Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that begins in childhood and can continue throughout adult life. It’s characterised by persistent difficulties with attention and/or hyperactivity and impulsivity that affect everyday life.
Adults with ADHD may experience difficulties with organisation, time management, working memory, regulating impulses, starting or completing tasks and maintaining attention. Emotional regulation and sleep difficulties are also common, although they're not required for an ADHD diagnosis.
It might seem like you hear about ADHD all the time now. And it’s true that ADHD is being diagnosed at higher rates now ever before – and at every age and gender. But this doesn’t mean that there are more people with ADHD – it’s just that they’re being assessed and diagnosed more. In Aotearoa, it’s estimated 1 in every 20 people has ADHD.
Partly this is down to a better understanding of ADHD. We now know that:
ADHD affects adults as well as children
ADHD isn’t only about hyperactivity
ADHD looks different in girls, women, and people assigned female at birth (AFAB)
ADHD often appears alongside other conditions, such as autism (but it’s only since 2013 that people can be diagnosed with both)
There’s also greater awareness – in the public and among clinicians – about ADHD and its symptoms. This means more people seek diagnosis, and more diagnoses are made.
All of this has meant that we’re now seeing more people diagnosed with ADHD who are also experiencing perimenopause.
It’s important to note that perimenopause doesn’t cause ADHD. For ADHD to be diagnosed, there must be evidence that symptoms were present during childhood, even if they weren’t recognised at the time.
We know that there are more people with ADHD symptoms who are currently experiencing perimenopause – or soon will be.
This is important because the fluctuating hormone levels that come with perimenopause can make ADHD symptoms more severe – and affect sleep, mood, concentration, and memory. These symptoms can overlap with ADHD and may make existing difficulties with attention, organisation, and emotional regulation harder to manage.
I chose not to take medication for my ADHD. Instead, I learned to manage the busy and make it work for me. But now that I'm in perimenopause, the brain fog is so bad and much more noticeable. I really struggle to think some days. I already had mood issues with my ADHD, but perimenopause has made me quicker to anger. On the plus side, sleep is actually better for me – I struggled to sleep before, but now I crash each night exhausted. I miss the old me and ADHD – and detest the brain fog and temper.”
Marie Jupp
Some women report that their ADHD medication feels less effective during perimenopause. However, research hasn’t yet established whether perimenopause consistently changes the effectiveness of stimulant medication or whether doses should routinely be adjusted. And not only can perimenopause exacerbate ADHD symptoms, but it may also unmask underlying symptoms.
Meanwhile, ADHD often exacerbates the symptoms of perimenopause. A 2025 study found that women with ADHD had more severe perimenopausal symptoms than those without.
Perimenopause and ADHD can be a double bind. Perimenopause can make ADHD symptoms worse – and ADHD can make perimenopause symptoms worse."
Katie McCullogh, Nurse Practitioner
There's also research indicating that women with ADHD are more likely to experience perimenopause earlier. And this is particularly important to be aware of, since women aren’t often prescribed hormone therapy if they’re considered “too young” – like in their late 30s to mid-40s.
Treating people with ADHD and perimenopause symptoms can be complex. Especially as women are often under diagnosed or undertreated for ADHD. And because there’s evidence people with ADHD are starting perimenopause earlier, we need to keep an open mind – and not discount hormone therapy from a younger age.
Managing perimenopause and ADHD can be complex. Treatment should be individualised and focus on the person’s main concerns. We should review ADHD symptoms, medication, sleep, mental health, and menopausal symptoms together – and agree on the person’s priorities for management.”
Katie McCullough, Nurse Practitioner
There is no single treatment plan that’s right for everyone. Assessment should consider:
the person’s menstrual pattern and menopausal symptoms
their lifelong history of ADHD symptoms and current functioning
sleep, mood, anxiety, and stress
possible physical causes of fatigue or cognitive changes
the benefits and side effects of current ADHD medication
cardiovascular health and other relevant health conditions
ADHD treatment and menopausal symptoms can be reviewed at the same time. ADHD medication may need to be assessed for effectiveness, duration of benefit, and side effects. Hormone therapy may be considered when someone has menopausal symptoms that are bothering them and it’s clinically appropriate.
Hormone therapy isn’t currently an established treatment for ADHD. However, when it improves hot flushes, night sweats, sleep or mood, some people may find that their concentration and ability to manage daily life also improve.
