ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN PERIMENOPAUSAL WOMEN: THE IMPACT OF HORMONAL CHANGES ON SYMPTOM SEVERITY AND CLINICAL IMPLICATIONS – A LITERATURE REVIEW

Nicole Aleksandra Ordyczyńska-Mardyła; Anna Łęczycka; Kinga Haduch; Zuzanna Michalska; Izabela Zuzanna Stranz; Aleksandra Stańczyk; Olga Helena Chorąży; Joanna Strzelczyk; Iga  Suchta; Amelia Kędziora

doi:10.31435/ijitss.2(50).2026.5500

Authors

Nicole Aleksandra Ordyczyńska-Mardyła District Hospital in Chrzanów, Chrzanów, Poland https://orcid.org/0009-0007-1502-8291
Anna Łęczycka Independent Public Health Care Facility of the Ministry of Internal Affairs and Administration in Gdańsk, Gdańsk, Poland https://orcid.org/0009-0004-9068-5222
Kinga Haduch University Hospital in Kraków, Kraków, Poland https://orcid.org/0009-0004-4853-9395
Zuzanna Michalska Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre in Olsztyn, Olsztyn, Poland https://orcid.org/0009-0005-8775-102X
Izabela Zuzanna Stranz Ludwik Rydygier Provincial Hospital in Toruń, Toruń, Poland https://orcid.org/0009-0002-3689-0132
Aleksandra Stańczyk Clinical Hospital of the Ministry of Internal Affairs and Administration with the Warmia-Mazury Oncology Centre in Olsztyn, Olsztyn, Poland https://orcid.org/0009-0000-2356-7841
Olga Helena Chorąży Independent Public Healthcare Center Myślenice, Myślenice, Poland https://orcid.org/0009-0001-3094-2299
Joanna Strzelczyk Nicolaus Copernicus Provincial Multispecialty Center for Oncology and Traumatology in Lodz, Łódź, Poland https://orcid.org/0009-0006-8212-9431
Iga Suchta District Hospital in Proszowice, Proszowice, Poland https://orcid.org/0009-0005-5837-5790
Amelia Kędziora University of Warmia and Mazury in Olsztyn, Olsztyn, Poland https://orcid.org/0009-0001-8883-4370

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5500

Keywords:

Attention-Deficit/Hyperactivity Disorder (ADHD); Women; Perimenopause; 17β-estradiol; Dopamine

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a lifelong condition; however, the impact of the menopausal transition on its symptomatic trajectory remains significantly under-researched. In females, ADHD is frequently masked by compensatory mechanisms until midlife, leading to diagnostic delays. This review examines the neurobiological and clinical intersection between fluctuating ovarian steroids and ADHD pathophysiology.

Methods: A narrative synthesis of 20 selected scientific sources was conducted, incorporating neuroendocrinological reviews, clinical cohort studies, neuroimaging data, and qualitative research.

Results: Evidence indicates a "double whammy" effect from the convergence of neurodevelopmental dopamine deficiency and perimenopausal estrogen withdrawal. 17β-estradiol acts as a critical neuromodulator of dopaminergic and serotonergic systems, exerting neuroprotective effects on the prefrontal cortex. Its decline during perimenopause unmasks previously latent ADHD symptoms, exacerbating executive dysfunction ("brain fog"), inattention, and emotional dysregulation. Women with hormone-related mood disorders such as PMDD exhibit heightened vulnerability. Additionally, "diagnostic overshadowing" frequently occurs, whereby ADHD symptoms are misattributed to menopausal depression or anxiety. The analysis highlights the efficacy of lisdexamfetamine in mitigating cognitive deficits in this demographic.

Conclusions: The menopausal transition represents a period of significant clinical vulnerability for women with ADHD. Optimizing outcomes requires individualized, interdisciplinary strategies integrating stimulant pharmacotherapy with Hormone Replacement Therapy (HRT) and gender-sensitive psychoeducation. Future longitudinal research is essential to establish standardized clinical guidelines.

References

Antoniou, E., Rigas, N., Orovou, E., Papatrechas, A., & Sarella, A. (2021). ADHD symptoms in females of childhood, adolescent, reproductive and menopause period. Materia Socio-Medica, 33(2), 114–118. https://doi.org/10.5455/msm.2021.33.114-118

Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience, 9, Article 37. https://doi.org/10.3389/fnins.2015.00037

Bendis, P. C., Zimmerman, S., Onisiforou, A., Zanos, P., & Georgiou, P. (2024). The impact of estradiol on serotonin, glutamate, and dopamine systems. Frontiers in Neuroscience, 18, Article 1348551. https://doi.org/10.3389/fnins.2024.1348551

Bürger, I., Erlandsson, K., & Borneskog, C. (2024). Perceived associations between the menstrual cycle and attention deficit hyperactivity disorder (ADHD): A qualitative interview study exploring lived experiences. Sexual & Reproductive Healthcare, 40, Article 100975. https://doi.org/10.1016/j.srhc.2024.100975

Chapman, L., Gupta, K., Hunter, M. S., & Dommett, E. J. (2025). Examining the link between ADHD symptoms and menopausal experiences. Journal of Attention Disorders, 29(14), 1263–1277. https://doi.org/10.1177/10870547251355006

de Jong, M., Wynchank, D. S. M. R., Michielsen, M., Beekman, A. T. F., & Kooij, J. J. S. (2024). A female-specific treatment group for ADHD—Description of the programme and qualitative analysis of first experiences. Journal of Clinical Medicine, 13(7), Article 2106. https://doi.org/10.3390/jcm13072106

Del Río, J. P., Alliende, M. I., Molina, N., Serrano, F. G., Molina, S., & Vigil, P. (2018). Steroid hormones and their action in women’s brains: The importance of hormonal balance. Frontiers in Public Health, 6, Article 141. https://doi.org/10.3389/fpubh.2018.00141

Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005

Eng, A. G., Nirjar, U., Elkins, A. R., Sizemore, Y. J., Monticello, K. N., Petersen, M. K., Miller, S. A., Barone, J., Eisenlohr-Moul, T. A., & Martel, M. M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158, Article 105466. https://doi.org/10.1016/j.yhbeh.2023.105466

Epperson, C. N., Shanmugan, S., Kim, D. R., Mathews, S., Czarkowski, K. A., Bradley, J., Appleby, D. H., Iannelli, C., Sammel, M. D., & Brown, T. E. (2015). New onset executive function difficulties at menopause: A possible role for lisdexamfetamine. Psychopharmacology, 232(16), 3091–3100. https://doi.org/10.1007/s00213-015-3953-7

Haimov-Kochman, R., & Berger, I. (2014). Cognitive functions of regularly cycling women may differ throughout the month, depending on sex hormone status: A possible explanation to conflicting results of studies of ADHD in females. Frontiers in Human Neuroscience, 8, Article 191. https://doi.org/10.3389/fnhum.2014.00191

Jakobsdóttir Smári, U., Valdimarsdottir, U. A., Wynchank, D., de Jong, M., Aspelund, T., Hauksdottir, A., Thordardottir, E. B., Tomasson, G., Jakobsdottir, J., Lu, D., Nevriana, A., Larsson, H., Kooij, S., & Zoega, H. (2025). Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. European Psychiatry, 68(1), Article e133. https://doi.org/10.1192/j.eurpsy.2025.10101

Kooij, J. J. S., & de Jong, M. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health, 6, Article 1613628. https://doi.org/10.3389/fgwh.2025.1613628

Martel, M. M., Klump, K., Nigg, J. T., Breedlove, S. M., & Sisk, C. L. (2009). Potential hormonal mechanisms of attention-deficit/hyperactivity disorder and major depressive disorder: A new perspective. Hormones and Behavior, 55(4), 465–479. https://doi.org/10.1016/j.yhbeh.2009.02.004

Osianlis, E., Thomas, E. H. X., Jenkins, L. M., & Gurvich, C. (2025). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders, 29(9), 706–723. https://doi.org/10.1177/10870547251332319

Osianlis, E., Thomas, E. H. X., Li, Q., Bellgrove, M., May, T., Chapman, D., Kulkarni, J., & Gurvich, C. (2026). ADHD in females: Survey findings on symptoms across hormonal life stages. Journal of Psychiatric Research, 193, 208–215. https://doi.org/10.1016/j.jpsychires.2025.11.035

Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

Shanmugan, S., Loughead, J., Nanga, R. P. R., Elliott, M., Hariharan, H., Appleby, D., Kim, D., Ruparel, K., Reddy, R., Brown, T. E., & Epperson, C. N. (2017). Lisdexamfetamine effects on executive activation and neurochemistry in menopausal women with executive function difficulties. Neuropsychopharmacology, 42(2), 437–445. https://doi.org/10.1038/npp.2016.162

Wynchank, D., Sutrisno, R. M. G. T. M. F., van Andel, E., & Kooij, J. J. S. (2025). Menstrual cycle-related hormonal fluctuations in ADHD: Effect on cognitive functioning—A narrative review. Journal of Clinical Medicine, 15(1), Article 121. https://doi.org/10.3390/jcm15010121

Young, S., Adamo, N., Ásgeirsdóttir, B. B., Branney, P., Beckett, M., Colley, W., Cubbin, S., Deeley, Q., Farrag, E., Gudjonsson, G., Hill, P., Hollingdale, J., Kilic, O., Lloyd, T., Mason, P., Paliokosta, E., Perecherla, S., Sedgwick, J., Skirrow, C., ... Woodhouse, E. (2020). Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry, 20(1), Article 404. https://doi.org/10.1186/s12888-020-02707-9