This article in Dr. Gunter’s The Vajenda newsletter focuses on the complicated and still under-recognized diagnosis of ADHD in the perimenopause population. The information is based on a lecture by Dr. Agnew-Blais, an epidemiologist from Queen Mary University in London, given at the British Menopause Society meeting in June 2025.
She comments on the prevalence of women struggling with ADHD symptoms in midlife, complicated by brain fog and other cognitive changes. At BRIA, we agree with Dr. Gunter that “ADHD is now being recognized as a lifelong condition that can be significantly impacted by hormonal fluctuations during, menstruation, postpartum, and yes, perimenopause and menopause”. In fact, we help with the assessment and treatment of ADHD symptoms, such as disorganization, lack of focus, forgetfulness, and impulsivity, which can often worsen around the week before menstruation (late luteal phase/ PMS time), postpartum, and throughout the menopause transition.
Dr. Gunter discusses the impact of ADHD symptoms, the association with other medical and mental health issues (including anxiety and depression), and why females are still underdiagnosed compared to males. Gender biases and a lack of studies on girls and women with ADHD remain an issue, especially around the vulnerable reproductive life stages.
Dr. Gunter goes on to discuss whether perimenopausal women with executive function or cognitive difficulties should be treated with a stimulant or menopause hormone therapy. The first objective would be to try to understand the underlying confounders of ADHD, such as poor sleep, vasomotor symptoms, or perimenopause brain fog.
At BRIA, we see many perimenopausal women with clinical depression or an anxiety disorder, both of which can present with executive function/ cognitive changes. Sometimes it’s an abundance of external stressors at this phase of life that leads to problems with concentration, motivation, and organization. Executive function therapy or individual psychotherapy can often be helpful to manage symptoms.
As a women’s mental health psychiatrist, I must emphasize the importance of treating any underlying depressive or anxiety disorders in addition to (and sometimes prior to) treating ADHD symptoms. Even though some studies show that stimulants like Lisdexamfetamine (Vyvanse) can be helpful for brain fog or other ADHD symptoms, these medications are not risk-free and can even be associated with worsening agitation, anxiety, or OCD symptoms.
Thank you, Dr. Gunter, for this thoughtful piece on ADHD and how it can worsen during perimenopause. It is important to remember that the cluster of symptoms can vary from person to person and may be exacerbated by other medical and mental health issues. Speaking to your primary care provider and getting an individualized assessment is helpful to get properly diagnosed, and to see which treatment is right for you.
