ADHD in Women

Falling Estrogen, Soaring ADHD: Menopause Care for Neurodivergent Women

Declining hormone levels can seriously aggravate your ADHD traits in perimenopausal and menopausal women. Here, learn how hormone replacement therapy can safely help.

By Jeanette Wasserstein, Ph.D. Updated on May 7, 2025
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The transition to menopause is, arguably, the most consequential stage of life for women with ADHD. Brain fog, moodiness, and memory loss are common complaints, along with overwhelm, time management difficulties, and emotional dysregulation.

Declining levels of hormones, especially estrogen, are to blame for the escalation of cognitive and physical symptoms that women with ADHD already experience leading up to menopause (when you’ve gone without a menstrual period for 12 consecutive months). Vaginal, sexual, and urinary symptoms are also common.

Collaborative Care

Your psychiatrist and gynecologist should collaborate to treat your symptoms of menopause and ADHD optimally. Your psychiatrist may need to adjust your ADHD medication regimen – the dosage or the formulation – to effectively treat changing ADHD symptoms as estrogen and progesterone decline. Ideally, your gynecologist would also consult with your psychiatrist about adding hormone replacement therapy (HRT) to help manage ADHD.

For women without risk factors such as breast cancer or diabetes, studies suggest that HRT can improve memory, attention, and cognitive function with benefits to sleep, muscle mass, and bone density.

The WHI Aftermath

In the early 2000s, the Women’s Health Initiative (WHI) released studies that revealed health risks associated with HRT, and many women and clinicians have feared it since. However, the WHI studies had serious limitations, including the use of a single formulation of estrogen, thought to increase risk of breast cancer.

[Get This Free Guide: ADHD Diagnosis for Women]

Subsequent studies and analyses of the WHI data have led to a better understanding of HRT, the benefits and risks of which depend on the type of HRT, age, dose, initiation and duration, and prior estrogen sensitive cancer, among other factors.

When to Start HRT

Generally, the earlier HRT is started relative to the onset of menopause, the better, and periodic re-evaluation is key. Women younger than 60 or within 10 years of menopause are ideal candidates for HRT, according to the North American Menopause Society (NAMS).

Other approaches to ease symptoms of ADHD and menopause, including hot flashes and insomnia, include cognitive behavioral therapy, exercise, and relaxed breathing techniques.

Doctor Visit Checklist

To gauge whether your providers are informed or open to learning about treatments for menopause and ADHD, ask these questions.

  • How knowledgeable are you about the impact of hormonal fluctuations, especially estrogen loss, on ADHD symptoms?
  • What are your thoughts on HRT? Am I a candidate for this treatment? Which other treatments and approaches might ease my menopause and ADHD symptoms?
  • What do you know about how hormonal fluctuations impact the therapeutic effects of stimulants?
  • How knowledgeable are you about the cognitive symptoms of menopause and how they overlap with ADHD symptoms?
  • How comfortable are you with reviewing patient-provided resources on ADHD and menopause?

Low Estrogen and ADHD: Next Steps

Jeanette Wasserstein, Ph.D., is a clinical assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York.

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