ADHD and Hormones: How Puberty, Menstrual Cycles, and Perimenopause Impact Symptoms

Kaitlyn Boudreault
Sep 16
8 min read

Updated: 6 days ago

Do your ADHD symptoms tend to fluctuate depending on the time of the month?

Maybe you are feeling like your focus, motivation, and emotional regulation are doing just fine one day. But the next, you feel completely off.

This may cause you to become frustrated, exhausted, or question your own worth. You may consider that you are “just lazy” or “not trying hard enough.”

Are you trying to make sense of all of this?

You’re not alone. For many neurodivergent individuals, especially women, those assigned female at birth (AFAB), trans, and nonbinary individuals, these shifts are the result of hormonal changes that occur during puberty, menstrual cycles, perimenopause, and menopause.

During certain life experiences, various hormones interact with the brain’s dopamine and norepinephrine systems.

All of these fluctuations affect various ADHD symptoms, including attention, executive functioning, emotional regulation, sleep, and energy levels. This can make ADHD feel more intense or overwhelming during certain times.

Understanding how all of these hormonal changes interact with ADHD symptoms can help you reduce self-blame and implement strategies to help you thrive.

Whether you’re just noticing these patterns or have lived with hormonally influenced ADHD for years, this guide will explore how ADHD interacts with hormonal changes across life stages, practical coping strategies, and tips for seeking neurodivergent-affirming support.

What Is Neurodivergence?

Before we dive into how hormones impact ADHD, it’s important to note that ADHD is an experience of neurodivergence.

“Neurodivergence” was coined by Kassiane Asasumasu around 2000 during the autistic rights movement. It describes individuals whose brain structure and function differ from societal norms.

Examples of neurodivergence include:

Autism
Dyslexia and other learning differences
Tourette’s
Mental health conditions like depression or anxiety
Giftedness
AuDHD (autism and ADHD combined)

Neurodivergent individuals, including those with ADHD, process the world differently and experience attention, emotions, and sensory input differently from others.

These challenges are part of the neurodivergent experience, but hormonal changes can amplify their impact.

What Is ADHD?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition and form of neurodivergence. It causes differences in attention, hyperactivity, impulsivity, and executive functioning.

These symptoms of ADHD differ from person to person and may be impacted by hormonal changes:

Sustaining attention
Organizing tasks
Emotional regulation
Impulse control
Sleep patterns

How Hormones Affect ADHD

Hormones may play a crucial role in various bodily and brain functions, including mood, sleep, digestion, and cognition.

ADHD symptoms are linked to some neurotransmitters including dopamine and norepinephrine activity in the brain. These affect focus, motivation, and emotional regulation.

Hormones interact with these neurotransmitters. This means that shifts in hormone levels can worsen or temporarily change ADHD symptoms.

There are several key hormones that interact with neurotransmitters and impact ADHD symptoms, including:

Estrogen: Supports dopamine function, attention, and working memory. Fluctuations in estrogen can affect focus, motivation, and emotional regulation.
Progesterone: Influences GABA activity, sleep, and mood. Some people notice increased irritability or fatigue when progesterone peaks or drops.
Testosterone: Affects energy, motivation, and emotional regulation. Changes in testosterone, such as during puberty or menopause, may influence ADHD symptoms.
Cortisol: A stress hormone that can exacerbate ADHD challenges when out of balance.

These hormones fluctuate during puberty, menstrual cycles, pregnancy, perimenopause, and menopause. These fluctuations can create predictable patterns in symptom intensity for many ADHDers.

ADHD and Puberty

Puberty is one of the stages in life that is marked by major hormonal shifts. These shifts in hormones can make the symptoms of ADHD worse.

Some hormones, in particular, estrogen, progesterone, and testosterone, tend to increase during puberty. This can impact an individual's attention, emotional regulation, and impulsivity.

For example, there are common experiences during puberty for neurodivergent teens, which include:

Heightened emotional sensitivity: Mood swings, irritability, or intense emotional reactions can increase. This can lead to conflict at school or home.
Focus and executive function fluctuations: Planning, organization, and memory may be inconsistent.
Hyperactivity or impulsivity may intensify, or conversely, some teens may feel “slowed down” in energy but still struggle with inattention.
Sleep disturbances: Irregular sleep patterns are common in teens, especially those with ADHD or mood regulation challenges. They may have difficulty falling asleep, staying asleep, or waking up in the morning.
Strong reactions to social rejection: Adolescents may respond intensely to perceived exclusion, criticism, or judgment from peers. This sensitivity can lead to feelings of shame, anxiety, or anger. All of this may cause withdrawal, overcompensation, or impulsive responses in social settings.

Unfortunately, the symptoms of ADHD in girls, AFAB, trans, and nonbinary youth often go underrecognized during puberty.

This is because the symptoms can be subtle or internalized. Some of the symptoms include inattentiveness, emotional sensitivity, and anxiety. In girls, AFAB, trans, and nonbinary youth, these symptoms may be mistaken for normal teenbehaviorur or “overly emotional” tendencies.

Many healthcare providers also rely on diagnostic criteria that typically focuses on cis boys. These criteria usually focus on hyperactivity and outward behavioural challenges. As a result, many individuals who don’t fit these stereotypical symptoms often go undiagnosed until adulthood.

Coping Strategies for Puberty-Related Symptom Shifts:

Track symptom patterns with a journal or app.
Build routines that accommodate hormonal highs and lows.
Practice self-compassion. Recognize these changes are biological, not personal failings.
Use executive function supports (timers, planners, visual schedules).
Seek neurodivergent-affirming therapy or coaching for guidance.

ADHD and Menstrual Cycles

The menstrual cycle consists of various stages.

For those who experience menstrual cycles, ADHD symptoms can often intensify during certain phases. This is particularly common in the luteal phase, which occurs roughly one to two weeks before menstruation.

During this phase of your menstrual cycle, various symptoms of ADHD are impacted. This includes the following changes:

A decline in focus and working memory.
Increased difficulty with emotional regulation. A person may experience increased irritability or sensitivity.
An increase in impulsivity or distractibility.

These changes to ADHD symptoms during the luteal phase of the menstrual cycle are often linked to a decrease in certain hormones, including estrogen and progesterone levels.

These decreases in these hormones also reduce the availability of dopamine in the brain. As a result, there is an impact on executive function, attention, and other ADHD symptoms.

When these changes to ADHD symptoms occur, many healthcare providers dismiss these symptom changes as just Premenstrual Syndrome (PMS).

They don’t usually recognize them as part of ADHD. This lack of diagnoses contributes to the systemic underdiagnosis and misdiagnosis of ADHD.

These challenges are particularly common for women, AFAB, and trans/nonbinary ADHD individuals, who are told that their struggles are “just hormonal” or “normal mood swings” instead of being referred for proper ADHD assessment and treatment.

ADHD and PMDD (Premenstrual Dysphoric Disorder)

For those with ADHD and premenstrual dysphoric disorder, the changes to the symptoms of ADHD during the luteal phase of the menstrual cycle may be even more severe. This can be especially true for the mood swings, anxiety, and executive dysfunction.

Strategies to Manage ADHD During Menstrual Cycles:

Cycle Tracking: Track symptoms alongside your cycle to anticipate challenges.
Flexible Scheduling: Plan cognitively demanding tasks during higher-focus phases.
Prioritize Sleep: Hormonal changes can disrupt sleep. Aim for a consistent bedtime routine.
Self-Compassion: Accept that some days will be harder and plan accordingly.
Nutritional Support: Balanced meals with protein and healthy fats can stabilize energy.
Exercise and Movement: Moderate activity can reduce emotional dysregulation and improve focus.

ADHD and Perimenopause/Menopause

Perimenopause, as the name would suggest, is the phase that occurs before menopause that involves the transition period to menopause.

For many women, AFAB, trans, and nonbinary individuals, perimenopause and menopause bring about changes in hormone levels.

In particular, perimenopause and menopause tend to see a fluctuation and an eventual decrease in estrogen and progesterone levels.

Since estrogen supports dopamine and norepinephrine function, its decline can worsen ADHD-related symptoms.

There are certain symptoms of ADHD that may be more likely to intensify during these stages, including:

Brain fog and memory lapses
Emotional dysregulation
Sleep disturbances
Heightened anxiety or irritability
Decreased motivation

If these symptoms go undiagnosed until later in life, an individual may be diagnosed with “late-diagnosed ADHD.”

Up until the diagnosis, women, AFAB, trans, and nonbinary individuals may go misdiagnosed with other conditions instead of ADHD, such as anxiety, depression, or cognitive decline. This reflects the gendered biases in the diagnosis of ADHD in the healthcare system.

Strategies to Support ADHD During Perimenopause/Menopause:

Track symptom patterns to identify triggers and low-energy periods.
Prioritize structured routines to compensate for memory or focus challenges.
Consider neurodivergent-affirming therapy, coaching, or medical consultation about hormone support.
Practice mindfulness or stress-reduction techniques to regulate emotional fluctuations.
Build support networks that understand ADHD and hormonal impacts.

Why Women, AFAB, Trans, and Nonbinary People Are Often Overlooked

The ADHD diagnostic criteria has typically focused on cis boys and the typical male symptom presentation. These symptoms usually display as hyperactivity and externalizing behaviours, such as impulsivity.

In contrast, females, AFAB, and trans/nonbinary individuals are more likely to present with inattention, emotional dysregulation, and internalized hyperactivity that shows up as anxiety.

Instead of clinicians recognizing these symptoms as ADHD, they may attribute the struggles to something else, such as stress, personality, or hormonal cycles. This leads to delayed or missed diagnoses.

When certain population groups remain undiagnosed until later in life, there can be very real consequences, such as delayed treatment, chronic stress, burnout, masking, low self-esteem, and mental health challenges.

The symptoms of ADHD may also impact various facets of an individual's life, such as school, work, relationships, or home responsibilities.

Neurodiversity-Affirming Strategies for Hormone-Influenced ADHD

Managing ADHD alongside hormonal fluctuations involves a combination of self-awareness, environmental adjustments, and professional support.

1. Medication Timing and Hormonal Awareness

If you use ADHD medications, tracking your hormonal cycle may help you notice variations in efficacy. Some people find that dosages or timing need adjustment during high-symptom phases. Always consult a knowledgeable provider before making changes.

2. Executive Function Supports

Task batching and planning: Align challenging tasks with periods of higher focus.
Visual reminders and planners: Help offset lapses in working memory.
Digital tools: Apps for reminders, calendars, or Pomodoro timers can reduce overwhelm.

3. Emotional Regulation Techniques

Mindfulness, grounding, and self-compassion practices can help regulate emotions during hormonal peaks or dips.
Neurodivergent-affirming therapy can help validate these experiences and provide coping strategies.

4. Sleep and Nutrition

Sleep disruption worsens ADHD symptoms. Prioritize consistent sleep routines, even during hormonal shifts.
Balanced nutrition, hydration, and protein-rich meals support dopamine and norepinephrine regulation.

5. Hormone-Sensitive Self-Care

Recognize when symptoms may be hormone-driven rather than “personal failings.”
Reduce high-stimulus activities during peak symptom periods.
Incorporate relaxation techniques: baths, stretching, yoga, or mindfulness exercises.

6. Advocacy and Accommodation

In educational or workplace settings, communicate your ADHD needs clearly and request accommodations when necessary.
Legal protections often exist for neurodivergent individuals under disability laws, including ADHD exacerbated by hormonal changes.

Addressing Systemic Healthcare Gaps

It’s not enough to manage symptoms individually. Healthcare systems must also:

Train clinicians to recognize ADHD presentations beyond male-centric hyperactivity.
Acknowledge the impact of hormones on ADHD symptoms.
Validate the experiences of women, AFAB, trans, and nonbinary individuals.
Reduce misdiagnosis and delayed diagnosis, particularly for marginalized groups.

Until these systemic changes are widespread, self-advocacy and informed healthcare partnerships are key to navigating ADHD across hormonal life stages.

When to Seek Professional Support

If ADHD symptoms significantly interfere with daily life, such as in school, work, relationships, or self-esteem, consider consulting:

A neurodivergent-affirming therapist or ADHD coach
Endocrinologists or primary care providers familiar with hormone-ADHD interactions
Peer-support networks for guidance and validation

Professional guidance can provide individualized strategies, hormonal interventions if appropriate, and emotional support.

Book a Free Consultation With Blue Sky Learning

Hormones and ADHD are deeply interconnected. Understanding the ways puberty, menstrual cycles, perimenopause, and menopause influence ADHD symptoms can empower neurodivergent individuals to: