This new research can lead to better support
ADHD is known to affect women differently, not only through different traits, but also symptom patterns that move with the menstrual cycle and fluctuating hormones. We already know that core symptoms are exacerbated during the premenstrual phase, and some reports even show decreased efficacy of ADHD medication in this phase.
So then what happens during perimenopause, as estrogen and progesterone levels start to swing and plummet. Do symptoms start to disappear? Do they get worse?
Up until this year, research into ADHD and perimenopause has been practically non-existent. But it’s now moving. We’re going to dive into the following picture that is emerging from the research, and explain how this can lead to better care.
Two experiences tend to happen simultaneously:
1. Perimenopause symptoms are worse for many women with ADHD, and perimenopause can also arrive years earlier.
2. ADHD-specific symptoms can worsen as hormones become more erratic during perimenopause.
New Study: Perimenopause is More Severe when you have ADHD
In a 2025 population-based cohort study in Iceland, researchers followed 5,392 women aged 35 to 55 (1).
They saw that women with ADHD had significantly higher total perimenopausal symptom scores on the MRS (Menopause Rating Scale) compared to those without ADHD. The prevalence of *severe level* perimenopause symptoms was higher in ADHD: 54% of women with ADHD showed this, compared to 30% in women without ADHD. And this was consistent across all symptom categories:
◉ Somatic (hot flushes/sweating, heart discomfort, joint pain, sleep problems): 30.4% with ADHD had severe symptoms, vs 13.9% without ADHD
◉ Psychological (depressive mood, anxiety, irritability): 58.6% vs 36.0%
◉ Urogenital (bladder issues, vaginal dryness): 43.2% vs 27.5%
The pattern held for general physical health too. Women with ADHD were nearly twice as likely to report severe physical symptoms overall (1). Whatever perimenopause does to the body, it appears to do it more forcefully when ADHD is part of the picture.
Interestingly, in another study, women with ADHD reported nearly 3x higher rates of using HRT than the non ADHD groups (2). This could reflect just how severe their symptoms are becoming, so they were more likely to seek treatment.
And when looking into descriptions of lived-experience in another interview study, women with ADHD described perimenopause as “hitting like a punch in the face” (3).
Could perimenopause Start up to a Decade Earlier in ADHD?
In women without ADHD, perimenopausal symptoms peaked between 45 and 49, roughly where you would expect. In women with ADHD, the perimenopause symptoms peaked at 35 to 39 years old (1). That’s a decade earlier than women are told perimenopause starts.
It means a woman with ADHD could be dismissed as "too young for perimenopause" throughout her mid-late thirties, that she’s “just stressed”, precisely when she needs correct support. She’s left to figure it out alone, during a transition that can be completely life altering.
This finding aligns with genomic evidence linking ADHD to earlier menopause (1). Research hasn’t uncovered mechanisms behind the earlier onset yet, and it isn’t everyone’s experience. However, if this connected some dots for you - you are not imagining it.
Why This Research Matters
Firstly, it can raise awareness amongst healthcare professionals regarding the more severe experience, and that it can start earlier, and help women be taken seriously. Secondly, authors are calling for proper clinical guidelines for the treatment and care of perimenopausal women with ADHD, including tailored interventions to address unique needs.
ADHD Exacerbation Runs Alongside This
In surveys of 1500 and 5000 women with ADHD from ADDitude, 94% said their symptoms grew more severe in perimenopause and menopause, and 63% said that ADHD had the greatest impact on their lives during this time (4). One participant describes her experience of this overlap:
“I feel the worst I have ever felt”
Why does this happen?
ADHD is closely tied to disruptions in the dopamine system, the network involved in reward, motivation and attention. In ADHD, there is less dopamine available to carry messages between brain cells, which is what makes sustained focus, impulse control, emotional regulation, and getting started on tasks so difficult.
Estrogen and dopamine are tightly connected. Estrogen has positive effects on dopaminergic signalling through modulation of receptor expression, making it easier for dopamine to act. It enhances dopamine neurotransmission in brain regions crucial for cognitive function like the prefrontal cortex (5).
Estrogen parallels dopamine. Studies show that high estrogen phases enhance dopaminergic activity, but low estrogen can lead to reduced dopaminergic signaling, relating to attentional and cognitive impairments. This is why the drop in estrogen before your period can make symptoms roar, and it’s also why the decline in estrogen during perimenopause can make them roar chronically and unpredictably.
For an ADHD brain that already runs on a reduced dopamine supply, this link to estrogen is the problem. A woman without ADHD may have enough baseline dopamine to absorb the drop in estrogen. A woman with ADHD often does not. As estrogen declines through perimenopause, the support that helped hold attention, memory and emotional regulation together starts to come loose, and symptoms that were once just about manageable - can become overwhelming (1,2,3,5).
Where Saffron Extract Fits In
One supplement ingredient that has been studied across several of the systems involved here is saffron extract. We usually talk about the evidence in PMS and PMDD but there is also evidence sitting at an interesting intersection of ADHD and perimenopause.
For ADHD, saffron extract has been tested in several randomised controlled trials and shown benefit compared to a placebo. In adults, adding saffron extract to methylphenidate (Ritalin) improved ADHD symptoms more than ritalin alone, without increasing side effects. Saffron extract may be useful both on its own and alongside existing medication (6).
For perimenopause, a 12-week randomised controlled trial, 86 perimenopausal women aged 40 to 60 received either a placebo or 28mg of saffron extract daily (7). The saffron group experienced a significant reduction in mood symptoms compared to placebo: a 33% reduction in anxiety and a 32% reduction in depression, with significantly lower negative affect, including feelings of stress, hostility and nervousness.
Many women in the community also report to us that HRT helped them, and if this is something you’re thinking about, it is worth a conversation with your doctor.
The Takeaway
Right now, women are navigating two under-researched conditions colliding at one, often with no road map. We hope that this new research into ADHD during perimenopause can begin to change that. It’s new, and there is still a great deal still to learn about how best to support women through it, but this is the start and we’re hopeful the shift from research into clinical practice will follow soon.
References
1. Jakobsdóttir Smári U, Valdimarsdottir UA, Wynchank D, de Jong M, Aspelund T, Hauksdottir A, Thordardottir EB, Tomasson G, Jakobsdottir J, Lu D, Nevriana A, Larsson H, Kooij S, Zoega H. Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. 2025 Sep 4;68(1):e133. doi: 10.1192/j.eurpsy.2025.10101. PMID: 40903825; PMCID: PMC12538516.
2. Boyd, C., Wrigley, M., Kilbride, K. et al. ADHD and the female reproductive stages: menstruation, perinatal and menopause. Arch Womens Ment Health 29, 89 (2026). https://doi.org/10.1007/s00737-026-01718-x
3. Kini-Seery C, Trevaskis S, Kilbride K, Wrigley M, Bramham J. “Hormones rule me”: A qualitative exploration of the impact of perimenopause on women with ADHD. Women’s Health. 2026;22. doi:10.1177/17455057261450178
4. ADDitude Editors (2022). ADHD Impairment Peaks in Menopause, According to ADDitude Reader Survey. [online] ADDitude. Available at: https://www.additudemag.com/menopause-symptoms-adhd-survey/?srsltid=AfmBOoq5T1viTd2bT4iVsGjTFCgrtzo-4xAZJVavX7wwA0gAZiKiJdAb [Accessed 26 Aug. 2026].
5. Wynchank D, Sutrisno RMGTMF, van Andel E, Kooij JJS. Menstrual Cycle-Related Hormonal Fluctuations in ADHD: Effect on Cognitive Functioning-A Narrative Review. J Clin Med. 2025 Dec 24;15(1):121. doi: 10.3390/jcm15010121. PMID: 41517370; PMCID: PMC12786913.
6. Pazoki B, Zandi N, Assaf Z, Moghaddam HS, Zeinoddini A, Mohammadi MR, et al. Efficacy and safety of saffron as adjunctive therapy in adults with attention-deficit/hyperactivity disorder: A randomized, double-blind, placebo-controlled clinical trial. Advances in Integrative Medicine. 2022
7. Lopresti, A. L., & Smith, S. J. (2021). The Effects of a Saffron Extract (affron®) on Menopausal Symptoms in Women during Perimenopause: A Randomised, Double-Blind, Placebo-Controlled Study. Journal of menopausal medicine, 27(2), 66–78. https://doi.org/10.6118/jmm.21002