ADHD, perimenopause and menopause

The short answer

Menopause does not cause ADHD. ADHD symptoms begin in childhood, and the diagnostic criteria require several symptoms to be present before the age of 12. However, menopause can make existing ADHD symptoms worse. Oestrogen supports dopamine and noradrenaline, two brain chemicals closely linked to ADHD, so as oestrogen falls, traits such as poor focus, forgetfulness and difficulty organising become harder to manage.

If you have new symptoms around menopause, speak to your GP. If you also recognise a pattern that goes back to your school years, an ADHD assessment can look at that. The free adult screening is a useful first step. A screening questionnaire is not a diagnosis.

How menopause can affect ADHD

The NHS describes perimenopause as the time when you have symptoms of menopause but your periods have not yet stopped. Females with ADHD, and females who later receive a diagnosis, often describe changes during this time such as:

• Focus and memory becoming noticeably worse, with more lost words, items and appointments
• Systems and routines that worked for years no longer working
• Feeling more easily overwhelmed, irritable or tearful
• Poorer sleep, which makes every other difficulty harder
• For those already on ADHD medication, a sense that it does not work as well as it did

The reason is chemical. Two neurotransmitters closely associated with ADHD, dopamine and noradrenaline (also called norepinephrine), rely on oestrogen for their uptake and activity in the brain. As oestrogen levels fall during perimenopause and menopause, that support drops, and ADHD symptoms worsen. How much this affects each person varies, which is why some females notice a large change and others very little.

Why menopause does not cause ADHD

ADHD is a neurodevelopmental condition, present from childhood. Many people are not diagnosed until adulthood, but when a clinician assesses an adult, they look for evidence that symptoms were present in childhood, and that they affect more than one area of life. Where difficulties seem to have started later, a clinician considers other explanations.

What can change at menopause is the balance between the demands on you and your ability to cope with them. Many females with undiagnosed ADHD have managed for decades through structure, effort and careful routines. If perimenopause disrupts sleep, mood and concentration at the same time, that balance can tip, and long standing traits become impossible to ignore. Our guide to ADHD in females explains why ADHD is so often missed until later life.

Menopause, ADHD or both?

The symptoms can overlap considerably. The NHS lists problems with memory and concentration, low mood, anxiety and sleep problems among the symptoms of menopause. Several of these can also resemble ADHD. Some questions that can help:

• Are the difficulties new? If you had no trouble with focus or organisation before, menopause is a more likely explanation.
• Do you recognise them from school? Daydreaming, lost homework or "could try harder" reports point to a longer pattern.
• Are there other menopause symptoms? Changes to your periods, hot flushes or night sweats suggest hormonal changes are involved.

Both can be true at once. Anxiety in particular can complicate the picture, and our guide to ADHD and anxiety explains how the two are told apart.

Talking to your GP about menopause symptoms

Your GP is the right first contact for menopause symptoms. NICE guideline NG23 sets out how menopause should be identified and managed, and your GP can discuss the treatment options that may suit you. To make the most of the appointment:

1. Keep a symptom diary for a few weeks, noting your periods, sleep, mood, memory and concentration.
2. Mention the effect on daily life, at work, at home and in relationships.
3. Say if you suspect ADHD, and whether you recognise the difficulties from childhood.
4. If your mood is low, or you have had thoughts of harming yourself, tell your GP, or call 111 and choose the mental health option.

When an ADHD assessment helps

An assessment is worth considering if, looking back, you can see a lifelong pattern of difficulty with attention, organisation or restlessness, and menopause has made it harder to manage. The clinician will look at your whole life rather than only recent changes, so old school reports, or a parent or sibling who remembers you as a child, can be very helpful. Our guide to adult ADHD assessment explains what is involved.

If you are already diagnosed and your medication no longer seems to fit, a review is a sensible step. ADH-Me offers a one-off medication appointment for £150 for people already taking ADHD medication. Stimulant and non-stimulant medicines are only one part of ADHD support, and medication is not right for everyone. Our guide to ADHD medication in the UK explains how reviews work.

If years of holding everything together have left you exhausted, our guide to ADHD burnout may also help.