When it may be menopausal ADHD and when it’s not
Navigating the cognitive challenges during perimenopause that arise during perimenopause can be perplexing, especially when symptoms mirror those of attention deficit hyperactivity disorder (ADHD).
Both conditions can manifest as memory lapses, difficulty concentrating, and mental fog, leading many women to question whether they are experiencing a resurgence of ADHD symptoms or the cognitive effects of hormonal changes. This may be even more apparent now with ADHD awareness on the exponential rise but with high quality information on differential diagnoses lagging behind(2). Understanding the distinctions between these two conditions is crucial for accurate diagnosis and effective treatment.
Understanding ADHD: A Lifelong Neurodevelopmental Disorder
ADHD is a neurodevelopmental disorder characterised by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), several symptoms must have been present before the age of 12 and should be evident in two or more settings (such as home, school, or work). This early onset and pervasiveness across different environments are key diagnostic criteria.
In adults, ADHD often presents as difficulties with time management, organisation, sustaining attention, and emotional regulation. While some individuals may develop coping strategies that hide symptoms during earlier life stages, these strategies can become less effective during periods of significant hormonal changes, such as perimenopause.
Perimenopause and Cognitive Changes
Perimenopause, the transitional phase leading up to menopause, involves fluctuating and eventually declining oestrogen levels. Oestrogen plays a vital role in cognitive functions, including memory and attention. The narrative review ‘Menopause and Cognitive Impairment’ (2) highlights that the menopausal transition is associated with subtle cognitive decline, particularly in memory and attention domains.
These cognitive changes are often temporary and differ from the persistent symptoms of ADHD. However, the overlap in symptoms can lead to confusion and misdiagnosis. For instance, a woman experiencing memory issues and difficulty concentrating during perimenopause might be misdiagnosed with ADHD if her full medical and developmental history isn't considered.
Differentiating Between ADHD and Perimenopausal Cognitive Decline
To distinguish between ADHD and perimenopausal cognitive changes, consider the following:
Onset of Symptoms: ADHD symptoms begin in childhood, whereas perimenopausal cognitive changes occur later in life.
Symptom Consistency: ADHD symptoms are chronic and pervasive across various settings, while perimenopausal cognitive issues are often situational and may fluctuate with hormonal changes.
Response to Hormonal Changes: Perimenopausal symptoms may improve with hormone therapy or as hormonal levels stabilise post-menopause. ADHD symptoms typically require targeted interventions, such as behavioural therapy or medication. Generally the advice is to try hormones first and see what impairments are left. But this is an individual decision to be made with a physician.
It is essential for healthcare providers to conduct comprehensive assessments that include developmental history, symptom chronology, and the impact of symptoms on daily functioning. This thorough approach ensures accurate diagnosis and appropriate treatment planning.
The Importance of Accurate Diagnosis
Misdiagnosing perimenopausal cognitive decline as ADHD can lead to unnecessary medication and overlook effective treatments like hormone therapy or lifestyle modifications. Conversely, attributing lifelong ADHD symptoms to menopause can delay appropriate interventions that could significantly improve quality of life.
Healthcare professionals should be vigilant in differentiating between these conditions, considering the patient’s entire medical and developmental history. Educating women about the cognitive effects of perimenopause and the characteristics of ADHD can empower them to seek appropriate care and advocate for their health needs.
Conclusion
While perimenopause and ADHD share overlapping cognitive symptoms, their origins, duration, and treatment approaches differ significantly. Recognising these distinctions is vital for accurate diagnosis and effective management. Women experiencing cognitive challenges during perimenopause should consult with healthcare providers who can conduct comprehensive evaluations to determine the underlying cause and recommend appropriate interventions.
Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: A narrative review of current knowledge. World J Psychiatry. 2021 Aug 19;11(8):412-428. doi: 10.5498/wjp.v11.i8.412. PMID: 34513605; PMCID: PMC8394691.
Karasavva V, Miller C, Groves N, Montiel A, Canu W, Mikami A (2025) A double-edged hashtag: Evaluation of #ADHD-related TikTok content and its associations with perceptions of ADHD. PLoS ONE 20(3): e0319335. https://doi.org/10.1371/journal.pone.0319335