenopausal symptoms are more severe, begin earlier in women with ADHD. ADDitude. https://www.additudemag.com/perimenopausal-symptoms-women-adhd/
[8] Sharma, A., Davies, R., Kapoor, A., Islam, H., Webber, L., & Jayasena, C. N. (2023). The effect of hormone replacement therapy on cognition and mood. Clinical Endocrinology, 98(3), 285–295. https://pmc.ncbi.nlm.nih.gov/articles/PMC11497347/ ↩
[9] Pennington, K. (2026, June 16). ADHD and menopause: The perfect storm no one warned us about. ADDitude. https://www.additudemag.com/menopause-symptoms-neurodivergent-women/ ↩
[10] ADDitude Editors. (2025, June 23). ADHD impairment peaks in menopause, according to ADDitude reader survey. ADDitude. https://www.additudemag.com/menopause-symptoms-adhd-survey/ ↩
[11] Rapoport, I. L., & Groenman, A. P. (2025). A review of sex and gender factors in stimulant treatment for ADHD: Knowledge gaps and future directions. Journal of Attention Disorders, 29(8), 602–616. https://pmc.ncbi.nlm.nih.gov/articles/PMC12064863/ ↩
[12] Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders, 29(9), 706–723. https://pmc.ncbi.nlm.nih.gov/articles/PMC12145478/ ↩
