For many women, ADHD doesn’t exist in isolation from their hormones.

Symptoms can shift throughout the menstrual cycle. Some women notice that their focus, motivation, emotional regulation or even their response to ADHD medication changes in the days before their period. And as hormones become increasingly unpredictable during perimenopause, those changes can become even more pronounced.

Now, new research suggests there may be another important piece to the puzzle: women with ADHD may experience symptoms of perimenopause earlier — and more severely — than women without ADHD.

And the age at which researchers saw the biggest difference may be surprising.

What did the study find?

The 2025 study, published in European Psychiatry, looked at 5,392 women between the ages of 35 and 55. Of those women, 535 reported an ADHD diagnosis and 4,857 did not.

Researchers compared perimenopausal symptoms between the two groups, looking at psychological symptoms, physical symptoms and urogenital symptoms.

The difference was substantial.

Overall, 54.2% of women with ADHD reported severe perimenopausal symptoms, compared with 30.1% of women without ADHD.

In other words, severe symptoms were about 80% more common among women with ADHD.

And it wasn't limited to one type of symptom.

Women with ADHD were more likely to experience severe:

• Psychological symptoms: 58.6% vs. 36.0%
• Physical symptoms: 30.4% vs. 13.9%
• Urogenital symptoms: 43.2% vs. 27.5%

The physical difference was particularly striking: severe somatic symptoms were more than twice as prevalent in women with ADHD.

But perhaps the most interesting finding wasn't simply that symptoms were worse.

It was when they appeared.

The biggest difference showed up in women aged 35–39

Among women without ADHD, perimenopausal symptom scores were highest between ages 45 and 49.

Among women with ADHD?

They were highest between 35 and 39.

In fact, the researchers found that the difference between women with and without ADHD was most pronounced within this youngest age group.

Women with ADHD aged 35–39 had an average perimenopause symptom score of 19.0, compared with 12.5 among women without ADHD.

Based on these findings, the researchers suggested that women with ADHD could begin experiencing perimenopausal symptoms up to 10 years earlier than average.

That's important because perimenopause is still commonly thought of as something that begins in your 40s.

For a 36-year-old suddenly experiencing worsening anxiety, disrupted sleep, brain fog, irritability or difficulty concentrating, hormones may not immediately be considered.

Instead, she may assume her ADHD has suddenly become harder to manage.

The reality may be more complicated.

Why would ADHD and perimenopause be connected?

We don't have a complete answer yet.

This study identified an association — it does not prove that ADHD causes earlier perimenopause or explain exactly why these women experienced more symptoms.

But there are some biologically plausible connections.

One of the most interesting involves estrogen and the brain.

Estrogen isn't just a reproductive hormone. It also plays a role in cognition, memory, mood and several neurotransmitter systems within the brain.

That includes dopamine — one of the major neurotransmitters implicated in ADHD.

This could help explain why some women with ADHD notice that their symptoms aren't consistent throughout the month.

Research cited by the study has found that ADHD symptoms can fluctuate alongside reproductive hormones, with some women reporting worsening symptoms — and even reduced effectiveness of stimulant medication — during the premenstrual phase, when estrogen levels are lower.

Perimenopause takes those hormonal fluctuations to another level.

Rather than estrogen following a relatively predictable monthly pattern, levels can begin rising and falling much more erratically.

For a brain that may already be particularly sensitive to changes in dopamine regulation, those hormonal swings could potentially make symptoms feel much more disruptive.

And the symptoms went far beyond focus

One of the important things about this research is that the differences weren't confined to cognitive or psychological symptoms.

Women with ADHD also reported significantly more physical symptoms associated with perimenopause.

These included symptoms such as:

• Hot flashes
• Sleep disruption
• Heart palpitations or increased awareness of heartbeat
• Joint and muscle discomfort
• Headaches
• Digestive symptoms
• Vaginal dryness
• Bladder symptoms
• Sexual discomfort

So while estrogen's effect on dopamine may help us understand why ADHD symptoms could change during this stage of life, it doesn't necessarily explain the entire finding.

There may be broader biological, psychological and lifestyle factors contributing to why women with ADHD experience this transition differently.

That's something researchers still need to understand.

Why this matters for women's healthcare

Women have historically been underrepresented in ADHD research. They've also historically been underserved when it comes to recognizing and treating perimenopause. Put the two together, and it's easy to see how women can fall through the cracks.

A woman in her late 30s may present with worsening anxiety, insomnia, difficulty concentrating, irregular cycles or changes in PMS and be told she's stressed. Her ADHD medication may be adjusted. An antidepressant may be discussed. Or she's simply told that her bloodwork is "normal." But if her symptoms have changed alongside her menstrual cycle, that's an important clue.

Hormonal changes shouldn't automatically be assumed to be the cause of every symptom. But they also shouldn't be ignored simply because someone seems "too young" for perimenopause.

For women with ADHD in particular, this research suggests clinicians may need to start having these conversations earlier.

The bigger picture

One of the themes emerging across women's health research is that reproductive hormones don't operate in their own isolated system. They interact with the brain, metabolism, mood, sleep and countless other physiological processes.

ADHD appears to be another area where that interaction may matter more than we've historically recognized. This study doesn't give us all the answers. But it does challenge one important assumption: that perimenopause affects all women at roughly the same age and in roughly the same way.

For women with ADHD, the transition may begin earlier. And when it does, it may hit harder.

Recognizing that connection could be the difference between spending years wondering why you suddenly don't feel like yourself — and understanding that there may be a hormonal component worth investigating.

Interested in understanding whether your hormones could be contributing to your symptoms?

At HorminaCare, we look beyond a single symptom or lab result to understand the broader hormonal patterns that may be influencing how you feel.

If you've noticed changes in your cycle, mood, sleep, energy or other hormone-related symptoms, you can book a free consultation with one of our licensed Nurse Practitioners to discuss what you're experiencing and whether further investigation may make sense.

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This article is for educational purposes only and is not intended to diagnose or treat any medical condition. Individual symptoms can have many possible causes, and treatment decisions should be made with a qualified healthcare provider.

Research reviewed: Jakobsdóttir Smári U, et al. Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. European Psychiatry. 2025;68(1):e133.