How the menstrual cycle & perimenopause affect ADHD

Hormonal fluctuations throughout a woman’s life – during menstruation and perimenopause exacerbate symptoms of ADHD like inattention, while also increasing symptoms of depression and PMS.

Women with ADHD often experience a stronger, more sensitive response to hormonal fluctuations, all the while not knowing why. Women with ADHD often present with the ‘quiet’ form of ADHD, formally known as the inattentive subtype of ADHD.

Typically, people associate ADHD with loud, hyperactive boys, bounding off the walls. These kids are often spotted by teachers and healthcare professionals and are more likely to receive recognition for their condition early on.

However, how ADHD affects people is unique to them and there are many, less discussed presentations.

Studies show that women are more likely to be diagnosed with the inattentive form of ADHD, which is more subtle, and often missed. Women are also more likely to mask their neurodivergent symptoms to fit in with the neurotypical population. Studies show that women and girls are more likely to employ coping mechanisms which make their symptoms invisible – making up for underachievement or struggles keeping up with their peers in school or in their professional work.

Women’s ADHD symptoms are sometimes mistaken by clinicians for anxiety or mood disorders like depression or bipolar, due to overlapping symptoms, or because they have both conditions at the same time.

Progress in our understanding of ADHD has led to many more women being diagnosed with ADHD.

Though the numbers of women and girls diagnosed with ADHD are on the increase, boys are still 2-9 times more likely to be diagnosed.

Signs of undiagnosed inattentive ADHD

Instead of being physically hyperactive, you might find your traits turn inwards, presenting as:
-          A restless mind with  racing thoughts.
-          Stimming – subtle fidgeting like playing with your hair, doodling, or touching your mouth.
-          Looking spacey or zoning out when being spoken to.
-          Becoming easily stressed, slipping into fight or flight. Being neurodivergent in a neurotypical world is often a traumatic experience, which can affect your stress response.
-          Having trouble being on time.
-          An endless list of projects or tasks that have been started but left unfinished.
-          Misplacing belongings.
-          Sensitivity to hormonal changes, with more extreme symptoms of PMS.
-          Dopamine seeking, often through doomscrolling, or thrill or novelty chasing, like moving rapidly from hyperfixation on one hobby to another, or becoming overly fixated on a new romantic interest.
-          Periods of overachievement, followed by periods of burnout.

Common ways women mask ADHD

-          Working twice as hard, or for longer in order to appear organised
-          Having rigorous organisations systems at home to keep track of items
-          Having a routine – which can help calm the nervous system and reduce the chance of unpredictable outcomes – this may be common in those who have AuDHD (a combination of autism and ADHD) as people with autism often crave routine
-          Relying on stimulus to function – like caffeine, cigarettes, alcohol or sweets
-          Exercising before doing something which requires a lot of mental work
-          Making sure they get enough sleep, as insufficient sleep (common among the neurodivergent population) can exacerbate symptoms

Some of these coping mechanisms are more supportive than others. If you suspect you have undiagnosed ADHD, watch out for habitual overworking, as this can lead to ADHD burnout, which can be challenging to recover from. Find a middle ground in which you’re not oscillating between extremes of overwork and burnout.

Take note and seek support if you feel like you’re using substances for a dopamine hit so you can function - dependence on substances is common among those with ADHD.

Body doubling (working alongside someone else who is also focusing on their own tasks) can help those with ADHD complete tasks.

How women’s menstrual cycles affect ADHD

Oestrogen plays a critical role in ADHD as it influences dopamine and norepinephrine levels, which are key for motivation and emotional regulation.

During your luteal phase (the period after ovulation, leading up to your period) oestrogen starts to drop, which can lead to increased mood swings. Women might find they’re more easily triggered or irritated during this phase.

Oestrogen levels also drop during the mid follicular phase (between menstruation and ovulation) and after ovulation.

Studies have linked low oestrogen levels in ADHDers to increases in inattention and other symptoms of ADHD. Women with ADHD also reported more depressive symptoms in the mid-luteal and pre-menstrual phase. Studies have shown that women with PMDD are more likely to meet ADHD diagnostic criteria.

ADHD and perimenopause

When perimenopause arrives, for many women, it feels like a second round of puberty. Hormonal fluctuation can result in worsening brain function – leading to forgetfulness and being scattered in your thoughts, particularly when you have ADHD.

The worsening of cognitive symptoms may come sooner for women with ADHD, before their period becomes irregular.

A 2025 study on women’s perimenopausal symptoms found that women with ADHD had higher symptom scores than women without ADHD, scoring 18 and 13 respectively. The study also found that women with ADHD experienced more severe perimenopausal symptoms sooner in life. Between the ages of 35 and 39 they scored 19 points, compared to women without ADHD who scored less than 0.01 between those ages.

Why a diagnosis may help

In my practice, I often see women in their late 30s to early 40s who put off a diagnosis for years.

They often dismiss their symptoms as being overwhelmed, and trying to cope while being a full-time professional and / or busy Mom juggling a handful of things on a daily basis.

If you struggle to follow through with tasks, or notice you’re particularly volatile, or more depressed before your period or in the approach to perimenopause, it’s worth taking note.

Diagnosis of ADHD can help you clearly define what’s influencing your mood and cognitive function so you can move through life with greater self-compassion and more tools to support yourself.

Regardless of your diagnosis status, we can test your hormone levels to assess whether fluctuations could be affecting your cognitive function during the lead up to perimenopause.

References 
U Jakobsdottir Smari et al, Perimenopausal symptoms in women with and without ADHD: a population-based cohort study, 2025.
D Wynchank et al, Menstrual cycle-related hormonal fluctuations in ADHD: effect on cognitive functioning – a narrative review, 2025.
L Penning et al, Boys score higher everywhere? Gender differences in parent-reported ADHD symptoms across age groups and four countries, 2026.
P O Quinn, M Madhoo, A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis, 2014.