Study: Perimenopausal Symptoms Are More Severe, Begin Earlier in Women with ADHD
More than half of women with ADHD experience debilitating symptoms of perimenopause compared to one-third of women without ADHD, finds a new population-based study.
November 20, 2025
Perimenopause begins up to 10 years earlier in women with ADHD, who report more severe perimenopausal symptoms than do women without ADHD.
This finding comes from a new population-based study published in European Psychiatry1 that found the highest prevalence of severe perimenopause symptoms occurred between the ages of 35 and 39 among women with ADHD and between the ages of 45 and 49 among women without ADHD.
Slightly more than half (54.2%) of women with a self-reported ADHD diagnosis experience debilitating symptoms during perimenopause (the period of years before menopause) compared to one-third of women without ADHD, the study reported.
“Our findings suggest a considerably higher symptom burden, including impairing psychological and somatic symptoms, among women with ADHD, compared to those without ADHD,” the researchers wrote. “These differences were most pronounced at age 35 to 39 years, suggesting an onset of perimenopause up to 10 years earlier in women with ADHD than in the average.”
The study examined data from 5,392 women, aged 35 to 55 years, who participated in the Icelandic Stress-and-Gene-Analysis (SAGA) cohort in 2018 and a follow-up survey in 2024. The researchers assessed perimenopausal symptoms using the Menopause Rating Scale (MRS). They found that women with a self-reported ADHD diagnosis encountered more physical symptoms, such as headaches and digestive problems, compared to women without the disorder. Women with ADHD also had higher MRS measurements in all perimenopausal symptom categories, including:
- somatic (hot flushes/sweating, heart discomfort, sleeping problems, and muscle and joint problems)
- psychological (depressive mood, irritability, anxiety, and tiredness)
- urogenital (sexual problems, bladder problems, and vaginal dryness)
Given the cross-sectional nature of measurements, the researchers could not confirm a causal relationship between ADHD and more severe perimenopausal symptoms.
“However, since ADHD develops in childhood, we could assert that the symptoms of the disorder precede perimenopausal symptoms in time,” the researchers wrote.
Impact of Hormonal Fluctuations During Perimenopause
Hormonal fluctuations in perimenopause could exacerbate existing ADHD symptoms or could lead to a diagnosis of previously unrecognized ADHD, the researchers also noted. In the study, about 8% of women without diagnosed ADHD, aged 35 to 44 years, reported having severe ADHD symptoms that decreased as they aged.
“We were unable to determine whether the women who had not been diagnosed with ADHD, but reported severe ADHD symptoms, had impairing ADHD symptoms in childhood, whether the symptoms emerged in later years, or what caused severe ADHD symptoms in these age groups,” the researchers wrote.
This is the first study assessing the differences in perimenopausal symptoms among women with and without ADHD. Emerging research and anecdotal reports have suggested that women with ADHD are more vulnerable to challenges before and after menopause.2, 3 “As estrogen vacillates wildly in perimenopause, many women find that their ADHD symptoms grow significantly worse,” says Lotta Borg Skoglund, M.D., Ph.D., an associate professor at Uppsala University in the Department for Women’s and Children’s Health and leader of the pioneering research group GODDESS ADHD.
In an ADDitude survey of nearly 5,000 women with ADHD, 63% of respondents aged 45 and older said ADHD had the greatest impact on their lives during perimenopause and menopause. (In contrast, less than 6% said ADHD had the biggest impact before age 20.)
More than 93% said they noticed a difference in the severity of some ADHD symptoms during perimenopause and/or menopause.
“Everything flared up in perimenopause. I feel the worst I have ever felt, and my life is in disarray,” wrote one respondent. “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.”
“In perimenopause, the brain fog and memory, inattention, distractibility, perfectionism, hyperactivity, and restlessness issues become progressively worse,” wrote a 52-year-old woman diagnosed with ADHD at age 50. “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.”
More recently, a systematic review published in Frontiers in Global Women’s Health found that hormonal fluctuations significantly impact the way ADHD symptoms present and progress across the female lifespan.4
More Research Needed on Perimenopausal Women with ADHD
The Frontiers in Global Women’s Health study also highlighted six significant gaps in scientific research that are crucial for improving the diagnosis and treatment of ADHD in women. It concluded that women with ADHD remain underdiagnosed, under-researched, and undertreated despite growing awareness of their unique challenges during hormonal changes across the lifespan.
“We need research investigating the role of hormones in ADHD symptom expression in girls and women,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD. “This research should examine hormonal levels across the reproductive lifespan, including puberty onset, menstrual cycle, pregnancy, postpartum period, and menopause, and post-menopause.”
“Whether it’s ADHD or perimenopause or ADHD and perimenopause, the impact of perimenopause and menopause on presentation of ADHD symptoms is an enormously unrecognized and important topic in global female health,” said Jeanette Wasserstein, Ph.D., during her 2023 ADDitude webinar “Hormonal Fluctuations and ADHD.” “We’re half the world, and this is a significant issue, and it should be recognized and addressed.”
Findings from the European Psychiatry study echoed the demands of other ADHD experts for more research on the impact of hormonal replacement therapy and/or stimulant treatment on the connection between ADHD and perimenopausal symptoms. The study also underscored the importance of developing guidelines for the treatment and care of perimenopausal women with ADHD.
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1Jakobsdóttir Smári, U., Valdimarsdottir, U.A., Wynchank, D., de Jong, M., Aspelund, T., Hauksdottir, A., Thordardottir, E.B., Tomasson, G., Jakobsdottir, J., Lu, D., Nevriana, A., Larsson, H., Kooij, S., Zoega, H. (2025). Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. https://doi.org/10.1016/j.jsbmb.2013.06.001
2Weber, M.T., Maki, P.M., & McDermott, M.P. (2014). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology. https://doi.org/10.1016/j.jsbmb.2013.06.001
3Dorani, F., Bijlenga, D., Beekman, A.T.F., van Someren, E.J.W., Kooij, J.J.S. (2020). Prevalence of hormone-related mood disorder symptoms in women with ADHD. J Psychiatr Res. https://doi.org/10.1016/j.jpsychires.2020.12.005
4Kooij, J.J.S., de Jong, M., Agnew-Blais, J., Amoretti, S., Bang Madsen, K., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., et al. (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. https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628
