ADHD and Hormones: How Menstrual Cycles, Pregnancy, and Menopause Affect ADHD

ADHD and hormones are closely linked, yet this connection remains widely misunderstood, particularly for women. For many ADHDers, late diagnosis is the norm rather than the exception [1]. While some are identified in childhood, many, especially those raised as girls, remain undetected until adulthood after years of struggling to meet increasing life demands.

The reasons for this delay are strongly shaped by gendered expectations and unhelpful stereotypes about what it means to be ADHD. Boys who display hyperactivity are often noticed early, while girls are more likely to internalise ADHD traits and be overlooked. Social expectations encourage girls to be compliant, organised, and emotionally attuned to others. So, instead of being disruptive in the classroom, girls often go to considerable lengths to mask their ADHD traits [2].

ADHD in Women and Gender-Diverse People

The difficulty in recognising ADHD extends well beyond childhood. Persistent stereotypes about what ADHD looks like, particularly the image of a hyperactive and disruptive boy, fail to reflect how ADHD often presents in women and gender-diverse people [3], as well as many people with inattentive type (i.e., non-hyperactive) ADHD.

While boys are more likely to be diagnosed due to overtly visible hyperactivity, ADHD girls often present differently:

Typical ADHD traits in boys (more likely diagnosed early)

• Hyperactive, loud, and disruptive in class

• Struggle with impulse control (blurting out, interrupting)

• Obviously restless and fidgeting

• Difficulty completing schoolwork

Common ADHD traits in girls and gender-diverse people (often overlooked or misattributed)

• Daydreaming and inattentiveness, often mistaken for shyness

• Strong emotional reactions (deep sensitivity to rejection, criticism, and change)

• Excessive talking, often dismissed as “girls chattering”

• Subtle fidgeting rather than running around or jumping out of their seat

Many girls unknowingly develop coping mechanisms to navigate gender role expectations, which means they often become overachievers, people pleasers, or anxious perfectionists, exhausting themselves in the process. Unfortunately, many do not realise that their struggles in trying to fit into a non-ADHD mould aren’t due to personal failure but rather undiagnosed neurodivergence that has shaped their life.

Because masking and internalisation are so common, many only recognise their neurodivergence later in life as an adult. This often occurs after their own child receives a diagnosis or when life stressors exceed their coping capacity [4]. For some, that breaking point comes during major hormonal shifts, such as pregnancy, postpartum, perimenopause, and menopause; phases that often exacerbate ADHD symptoms due to fluctuating oestrogen levels [5].

ADHD and Hormones

Hormonal fluctuations across the menstrual cycle can significantly influence ADHD traits. Oestrogen plays a significant role in dopamine regulation. Dopamine is a key neurotransmitter in ADHD which directly affects attention, motivation, and emotional regulation [6]. This means ADHD traits fluctuate across the menstrual cycle, intensifying during periods of low oestrogen, such as the premenstrual phase, postpartum, and menopause.

Common patterns include:

• Ovulation (mid-cycle): Often a “sweet spot” with improved focus and motivation

• Luteal phase (premenstrual phase): Many experience heightened challenges, such as increased emotional dysregulation and fatigue

• Menstruation (period): ADHD symptoms can intensify, leading to brain fog, impulsivity, and heightened sensitivity

ADHD across the Menstrual Cycle

These cyclical changes are frequently misinterpreted as personal weakness or mood instability, rather than predictable neurobiological responses to hormonal shifts.

ADHD and Menopause

Perimenopause and menopause can present significant challenges for ADHDers. As oestrogen levels decline, many experience increased forgetfulness, decreased motivation, and heightened anxiety. Some only recognise ADHD during menopause, having unknowingly compensated for decades [7]. When hormonal buffering decreases in this life-stage, long-standing ADHD traits may become more visible. At MindMatters Clinic, we've found that this often leads people to seek their first ADHD assessment in mid-life, frequently after years of self-blame and burnout.

ADHD and Parenting

For ADHDers, parenting can feel like an overwhelming juggling act, demanding organisation, planning, and multitasking that the ADHD brain can inherently struggle with. While non-ADHD parents find household management challenging, people who are ADHD often describe it as completely mentally exhausting, leading to burnout and chronic self-criticism.

Why people with ADHD struggle with parenting:

• Executive dysfunction makes it hard to manage routines, meal planning, and schedules

• Household chaos - ADHD brains struggle with clutter, making it mentally exhausting to keep a tidy home

• Decision fatigue - having to constantly plan, organise, and keep track of everything can lead to shutdown or avoidance

• Increased sensory overload – noise, touch, and interruptions can be overwhelming

• Emotional dysregulation – heightened stress levels can lead to outbursts, frustration, or burnout 

Sometimes, especially as ADHD parents, we just need to take a deep breath and embrace the chaos.

Societal expectations that parents, particularly mothers, should be organised, tidy, and effortlessly on top of everything can cause deep shame in ADHDers who struggle with the clutter, forgetfulness, and decision fatigue that accompany parenting and running a household.

How to Get Support as an ADHDer

If this resonates, you are not alone. There are meaningful ways to seek understanding and support.

1. Seek a diagnosis: A clear diagnosis can provide validation and access to appropriate support.

2. Recognise hormone-related patterns: Track how ADHD traits fluctuate across your cycle. If your menstrual cycle or menopause symptoms impact ADHD traits significantly, speak to a specialist about options. Some ADHDers learn how to adjust both their medication and non-medication strategies depending on where they are in their hormonal cycle.

3. Use ADHD-affirming strategies: Tools such as body doubling, visual reminders, timers, external accountability, and outsourcing especially challenging tasks are often more effective than traditional organisation systems. See our article on motivation in ADHD for more.

4. Adjust your environment, not yourself: Adjust surroundings and expectations to support how your brain works.

5. Join an ADHD community: Connecting with others who share your experiences can be life-changing. Online forums, such as ADHD New Zealand who have local Facebook and meet-up support groups, or ADHD-specific therapy can provide valuable insight and validation. Reading or listening to others' stories, such as via ADHD podcasts like ADHD Chatter, can also help.

6. Explore formal support options: Medication, psychological therapies (especially ADHD-informed CBT by an ADHD-experienced clinician), and lifestyle changes like exercise and supported routines can significantly improve quality of life. There is also a growing interest in nutrient supplementation for ADHD.

ADHD remains underdiagnosed and misunderstood for those outside of the stereotype of a hyperactive ADHD boy. But awareness is growing. Understanding how ADHD and hormones interact, and how social expectations shape our lived experience, is essential for self-compassion and sustainable support. You are not broken, lazy, or failing. Your brain simply operates outside the mould that society expects.

By embracing self-awareness, seeking tailored support, and connecting with others, you can navigate ADHD with greater self-compassion, confidence, and success. The journey to understanding your ADHD is not about fixing yourself; it’s about learning to thrive in a way that aligns with your unique mind.

Diante Fuchs is a consultant clinical psychologist at MindMatters Clinic, a team of New Zealand leading clinical experts supporting organisations across Aotearoa in the areas of wellbeing, mental health, and neurodiversity. MindMatters offers training workshops, speaking events, resources, and consulting services. We also operate a nationwide diagnostic clinic for adult ADHD and autism.

This article provides general information and is not personalised health advice. The language used is guided by the AADPA Guidelines and we acknowledge individual preferences may differ.

---

References

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC9616454/

[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330/#bibr7-10870547231161533

[3] https://www.additudemag.com/adhd-in-women-misunderstood-symptoms-treatment/?srsltid=AfmBOooYOtkPUl8jM4lr_78G52kiGBo5eOTIqzQiljYvhcE2U2cKpEdN

[4] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02707-9

[5] https://doi.org/10.1016/j.yhbeh.2023.105466

[6] https://add.org/adhd-dopamine/

[7] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02707-9