‘I thought I was fine, but now I’m barely functioning’: Why ADHD could be the hidden cause of overwhelm during menopause

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Feeling regularly overwhelmed should not be a fact of life. But according to a first-of-its-kind survey by ADHD magazine ADDitude, 70% of women described ADHD-related overwhelm as having a ‘life-altering impact’ in their 40s and 50s. 

One respondent to the survey described how ADHD symptoms became unmanageable once she entered menopause: ‘Age 40 was when I dropped all the plates I’d been struggling to keep spinning; the overwhelm and inability to cope reached a breaking point.’

Whether you’re diagnosed or not, you may have learned various coping mechanisms to be able to manage symptoms throughout your life – so why is it that, when menopause hits, they so often go out the window?

‘There can be a significant overlap with symptoms of perimenopause and menopause, which is one reason it can be difficult to distinguish between the two,’ says women’s hormone specialist, Dr Louise Newson.

‘A woman who has always misplaced her phone because of ADHD, for example, may find that brain fog in perimenopause and menopause means she is doing it much more frequently.’

‘Some women only recognise ADHD at this stage of their lives. Others start questioning whether they might have ADHD after their child receives a diagnosis, as there appears to be a strong genetic component to the condition.’

The hormone link between menopause and ADHD

When we reach perimenopause, fluctuating and falling hormone levels in women are responsible for more than just the reproductive system. There’s a complex relationship between them and the brain, too.

‘Menopause and perimenopause can feel so destabilizing because estrogen impacts dopamine,’ explains board-certified psychiatrist and ADHD clinical specialist Dr Sasha Hamdani.

‘Dopamine is the great regulator in the brain and aids in regulating mood, attention, motivation, and executive function. ADHD is already a condition of executive function and dopamine regulation, so when estrogen starts fluctuating or declining, the coping systems that used to work may suddenly feel inadequate.’

‘Many women describe it as, “I used to be able to do this and now I can’t.”’

Worsening ADHD symptoms in menopause

With the fall of estrogen, a whole host of ADHD-related traits can become gradually worse, leading many previously undiagnosed women to seek diagnoses. 

You may notice more forgetfulness, disorganization, brain fog, procrastination, time blindness, emotional reactivity, and difficulty finishing tasks; you may also become more irritible or more easily overstimulated, says Dr Hamdani.

‘For women who were never diagnosed, this can be especially confusing because they may have spent decades masking symptoms through perfectionism, anxiety, overworking, or very rigid systems. Perimenopause can make those compensatory strategies stop working, which is often when ADHD finally becomes visible.’

ADHD, menopause, and overwhelm

It’s understandable, then, that many women with ADHD find themselves overwhelmed during menopause. Not only are you dealing with the fallout from increasing ADHD traits, but you’re navigating new symptoms from menopause, too. 

According to Mayo Clinic, between 40 and 60% of women report having sleep problems during menopause, contributing to what Dr Newson calls ‘a double helping of the same symptoms.’

‘Poor sleep can make it harder to concentrate and cope, while brain fog and forgetfulness can make everyday tasks feel more difficult. For someone who has already been using a great deal of energy to manage ADHD symptoms, these additional challenges can become overwhelming. 

‘This is why it’s so important that women do not simply dismiss significant changes in how they are feeling or functioning as ‘just hormones’. They deserve to have their symptoms listened to and properly assessed.’

HRT + ADHD

There is currently a lack of research around whether HRT can directly help ADHD in menopause, though many find it helpful for menopause symptoms specifically.

‘Hormone treatment is the most effective treatment for symptoms of hormonal change,’ says Dr Newson. ‘In my clinical experience, when women with ADHD receive the right dose and type of hormones, many report improvements in symptoms such as brain fog, memory, cognition, mood and motivation. Treatment can include estradiol, progesterone and testosterone.’

Many recommend a combined approach to treating symptoms of ADHD and menopause, such as medication and HRT, cognitive behavioral therapy (CBT), lifestyle changes, and mindfulness, in order to tackle all areas effectively.

However, if you’re already taking ADHD medication, it’s important to discuss options thoroughly with your doctor and monitor your symptoms to make sure they don’t interact with hormone treatment or other medications.

You may also find it helpful to track your symptoms over time (such as sleep, cycle changes, mood, and focus), to see if any patterns emerge These may help your doctor to understand the whole picture more clearly and decide the most appropriate treatment, if and when you decide to speak with them.

‘A good evaluation should look at ADHD symptoms across the lifespan, not just what started in midlife, while also screening for depression, anxiety, trauma, thyroid issues, sleep disorders, and other medical contributors,’ concludes Dr Hamdani.