Whats the link? ADHD, Menopause, PMDD and Trauma

Is it ADHD, PMDD, menopause – or all three?
Many women spend years trying to understand their cycles of mood swings, brain fog, fatigue, and emotional overwhelm. Often dismissed as “just hormones” or misdiagnosed with bipolar or borderline personality disorder, thousands of women are only now discovering that ADHD has been part of their story all along.

In this evidence-based deep-dive, we explore the constellation of connections between ADHD, PMDD, and the menopause transition. From missed childhood diagnoses to the hormonal rollercoaster of perimenopause, this article unpacks the science, symptoms, and misdiagnosis patterns that leave so many women feeling confused, unsupported, and unseen by healthcare systems – especially in the UK.

💡 You’ll find:

• Up-to-date prevalence stats and scientific research
• Symptom overlap tables (ADHD vs PMDD vs Menopause)
• How hormone fluctuations impact ADHD
• Why so many women are misdiagnosed with BPD or bipolar disorder
• What the NHS is missing – and what women need instead
• A visual “constellation map” of the hormonal ADHD journey

This is essential reading for any woman in her 30s, 40s, or 50s who suspects there’s more behind her symptoms — and for professionals who want to understand how ADHD truly presents across a woman’s lifespan.

👉 Read the full article here…………It’s quite long, so buckle up!

ADHD, PMDD, and Menopause: Intersecting Challenges Across the Lifespan

Introduction and Background

Attention-Deficit/Hyperactivity Disorder (ADHD) in women has historically been under-recognised, with many females receiving diagnoses only in adulthood.

Recent data indicate that roughly 6% of adults have ADHD, and women are nearly as likely as men to be affected.

Notably, 61% of women with ADHD are diagnosed in adulthood, compared to 40% of men. This delay (averaging ~4 years later than males in one study) often means that women reach their 30s, 40s, or even 50s before their ADHD is identified.

During these years, women experience significant hormonal events – monthly menstrual cycles, pregnancies, and eventually perimenopause and menopause – which can all influence ADHD symptoms. Increasingly, researchers and clinicians are examining the entire hormonal trajectory of a woman’s life, from menarche (the start of menstruation) through menopause, to understand how ADHD and hormone-linked conditions like Premenstrual Dysphoric Disorder (PMDD) and menopausal symptoms interact.

Prevalence of ADHD in Women:

ADHD was once thought to affect far more boys than girls, but current evidence shows adult prevalence is nearly equal by gender. In the UK, for example, ADHD is estimated to affect about 5% of the population (1 in 20).

Diagnosis rates are rising sharply among women in recent years, partly due to greater awareness.

NHS data in England showed the number of women on ADHD medication tripled between 2021 and 2024, with the largest increase in women aged 25–40​ Similarly, the U.S. Centers for Disease Control (CDC) reported that over half of all ADHD cases are now diagnosed in adulthood and highlighted the need for formal guidelines for evaluating adult ADHD.

Many of these new diagnoses are women who were overlooked in childhood.

Factors contributing to missed or late diagnosis include the predominance of the inattentive subtype in females (which is less disruptive and thus less obvious), compensatory behaviours that mask symptoms, and a lack of historical research on females with ADHD. As a result, women have often gone without proper support until their symptoms became unmanageable, sometimes triggered by hormonal changes in midlife​.

Overlap with Hormonal Conditions:

Complicating the picture, many symptoms of ADHD overlap with those of PMDD (a severe form of premenstrual syndrome) and of menopause.

Women with ADHD frequently report that their attention, mood, and energy levels fluctuate along with their menstrual cycle or life stage​.

This can make it challenging to distinguish what is causing which symptoms.

For instance, is a late-40s woman’s forgetfulness and irritability due to perimenopause or long-standing (but undiagnosed) ADHD?

 Often, the answer is both.

Recent research confirms significant associations between ADHD and hormonally mediated conditions: in one study, women with ADHD were about 10 times more likely to report PMDD symptoms than women without ADHD.

Another assessment found 46% of women with ADHD experience PMDD, versus only about 3–9% in the general female population.

Likewise, nearly 58% of mothers with ADHD had postpartum depression symptoms, compared to ~15% of mothers overall. And during menopause, women with ADHD report notably higher rates of mood disturbances, cognitive difficulties, and other menopausal symptoms than their non-ADHD peers.

​These statistics underscore that the interaction between ADHD, PMDD, and menopause is not coincidental but correlated, likely through underlying hormonal mechanisms.

The sections below explore these relationships in detail, including symptom profiles, common misdiagnoses, biological underpinnings, and challenges in diagnosis and treatment (with a focus on women in their 40s and 50s).

Figure 1: Conceptual “constellation model” linking ADHD with hormonal life stages. ADHD symptoms in women may intensify or manifest during periods of hormonal change – notably the premenstrual phase (PMDD), the postpartum period, perimenopause, and menopause.

Symptom Profiles and Overlaps

A critical step in untangling ADHD, PMDD, and menopause is understanding their symptomatology and where those symptoms intersect.

The table below summarizes common symptoms of ADHD, PMDD, and menopause, highlighting areas of overlap (✓). As we will see, many cognitive and mood symptoms are shared among these conditions, which can lead to diagnostic confusion.

Symptom	ADHD	PMDD	Menopause
Inattention / “Brain fog”	✓ frequent (chronic poor focus)​mayoclinic.org	✓ during luteal phase (pre-period)​additudemag.com	✓ (“brain fog” common)​nhs.uk
Memory lapses / Forgetfulness	✓ (may forget tasks, appointments)​mayoclinic.org​mayoclinic.org	✓ (reported premenstrually)​additudemag.com	✓ (midlife memory issues)​nhs.uk
Mood swings / Emotional lability	✓ (rapid mood shifts, low frustration tolerance)​mayoclinic.org​mayoclinic.org	✓ (marked mood swings before period)​additudemag.com	✓ (changes in mood common)​nhs.uk
Irritability & Anger	✓ (hot temper, impatience)​mayoclinic.org​mayoclinic.org	✓ (heightened irritability premenstrually)​additudemag.com	✓ (common symptom)​nhs.uk
Anxiety or Tension	✓ (often co-occurs or linked to ADHD stress)​mayoclinic.org​mayoclinic.org	✓ (heightened anxiety pre-period)​additudemag.com	✓ (anxiety increases in peri/menopause)​nhs.uk
Depressed or low mood	✓ (possible chronic low self-esteem or dysthymia)​mayoclinic.org​mayoclinic.org	✓ (clinical depression in PMDD episodes)​additudemag.com	✓ (low mood can occur in menopause)​nhs.uk
Feeling overwhelmed / out of control	✓ (difficulty coping with stress)​mayoclinic.org​mayoclinic.org	✓ (common in PMDD – “feeling of overwhelm”)​additudemag.com	✓ (many feel life impacts of symptoms)​nhs.uk
Fatigue / Low energy	✓ (mental fatigue, especially from effort of focusing)​mayoclinic.org	✓ (common premenstrual symptom)	✓ (fatigue and sleep problems common)​balance-menopause.com​balance-menopause.com
Sleep disturbances	✓ (insomnia or restless sleep often seen)​additudemag.com	✓ (PMDD can cause insomnia or hypersomnia)​additudemag.com	✓ (night sweats and insomnia in menopause)​balance-menopause.com
Disorganization / Poor focus	✓ (hallmark ADHD symptom – disorganization, poor task follow-through)​mayoclinic.org​mayoclinic.org	✓ (possible in PMDD due to concentration difficulties)​additudemag.com	✓ (brain fog leads to organizational issues)​nhs.uk
Hot flashes / Night sweats	–	–	✓ (classic menopausal symptoms)​balance-menopause.com
Irregular or absent periods	–	✓ (PMDD occurs in context of menstrual cycles)	✓ (menopause defined by cessation of periods)​nhs.uk
Hyperactivity (fidgeting, restlessness)	✓ (especially in younger individuals; often becomes inner restlessness in adults)​mayoclinic.org​mayoclinic.org	–	– (not a feature; physical changes instead)
Impulsivity	✓ (impulsive decisions, interrupting, etc.)​mayoclinic.org​mayoclinic.org	–	–

Sources: ADHD symptoms from Mayo Clinic  ​mayoclinic.org​mayoclinic.org and other clinical descriptions; PMDD symptoms per DSM-5 criteria as summarised by Additude magazine ​additudemag.com​additudemag.com; Menopause symptoms from NHS and clinical literature ​nhs.uk​balance-menopause.com.

Overlapping symptoms (middle columns) demonstrate why ADHD in women can be mistaken for mood disorders or dismissed as menopausal/PMS-related issues. For example, “brain fog,” mood swings, and irritability appear in all three conditions.

A woman in midlife who reports these could be experiencing menopause – but if she has ADHD, those symptoms might be magnified beyond a typical menopausal experience. Likewise, cyclical bouts of anxiety, depression, and fatigue before menstruation (PMDD) may exacerbate underlying ADHD executive function problems, making each condition harder to manage.

It’s important to note that ADHD’s core features are lifelong and not inherently tied to hormonal timing: problems with attention, impulsivity, and (to a varying degree) hyperactivity are usually present since childhood.

​By contrast, PMDD symptoms are cyclic, emerging in the luteal phase (week or so before menses) and remitting when the period begins.

​ Menopausal symptoms typically onset in midlife as estrogen levels wane, and can last for several years around the menopause transition.

However, when a woman has ADHD, these hormonal factors can modulate the severity of her ADHD-related impairments.

Many women report that their ADHD felt manageable in youth, but became far more challenging in their 40s during perimenopause – a time when fluctuating estrogen can trigger memory issues, concentration trouble, and mood instability for anyone​ and even more so for those with ADHD. Similarly, anecdotal accounts tell of women whose undiagnosed ADHD was masked by coping strategies until they began experiencing pronounced premenstrual mood crashes (PMDD) or postpartum struggles, which finally led them to seek an ADHD evaluation.

Diagnostic Challenges and Common Misdiagnoses

Because of the overlapping symptoms outlined above, women with ADHD are frequently misdiagnosed with other conditions, or their ADHD goes unrecognised while attention focuses on mood symptoms.

Two of the most common misdiagnoses for women with ADHD are Bipolar Disorder (particularly type II) and Borderline Personality Disorder (BPD). All three conditions involve mood instability, impulsivity, and difficulty with emotional regulation, so distinguishing them requires careful evaluation of history and symptom context.

• ADHD vs. Bipolar Disorder: Bipolar disorder is characterised by episodes of depression and mania/hypomania, whereas ADHD is a continuous neurodevelopmental condition. However, both can present with erratic behavior, racing thoughts, impulsivity, and mood swings.
• Clinicians note that since ADHD is more common, bipolar symptoms in an ADHD patient can be overlooked; conversely, an ADHD patient might be incorrectly labelled as bipolar​. Harvard clinician Roberto Olivardia, Ph.D., points out that bipolar disorder is “often missed or misdiagnosed” in patients with ADHD due to the symptom overlap​,
• A key difference is that ADHD mood changes are often rapid and situation-triggered, whereas bipolar mood shifts last for weeks and have a more episodic pattern. Misdiagnosis in either direction is dangerous: treating someone for bipolar when they actually have ADHD can lead to unnecessary mood stabilisers while the core attentional issues remain untreated; missing bipolar in an ADHD patient could leave serious mood episodes unaddressed. Careful longitudinal assessment is required to parse these conditions​.
• ADHD vs. Borderline Personality Disorder: BPD involves chronic instability in emotions, self-image, and relationships, with intense episodes of anger, fear of abandonment, and impulsive self-damaging acts. Many BPD features (emotional impulsivity, anger outbursts, feeling “out of control”) resemble those of ADHD, especially ADHD with pronounced emotional dysregulation. In the past, “ADHD was rarely diagnosed in inattentive women,” so many women who presented with emotional volatility were mislabeled as BPD​.
•  One expert noted that many women living with ADHD have historically lived with a misdiagnosis of BPD​.  in part because their true condition (ADHD) wasn’t on clinicians’ radar for women.
•  It is true that ADHD and BPD can co-occur at times, and having ADHD increases the risk of developing BPD traits due to years of negative feedback and low self-esteem. But the treatment approaches differ markedly. The Devon NHS ADHD service explicitly warns that women with ADHD can sometimes be given a diagnosis of BPD or bipolar disorder or anxiety/depression by mistake, and that while these conditions may co-exist, the ADHD often “goes unrecognised” if clinicians attribute symptoms to the wrong disorder. This misattribution is unhelpful, as the patient is then not given ADHD-targeted support, potentially perpetuating her struggles.
• Other Misdiagnoses or Missed Diagnoses: Women with ADHD are also frequently diagnosed with anxiety or depression (which may be valid diagnoses but sometimes are only part of the picture). Chronic unmanaged ADHD can indeed lead to secondary anxiety and depressive symptoms – for example, a lifetime of missed deadlines and forgetfulness can produce anxiety, and repeated failures can breed depression.
• If a clinician treats the depression/anxiety without recognising the underlying ADHD, the woman may only partially improve. Additionally, some women internalise their difficulties, leading to an outward appearance of coping while they privately struggle; such women might never be evaluated for ADHD and instead are told they have “burnout” or menopause-related issues. The situation is compounded by the fact that historically, diagnostic criteria and screening tools were normed on males, and clinicians were taught to look for ADHD in hyperactive boys, not dreamy, overwhelmed adult women. This has begun to change, with expert consensus calling for better identification of ADHD in girls and women. The key is training professionals to differentiate ADHD from look-alike conditions. For example, ADHD-related anger tends to be reactive and remorseful, whereas BPD anger might be more prolonged and tied to fear of abandonment; bipolar mood changes have a distinct periodicity; perimenopausal cognitive complaints might be new-onset in midlife (whereas ADHD is lifelong). Such nuances must be explored during diagnosis. Ultimately, a comprehensive history that spans childhood to adulthood, and tracking symptoms in relation to hormonal cycles, will yield the most accurate diagnoses.

ADHD and Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder is a severe form of premenstrual syndrome characterised by debilitating mood changes, irritability, and other symptoms in the week before menstruation, resolving with the period.

Research has identified a strong link between ADHD and PMDD. Women with ADHD are far more likely to suffer from PMDD than women without ADHD.

One study of 209 women (aged 18–71) with ADHD found that 45% reported PMDD symptoms, a prevalence “about ten-fold higher” than observed in the general population.

Another report estimates up to 46% of women with ADHD have PMDD (versus roughly 3–9% of all women)​.

 This high co-occurrence suggests a meaningful connection between the two conditions.

Symptom Intersection: The overlap in symptoms is a major reason for the co-occurrence.

PMDD causes depression, anxiety, mood swings, anger/irritability, and cognitive difficulties (like concentration problems and feeling overwhelmed) in the luteal phase​, precisely the kinds of symptoms that can exacerbate ADHD.

A woman with ADHD might generally cope reasonably well, but during those days before her period, she could experience a dramatic worsening in focus and emotional control.

Conversely, having ADHD might predispose someone to more severe premenstrual symptoms: ADHD brains have dysregulated neurotransmitters (like dopamine and possibly serotonin), and they may be more sensitive to hormonal fluctuations​.

 One theory is that because people with ADHD have lower baseline dopamine activity, the natural drop in estrogen and progesterone premenstrally (which affects serotonin and dopamine levels) hits them harder, leading to PMDD symptoms where a neurotypical person might just feel mild PMS​.

 In short, ADHD may lower the threshold for tolerating the cyclic hormone-driven changes, resulting in mood dysregulation every month.

Evidence of Hormonal Impact: Emerging research supports this biochemical explanation.

Estrogen, a hormone that rises in the first half of the menstrual cycle and falls in the days before menstruation, has known effects on the brain’s serotonin and dopamine systems.

As estrogen levels fall sharply in the luteal phase, ADHD symptoms often worsen​. Women (even without ADHD) may notice more distractibility and irritability premenstrally; in women with ADHD, studies show clear patterns of cyclical symptom change​.

 In fact, clinicians have begun to respond to this by timing treatments around the cycle. A Dutch clinical team reported success in temporarily increasing stimulant medication doses in the premenstrual week for ADHD patients who have PMDD or PMS exacerbation of symptoms.

By doing so, they aim to compensate for the hormone-related dip in cognitive function. Other treatments for PMDD, such as selective serotonin reuptake inhibitors (SSRIs) or oral contraceptives, might also benefit ADHD women by smoothing out hormonal swings. There is ongoing research into specialised therapy groups for women with ADHD and PMDD – for example, a pilot program in the Netherlands combined psychoeducation on hormone effects with ADHD coping strategies, helping women chart their symptoms and validate that the premenstrual worsening is real and treatable.

Life Impact:

For women dealing with both ADHD and PMDD, the monthly rollercoaster can be devastating.

During one to two weeks of each cycle, they may experience severe impairment – difficulty concentrating (jeopardising work performance), profound depression or irritability (straining relationships), and physical symptoms like fatigue and pain.

Then symptoms lift after menstruation, only to recur the next month. Many such women have been mischaracterised as having recurrent depressive disorder or even bipolar disorder due to the cyclical nature of their mood symptoms.

Recognising the PMDD pattern is crucial. Treatment may involve a combination of ADHD medications, PMDD-specific treatments (like SSRIs in luteal phase), lifestyle adjustments, and therapy. The good news is that PMDD disappears after menopause (since menstrual cycles cease), but the bad news is that perimenopause can temporarily worsen the picture before that relief comes, as cycles become irregular, hormonal swings can become even more erratic, sometimes intensifying PMDD symptoms in the 40s. We turn next to ADHD in the context of perimenopause and menopause.

ADHD and Menopausal Transitions (Perimenopause & Menopause)

For many women, midlife (ages ~45–55) is a period of significant change: hormonally, the ovaries gradually produce less estrogen and progesterone, leading up to menopause (defined as 12 months without a menstrual period).

Perimenopause refers to the transitional years leading to menopause, when hormone levels fluctuate dramatically, and menopause is the time when hormone levels stabilise at low levels post-menopause. These changes can have pronounced effects on brain function and mood. Women often report symptoms such as hot flashes, night sweats, sleep disturbances, “brain fog” (memory and concentration problems), irritability, anxiety, and depression during this transition.

In women with ADHD, these menopausal symptoms don’t occur in isolation – they intersect with the pre-existing attentional and executive function deficits.

Worsening of ADHD in Midlife:

Clinical observations and patient surveys have consistently found that ADHD symptoms can intensify during perimenopause. In an ADDitude survey of nearly 5,000 women with ADHD, 63% of women aged 45+ said their ADHD had the greatest impact on their lives during perimenopause or menopause, far more than those who said adolescence or young adulthood were the hardest periods.

Moreover, 93% of respondents noticed a change in the severity of some ADHD symptoms during the menopausal transition.

The symptoms that these women rated as having a “life-altering impact” between ages 40–59 included: feelings of overwhelm (74%), brain fog and memory issues (74%), procrastination (66%), time-management difficulties (64%), inattention/distractibility (62%), disorganisation (61%), and emotional dysregulation (59%).

These are all classic ADHD issues – suggesting that the menopause transition brings ADHD to the forefront in a way that these women perhaps hadn’t experienced before. In contrast, less than 6% of women in that survey said ADHD impacted them most before age 20, highlighting how much more impairing the condition felt in midlife.

Physiologically, this makes sense. By about age 51 (the average age of menopause), estrogen levels have declined ~65% from pre-menopausal levels. Estrogen has a neuroprotective effect: it modulates neurotransmitters like serotonin and dopamine, which are critical for mood and attention.

As estrogen falls, the brain’s levels of serotonin and dopamine also drop. This can result in “moodiness, sadness, irritability, fatigue, fuzzy thinking, and memory lapses” during menopause – symptoms that sound remarkably like ADHD.

For a woman who already has ADHD, losing the beneficial effects of estrogen can be like “taking the brakes off” her symptoms. Many women report that they didn’t need ADHD medication or could compensate with coping strategies when they were younger, but once perimenopause hit, their usual strategies stopped working. Some even say that it felt like their ADHD appeared for the first time at menopause, when in hindsight signs were there in childhood but were milder.

Indeed, clinicians have documented cases where women first received an ADHD diagnosis in their late 40s or 50s because the menopausal exacerbation finally drove them to seek help​.

Menopausal Mood vs. ADHD Mood:

 It’s important to differentiate primary menopausal symptoms from ADHD, though they intertwine. Menopause can cause mood disturbances in anyone – for example, a 2024 study noted that perimenopausal women are 40% more likely to experience depression than premenopausal women.

Sleep problems from night sweats can cause daytime fatigue and poor concentration. These issues affect non-ADHD women too. However, researchers Nonacs et al. found that women with ADHD reported significantly higher levels of menopausal symptoms (especially anxiety, depression, and cognitive difficulties) compared to the normative population.

In their sample of ADHD women who were post- or perimenopausal, these patients had higher total scores on the Greene Climacteric Scale (a menopause symptom inventory), particularly on subscales for anxiety, depression, vasomotor (hot flashes), and sexual dysfunction, relative to typical menopausal norms.

This suggests that ADHD and menopause may have an additive effect: the hormonal changes might provoke more extreme symptoms in the ADHD population. Some experts describe it as unmasking or amplifying ADHD – e.g. “the fluctuating hormone levels have a big impact on ADHD symptoms”​– and thus what might be attributed purely to menopause could actually be an interplay of menopause with underlying ADHD.

Managing ADHD Through Menopause: Recognising this interaction, there are calls for tailored treatment during menopause.

Hormone Replacement Therapy (HRT), which is often used to alleviate menopausal symptoms by supplementing estrogen (and sometimes progesterone), may indirectly help with ADHD symptoms for some women by stabilising hormone levels. While robust studies are limited, clinicians note anecdotal accounts of symptom exacerbation during post-menopause and suggest considering HRT to see if it improves cognitive and mood symptoms.

In parallel, adjustments in ADHD medication may be necessary. A woman who previously managed on a low-dose stimulant might find she needs a higher dose or an additional non-stimulant to address executive dysfunction that emerged with menopause.

There’s also emerging interest in using ADHD medications for menopausal cognitive complaints, even in women without ADHD – small studies have shown that midlife women without ADHD experienced improved focus and memory on stimulant medication.

This hints at a broader principle: that the cognitive effects of estrogen loss resemble ADHD enough that ADHD treatments can help.

Each woman’s case is unique, of course. Multimodal treatment – combining medication, cognitive-behavioural strategies, lifestyle adjustments (sleep hygiene, exercise, diet) – is often recommended.

Support groups or therapy can also help women navigate the emotional changes of midlife. The menopause transition is temporary, but for some, it can be a difficult few years; ensuring their ADHD is optimally managed during this period can significantly improve quality of life.

Finally, it should be noted that after menopause, some women find their severe cyclical mood swings (like PMDD) disappear (since they no longer have cycles), which is a relief – but their baseline ADHD remains and may still require treatment.

Others might find that once the turbulence of perimenopause settles, they can slightly adjust their ADHD treatment again. In any case, awareness of the menopause–ADHD connection is now growing among practitioners, which is good news for women who have long felt that “something changed” in midlife and that their ADHD suddenly got worse.

 It wasn’t their imagination; we now understand it as a real, biologically driven phenomenon​.

Hormonal Fluctuations Across the Lifespan and ADHD

Considering the evidence, a clear picture emerges: hormonal fluctuations across a woman’s lifespan can significantly modulate ADHD symptoms.

From puberty through the postmenopausal years, hormone-driven phases present inflection points where ADHD may worsen or, in some cases, improve. Below is a brief tour of these phases and their interaction with ADHD:

• Puberty and Menarche: Puberty entails a surge of sex hormones (estrogen, progesterone in girls, along with others like growth hormone). Some research suggests that girls with ADHD may experience increasing challenges with emotional regulation once they begin menstruating, as the monthly hormone cycle commences​. One commentary noted the need to consider “times of hormonal change” – like puberty – in ADHD diagnosis and treatment for females. During adolescence, many girls with ADHD see a shift from primarily hyperactive symptoms (more common in childhood) to inattentive and internalising symptoms. The hormonal component is not fully understood, but clinicians are urged to keep an eye on ADHD symptoms around menarche. Unfortunately, due to under-recognition, many of these girls were simply labelled as moody or anxious teens rather than being evaluated for ADHD.
• Monthly Menstrual Cycles (Ongoing): Once regular cycles are established, cyclical ADHD symptom variation is a common report. As described earlier, the mid-cycle (when estrogen is high, around the ovulation time) tends to be a period of better focus and mood for women with ADHD, whereas the late luteal phase (premenstrual week, when estrogen and progesterone plummet) is often the worst time​.   Women have described this as feeling like a “fog rolls in” or their medication “stops working” in the days before their period, then lifts afterwards. For clinicians, a useful tip is to have women chart their symptoms daily for a couple of months – if a pattern of premenstrual spikes in ADHD symptoms emerges, it may indicate co-occurring PMDD or simply hormone sensitivity. This could justify treatments like those discussed (targeted SSRIs, temporary stimulant dose changes, or even birth control pills to stabilise hormone levels). The key point is that hormones can cause intra-individual variability in ADHD symptom severity, which is unique to females. Men do not experience anything analogous (though men do have other hormone fluctuations, they are not as pronounced or cyclic), and thus, earlier ADHD research largely ignored this factor. Now, however, the literature is catching up, and experts emphasise that “the impact of hormonal fluctuations can no longer be neglected in treating women with ADHD”.
• Pregnancy and Postpartum: Pregnancy leads to radically increased levels of estrogen and progesterone (especially in the third trimester, estrogen can be extremely high, then it abruptly falls after childbirth). Interestingly, some women with ADHD report feeling better during pregnancy – possibly due to estrogen’s boosting effect on dopamine and mood. However, after delivery, the postpartum period is another high-risk time for mood disorders (postpartum depression, anxiety) and possibly for ADHD symptom changes. As mentioned, ADHD women have a higher incidence of postpartum depression (PPD); in one retrospective survey, 57.6% of ADHD mothers had significant PPD symptoms (score ≥10 on EPDS), versus ~15% in general population. They were nearly three times more likely to experience postpartum depressive symptoms than typical mothers. This suggests that the withdrawal of hormones after birth might hit ADHD brains harder, or that the stress of caring for a newborn while coping with ADHD (disrupted routines, sleepless nights are particularly challenging for someone with ADHD’s need for structure) precipitates depression. Another consideration is medication management: women who stop their ADHD stimulants during pregnancy (to avoid any potential risks to the fetus) may experience a resurgence of ADHD symptoms that also contributes to depression. A study at Massachusetts General Hospital observed that pregnant women with ADHD who discontinued stimulant medication had higher rates of depressive symptoms during pregnancy than those who continued medication. Dr. Allison Baker (CWMH) is investigating how these women fare postpartum. For clinicians, being mindful of ADHD in the perinatal period is important – standard practice is to discontinue stimulants in pregnancy, but if doing so risks severe functional impairment or depression, this becomes a complex risk-benefit decision. Postpartum, once breastfeeding is established or if the mother is not breastfeeding, resuming ADHD treatment can be crucial not only for the mother’s attention but also her mood and overall ability to cope.
• Perimenopause and Menopause: This phase has been covered in depth in the prior section. To summarise here: perimenopause is characterised by erratic swings in hormone levels, and women with ADHD often report new or worsening symptoms in their mid to late 40s as perimenopause begins. Menopause itself (early 50s and beyond) leaves women with chronically low estrogen/progesterone. Some ADHD women describe menopause as a mixed bag – the absence of monthly hormone fluctuations is a relief (no more PMDD), but the permanently low estrogen can mean persistently more difficulty with focus and memory than they had pre-menopause. Hormone therapy can partially mitigate this, and some women find that after the transition, they adapt to the new baseline. The constellation model (Figure 1) illustrates how ADHD sits at the centre, with hormonal events like menarche, pregnancy, and menopause each exerting an influence. Not every woman will experience all these events (for example, not all women become pregnant, some may have early menopause, etc.), but the model provides a framework for anticipating when a woman with ADHD might need extra support or reevaluation of her treatment plan.

In summary, a woman’s ADHD symptom trajectory is not always linear; it can wax and wane with her body’s hormonal rhythms. This underscores the importance of a collaborative approach to care: patients tracking their cycles and symptoms, clinicians inquiring about hormonal status, and both working together to adjust strategies through the life stages.

An evidence-based understanding of these patterns can empower women, for instance, knowing that her extreme focus problems in the days before her period are not “personal failures” but a biological effect can be validating and lead to proactive strategies rather than self-blame.

Discrepancies in Diagnosis and Treatment: UK’s NHS vs. Global Context

Diagnosing and treating ADHD in women involves not just medical complexity but also systemic challenges. There are notable discrepancies in how different healthcare systems approach adult ADHD, and many women report struggles in getting proper care.

 In the UK, the National Health Service (NHS) has been under strain concerning ADHD services, especially given the recent surge in adult (and female) referrals. In contrast, other countries (like the US) have more established adult ADHD practices but still face gaps in addressing female-specific needs.

NHS Challenges:

 In the UK, demand for adult ADHD assessments has exploded. Clinics have reported 400% increases in referrals since 2020 for adult ADHD, largely driven by greater awareness and recognition in women. This has led many NHS trusts to close their waiting lists because they cannot cope with the volume.

Dr. Max Davie of ADHD UK noted in 2023 that services have been “swamped,” with waiting lists “through the roof” and “wildly inadequate services for ADHD diagnosis, particularly for adults”. Accurate waiting time data are hard to come by (NICE guidelines set no maximum wait for ADHD assessments), but there are reports of patients waiting years, some even 5 to 8 years, for an evaluation.

This delay can be critical for women in their 40s-50s who are suffering now. During such a wait, a perimenopausal woman could spiral into job loss or severe depression without support.

Many turn to private clinics despite the cost, or, unfortunately, some resort to self-medicating. The NHS has also faced criticism for not having enough specialists: “The NHS simply doesn’t have enough clinicians with appropriate training, experience and time to deliver good quality clinical work” in adult ADHD. This is gradually being recognised as a public health issue, as under-treatment of ADHD leads to higher costs in mental health, physical health, and social outcomes long-term.

Additionally, UK-specific barriers include a historical scepticism towards adult ADHD. Some commentators have dismissed the rise in diagnoses as a “fad” or accused patients of seeking labels or stimulant drugs.

This stigma is even more pronounced for women, who might be told they are “just hormonal” or “stressed, not ADHD.” The ADHD Foundation UK emphasises that

“Dismissing ADHD as a cultural construct and undeserving drain on finite NHS resources only adds to the enduring stigma and stereotyping” of those with ADHD.

Fortunately, advocacy is increasing.

Charities and patient groups have been vocal, and there’s a recent “Women with ADHD – Call to Action” in the UK highlighting that an estimated 423,000 girls under 18 have ADHD but are three times less likely than boys to be diagnosed.​

 Efforts are underway to develop better care pathways, but change is slow. The NHS has begun some initiatives (e.g., training GPs to recognize adult ADHD, creating integrated care pathways), but many women still feel left in limbo.

Global Comparisons:

Elsewhere, adult ADHD treatment is somewhat more accessible. In the U.S., while there is no unified health system, adult ADHD is widely recognised and there are many speciality clinics and providers.

The CDC’s recent inclusion of adult ADHD in their reports (with 6% prevalence noted) and professional organisations like APSARD calling for adult ADHD guidelines show progress.

However, even in the U.S., there is criticism that research and practice haven’t fully caught up to women’s needs. Until recently, clinical trials on ADHD meds had predominantly male participants, and issues like the menstrual cycle effect were not studied.

There is now a growing field of “women’s ADHD” research. For instance, the Netherlands (as seen in prior sections) is producing studies on hormone-related symptom changes and testing treatment adjustments.

In Australia, awareness campaigns are pointing out that many midlife women are being diagnosed with ADHD for the first time and that clinicians should differentiate ADHD from conditions like BPD or menopause (mirroring global findings)​.

 Some countries in Europe still have very restrictive attitudes to adult ADHD (in parts of Scandinavia, stimulant prescribing is tightly controlled), which can make treatment difficult for women who finally get a diagnosis.

One notable discrepancy in treatment is the approach to hormone therapy. In some countries, menopause is treated fairly aggressively with HRT if symptoms are present, whereas in others (including historically in the UK after the early 2000s) HRT was underutilised due to past safety concerns.

If a woman with ADHD in midlife is in a system where HRT isn’t offered, she might suffer more than her counterpart in a system where it is an option. Similarly, access to psychotherapy and coaching for adult ADHD varies; countries like the US have a robust ADHD coaching industry, while in the UK, one might only get medication without much psychological support due to NHS resource constraints.

The Need for Integrative Care:

Across the board, experts advocate for an integrative approach to women’s neurodiversity. A recent expert consensus on females with ADHD calls for clinicians to “consider women-specific issues, like times of hormonal change, in ADHD diagnosis and treatment.” This means in practice: asking women about their menstrual cycle, pregnancies, and menopause status during an ADHD assessment; providing guidance on managing PMS/PMDD as part of ADHD care; collaborating with gynaecologists or endocrinologists when needed; and educating patients on what to expect at different life stages. The consensus is that treating a woman’s ADHD in isolation from her hormonal context is incomplete care.

 In the UK’s NHS, this integrated model is not yet standard, but some speciality centres (like the Devon clinic that produced the guide we cited) are explicitly addressing hormone changes in their patient education. They note that historically, “hormonal fluctuations and changes [were] rarely considered when assessing females,” which likely contributed to underdiagnosis and misdiagnosis.

By contrast, the ideal model (perhaps something to work towards globally) is a constellation or whole-lifespan approach, where an ADHD specialist, a mental health provider, and a women’s health provider might collaboratively manage a patient.

For example, if a patient has severe PMDD and ADHD, a psychiatrist and gynaecologist might coordinate to ensure she has both her SSRI (for PMDD) and stimulant (for ADHD) optimised, and maybe add cognitive-behavioural therapy focusing on stress and organisation strategies around those tough premenstrual days.

In terms of statistics and research, we now have far more data in 2024–2025 than ever before, validating women’s experiences.

Large-scale studies are confirming that ADHD is not rare in women – in fact, adult women are one of the fastest-growing groups receiving diagnoses.

They also confirm comorbidities: for instance, a Swedish population study found individuals with ADHD had 19 times higher odds of having a BPD diagnosis than those without ADHD (underscoring the overlap of those two).

Another study noted adult women newly diagnosed with ADHD doubled in rate from 2020 to 2022, which likely correlates with the increased recognition of how ADHD can present in women (often less hyperactivity, more internal restlessness and emotional instability).

On the hormonal front, a 2021 study (Dorani et al.) formally documented the higher prevalence of PMDD and menopausal complaints in ADHD women, which we discussed. Ongoing trials are looking at whether stimulant medication dosages should be adjusted during different cycle phases or if non-stimulant ADHD meds might help specifically with emotional symptoms in perimenopausal women.

The bottom line for treatment is that a one-size-fits-all approach is outdated.

Historically, treatment guidelines made no distinction by sex; men and women got the same protocols. Now, there is a push to personalise care. This could mean timing dosing, adding hormone treatments, or simply providing more frequent monitoring during vulnerable periods. It also means training clinicians in women-specific presentations so that, for example, a woman in her 50s isn’t told her cognitive complaints are “just menopause” and sent away with HRT alone when she also has ADHD, or vice versa – treating only ADHD when maybe she also would benefit from HRT. Integrated care is admittedly in its early days, but the trajectory is toward improved outcomes as awareness spreads.

Conclusion

ADHD in women exists at a complex crossroads of neurology and endocrinology.

As this report has detailed, the intersections between ADHD, PMDD, and menopause form a constellation of influences that can shape a woman’s mental health across her life.

During adolescence, ADHD may be muted or missed, only for hormonal changes to amplify symptoms in cyclical patterns (PMDD) or at life transitions (perimenopause).

We have seen that prevalence rates of ADHD in women are higher than once thought, and a significant subset of women with ADHD also experience hormone-related conditions: nearly half have PMDD, and many face postpartum or menopausal mood challenges at rates well above the general population.

The symptom overlap among these conditions – from brain fog and forgetfulness to mood swings and fatigue – means women often suffer through misdiagnoses of bipolar disorder, depression, or personality disorders, while the root cause (or an important contributor) is untreated ADHD​.

Evidence-based correlations underscore that these overlaps are not just psychological but physiological.

Fluctuating estrogen and progesterone levels can modulate dopamine and serotonin in the brain, thereby affecting ADHD symptom severity​. This explains why an ADHD woman’s focus might falter premenstrally, or why she might experience a cascade of executive function difficulties in her late 40s.

It also offers targets for intervention – for instance, stabilising hormone levels or adjusting ADHD medication dosing at certain times.

Research is ongoing, but preliminary studies and clinical consensus suggest tangible benefits to such approaches​.

From a healthcare perspective, we have identified significant discrepancies in diagnosis and treatment standards.

The NHS in the UK, facing unprecedented demand from adult women seeking ADHD evaluations, is struggling with long wait times and limited specialised resources.

Many women spend years in diagnostic limbo or pay out-of-pocket for private assessments.

Globally, while awareness of adult ADHD (and female ADHD) is better in 2025 than ever before, there is still a gap in fully integrating hormonal considerations into practice.

The encouraging news is that this is changing: literature from 2020–2024 increasingly calls for “women-centered” ADHD care, and patients themselves are driving change by sharing their stories on social media and in support groups (the viral spread of #ADHD experiences on TikTok, for example, has reduced stigma and empowered women to seek answers​t).

In closing, a woman in her 40s or 50s today who suspects she has ADHD, perhaps because she notices her difficulties sharply during PMS or menopause, should be taken seriously and evaluated with a broad lens.

Her care team ideally will acknowledge all the facets: treating the “whole person” across her hormonal lifespan.

As the field evolves, we can anticipate more refined treatment algorithms (for example, specific guidance on managing ADHD during perimenopause) and better training so that clinicians don’t reflexively attribute a woman’s cognitive complaints to “just menopause” or her emotional volatility to “just PMS.”

The personal and societal payoff of getting this right is immense: proper diagnosis and treatment of ADHD (and its hormonal comorbidities) in women leads to improved mental health, more productive work life, better family relationships, and overall enhanced quality of life.

As the banner of a recent women’s ADHD health campaign stated, “We Demand Attention” – a play on words underscoring that women with attention deficits deserve attention from the medical community.

By bringing ADHD, PMDD, and menopause into the same conversation, as we have in this report, we move closer to that goal: ensuring no woman’s suffering is written off when it might be a treatable constellation of neurodevelopmental and hormonal factors.

References:

1. Dorani, F. et al. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. (Summary: Found high rates of PMDD, postpartum depression, and menopause symptoms in 209 adult ADHD women).
2. Agnew-Blais, J. (2024). Hidden in plain sight: delayed ADHD diagnosis among girls and women (Commentary on Skoglund et al. 2023). J. Child Psychol. Psychiatry, 65(10):1398-1400. (Notes ~4-year average diagnostic delay for women vs men and importance of considering hormonal change times in ADHD).
3. ADDitude Magazine (2024). Menopause, Perimenopause Research Needed for Women with ADHD. (Reported results of an ADDitude survey of 4,700 women; 63% said ADHD most impacted them during peri/menopause; details symptom severity in ages 40–59).
4. NHS Devon Partnership Trust (2024). Attention Deficit Hyperactivity Disorder (ADHD) and Women (Patient information booklet). (Provides insight into issues like misdiagnoses in women – e.g., BPD, bipolar – and the need to consider hormonal life events in assessment).
5. Littman, E. (2025). ADHD and BPD: Borderline Personality Disorder’s Link to ADD. ADDitude Magazine​additudemag.com. (Explains overlapping symptoms and historical misdiagnosis of women with inattentive ADHD as BPD).
6. Olivardia, R. (2025). The Physician’s Guide for Distinguishing Bipolar Disorder and ADHD. ADDitude Magazine​additudemag.com. (Provides clinical guidance on differentiating ADHD from bipolar, noting 20% comorbidity and frequent misdiagnosis due to symptom overlap).
7. Women’s Mental Health Blog – MGH (2020). Are Women with ADHD at Increased Risk for Hormonally Mediated Mood Disorders? by R. Nonacs. (Discusses a Dutch study where 45% of ADHD women had PMDD, ~58% PPD, and more menopausal symptoms, and cautions about methodology but acknowledges the trend).
8. Morales, T. (2024). PMDD, Autism, and ADHD: The Hushed Comorbidity. ADDitude Magazine​additudemag.com​additudemag.com. (Defines PMDD symptoms and notes up to 46% of women with ADHD have PMDD; also cites 3–9% general prevalence of PMDD and theories on why neurodivergent women are more affected).
9. Balance (2022). ADHD and the Perimenopause/Menopause (Balance-Menopause.com)​balance-menopause.com​balance-menopause.com. (Patient-facing article explaining how estrogen fluctuations in menstrual cycle and the estrogen crash in perimenopause affect ADHD symptoms; notes symptoms best during high-estrogen phase and worst premenstrually).
10. The Guardian (Jul 2024). Record numbers in England taking ADHD medication, NHS data shows by S. Marsh & C. Aguilar García​theguardian.com. (News report: ADHD medication use up 18% in one year, with biggest rise among women 25-40; number of women on ADHD meds tripled from 2021 to 2024).
11. The Guardian (Jan 2023). ADHD services ‘swamped’, say experts as more UK women seek diagnosis. (Highlights the surge in adult women seeking ADHD diagnosis, lack of capacity in NHS, some stats like 170k patients on ADHD meds in 2022; quotes experts on under-diagnosis and stigma).
12. NHS UK (2022). Menopause – Overview and Symptoms​nhs.uk. (Official health information site noting menopause/perimenopause symptoms including anxiety, mood swings, brain fog, hot flushes; symptoms can start years before periods stop).
13. Mayo Clinic (2023). Adult ADHD – Symptoms & causes​mayoclinic.org​mayoclinic.org. (Outlines common adult ADHD symptoms such as disorganization, poor time management, trouble focusing, restlessness, mood lability, hot temper, stress intolerance).
14. Halbreich, U. et al. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder. Psychoneuroendocrinology, 28(Suppl 3):1–23. (Classic study on PMDD prevalence ~5%; provides context that PMDD is much rarer than milder PMS)​additudemag.com.
15. Skoglund, C. et al. (2023). Delayed ADHD diagnosis in girls and women. J. Child Psychol. Psychiatry (as referenced in Agnew-Blais 2024 commentary). (Found that despite high mental health service contact, women get ADHD diagnosis ~4 years later than men, underscoring systemic delays).