One of the persistent and unhelpful myths around ADHD is that it is a disorder of young males. There are clear differences in the rates of diagnosis of ADHD between males and females in childhood, with as many as nine males diagnosed for every female. In adults however, ADHD is found at almost equal rates in each sex. In adult-diagnosed ADHD, females tend to be older than males when diagnosis is made.
There are several reasons for the seemingly higher rates of ADHD in male children, including males being more likely to externalise their symptoms and exhibit overt behaviours, whereas females are generally better at developing coping strategies and ‘masking’, or hiding, their symptoms. Girls also tend to be less hyperactive and internalise their ADHD symptoms, and so get noticed less. Missed diagnosis of ADHD in females may occur when co-existing anxiety or depression is present as several symptoms of ADHD may mistakenly be attributed to that coexisting condition.
ADHD in adult women
The coping strategies that often lead to missed diagnoses as young females can start to fail however as they grow and start to face life’s challenges, such as university, employment and relationships. In addition, there are issues unique to females related to the effects of sex hormones on ADHD symptoms and response to treatment. The normal monthly changes in hormone levels, and major hormonal changes such as puberty, pregnancy, perimenopause and menopause can significantly impact ADHD symptoms.
The reason for this is that oestrogen, the primary female sex hormone, regulates the levels of the brain chemicals such as dopamine which do not work as effectively in ADHD. Clinical research has shown that attention and ‘executive thinking skills’, such as planning and working memory, can improve when oestrogen levels are higher but that ADHD symptoms can worsen when oestrogen levels are lower.
Around perimenopause and menopause, when oestrogen levels change significantly, symptoms like ‘memory fog’ and difficulty focusing occur, which can be even more difficult for women with ADHD.
Managing ADHD and hormonal changes
There are practical steps which can help women who have to deal with the dual challenge of menopause and ADHD symptoms. These include:
- Keeping a symptom diary to track your symptoms on a daily basis.
- Speaking to your GP about whether you need a referral for an assessment for ADHD.
- Discussing your hormonal changes with your GP. There are blood tests which can help identify if you are either perimenopausal or menopausal. It might be recommended that you have access to hormone replacement therapy (HRT) if appropriate.
- Leading a healthy lifestyle, including getting regular exercise and eating a healthy diet
- Learning more about both ADHD and menopause, and how they affect your everyday life (known as psychoeducation)
How treatment can help
ADHD can be effectively treated once diagnosed, through medication and/or psychotherapy. Treatment of ADHD with medication can improve the symptoms which both ADHD and menopause share, and have a positive impact on everyday tasks. Equally, where appropriate, accessing HRT to help stabilise hormonal levels can help out with some of the shared symptoms of menopause and ADHD.
The relationship between hormones, ADHD symptoms and stimulant medication commonly used to treat ADHD can be complex, and there is evidence that the stimulant medications used to treat ADHD, such as Vyvanse, actually improve executive functioning in healthy menopausal women, and that the latter, as shown by neuroimaging, activates executive brain networks. These findings suggest that some women may benefit from ADHD medication to treat cognitive impairments during menopause. on functioning during key times of hormonal change
If you already have a diagnosis of ADHD and find that hormonal changes impact how your medication works, talk to your doctor, as changes to dose or even type of ADHD medication can be offered, as well as psychotherapy if needed.
This article was edited on 24/1/2023.
Fantastic information. Is so helpful to read a text that brings inforamtion I coud not think of, such as menopause and ADHD – which is my case. Knowledge together with medicine can work very well. Thanks!
Hi Maria – It is always really gratifying to know that our blog articles have been helpful. We know that so many women are struggling with ADHD, and we are working to make more information available on this topic. We will shortly be launching a Resources page on our website, and this is a topic that we will definitely be visiting.
Interesting article, thank you. I am slightly confused by Strattera being described as stimulant medication, though, as the active ingredient Atomoxetine is a non-stimulant as far as I know.
Hi Taria – Thank you for getting in touch. This was an error in editing and the article has been updated. Atomoxetine is indeed a non-stimulant and we are grateful that you spotted this.
I’m interested to know what is known about how HRT impacts the efficacy of stimulant medications, and vice versa. Has anyone done any studies yet on this? I would like to know if it is just Oestrogen or if Progesterone and Testosterone have impacts on medication and vice versa?
Hi Rachael – This is a great question. Whilst there is very little or no research into the effects of HRT on ADHD symptoms, individually there is limited evidence that Oestrogen can decrease ADHD symptoms (in some) and Progesterone and Testosterone can increase symptoms of ADHD (in some). However, more research is needed to clarify this.
Ended up here while looking for answers to exactly the question of HRT as (temporary) off-label treatment for ADHD symptoms. As there’s a wait list for ADHD assessment and thus medication where I am, I’m hoping my GP will agree to give me HRT for cognitive symptoms even though I have no need for it for any other reason (luckily). Some sort of renewed bleeding/spotting seems a small price to pay to get some of my EF back if that is an option.
Very interesting, there is just one sentence which I find a bit confusing: “…and there is evidence that the stimulant medications used to treat ADHD, such as Vyvanse or Strattera actually improve…”.
As far as I know Strattera is NOT stimulant medication.
Hi Dina – Thank you for getting in touch. This was an error in editing and the article has been updated. Strattera is indeed a non-stimulant and we are grateful that you spotted this.
Yes, I agree we have our issues, until we come to the point where we can discuss these issues we will continue to suffer in silence. This is something I am no longer prepared to do, women have issues that are unique to men with one thing in common we are women with different needs – we have to start to embrace ourselves as women irrespective of ADHD. Very enlightening and encouraging to read. Like Knowledge and medicine can work well.
Very encouraging. I find myself in this position now – just receive adhd diagnosis at age 44 as I head towards peri M.
Very interesting article. I am 49 and diagnosed with ADHD. About 10 years ago I was having flooding and due to this I had the coil fitted- I wish I had done this decades ago. Over the past two years, I have noticed an increase in my ADHD symptoms as well as an increase in facial hair, night sweats, emotional dysregulation, etc. Because of the coil ( I have no bleeding with the coil so cannot use the increase/decrease of bleeding as a signifier of perimenopause), my female GP pushed back on my experience of feeling as though I was peri-menopausal. Six months later I returned to my GP to insist that we discuss HRT. I was asked to do blood tests (which came back fine), blood pressure tests and because I mentioned sporadic bleeding she has referred me to a gynaecologist. The wait to see a gynaecologist is 2 YEARS! And so I sit with worsening symptoms that are drastically impacting my life- both professionally and personally. It is incredibly frustrating and I worry about the long term impact.
Hi Suzanne – Thank you for getting in touch, and for sharing your experiences. This is always helpful for other readers who may be experiencing similar symptoms/issues.
It may be worth you referring your GP to the NICE guidelines. For women who are over 45 who are experiencing perimenopause or menopause symptoms, they should not be relying on test results