Lost in the Fog: How Perimenopause and Menopause Worsen ADHD (and What to Do About It) | Seanna Crosbie, LCSW-S Therapist in Austin, Texas & California

The Frustration of a Changing Brain

You stand in the kitchen, staring at the counter. Your keys were just there—weren’t they? You retrace your steps, only to get distracted by another thought. What were you even doing?

Lately, everything feels harder. Focus slips away mid-task. Words vanish mid-sentence. The mental fog is relentless, emotions feel heightened, and motivation seems to have disappeared.

For years, you may have managed your ADHD with strategies—sticky notes, reminders, routines—but suddenly, those tools aren’t enough. Is it stress? Aging? Or something else?

If this sounds familiar, you’re not imagining it. ADHD symptoms often worsen during perimenopause and menopause, and hormones are at the root of it.

The Estrogen-ADHD Connection

Estrogen isn’t just a reproductive hormone—it plays a key role in brain function. It regulates the production and processing of dopamine and serotonin, neurotransmitters that impact focus, mood, and emotional regulation.

If you have ADHD, your brain already struggles with dopamine regulation. When estrogen levels begin fluctuating in perimenopause and drop significantly in menopause, the effect can be profound.

Many women experience:

• Increased brain fog – Thoughts feel scattered, and focus is elusive.

• Forgetfulness – More difficulty recalling words, names, or where things are placed.

• Heightened emotional sensitivity – Anxiety, irritability, and mood swings become more intense.

• Increased overwhelm and burnout – Small tasks feel exhausting.

• Trouble with time management – Deadlines, appointments, and transitions become harder to track.

• Sleep disruptions – Hormonal changes interfere with sleep, which worsens ADHD symptoms.

Many women who have long coped well with their ADHD find themselves struggling in ways they never did before. Unfortunately, many doctors overlook the connection between ADHD and menopause, dismissing worsening symptoms as simple aging or stress.

Mental Health and ADHD During Menopause

The impact of hormonal changes on ADHD extends beyond focus—it affects mental health, too.

• Increased anxiety – Lower estrogen means less serotonin regulation, leading to heightened stress and anxiety.

• Depression or low mood – Estrogen fluctuations can lead to emotional instability, increasing the risk of depressive symptoms.

• Impulsivity and irritability – Changes in dopamine levels may make emotional regulation harder, leading to frustration and short tempers.

• Lower self-esteem – Struggling with focus and motivation can trigger self-doubt or feelings of inadequacy.

For many women, the emotional impact of these changes is just as challenging as the cognitive symptoms. Therapy can be an essential tool during this transition, helping you navigate emotional shifts, develop coping strategies, and improve overall well-being.

Different types of therapy can provide support based on your needs:

• Cognitive Behavioral Therapy (CBT): Research shows that CBT can be highly effective for managing ADHD and mood-related symptoms. It helps you address negative thought patterns, improve emotional regulation, and develop practical strategies for focus, time management, and organization. Studies indicate that CBT can reduce ADHD-related distress and improve executive functioning.

• Mindfulness-Based Therapy: Mindfulness practices have been found to enhance attention, reduce emotional reactivity, and lower stress. Mindfulness-Based Cognitive Therapy (MBCT) and Mindfulness-Based Stress Reduction (MBSR) can help you build resilience against anxiety and depression, which often worsen during hormonal changes.

• Acceptance and Commitment Therapy (ACT): ACT helps you accept the challenges of this stage of life while focusing on values-based actions. It emphasizes psychological flexibility, self-compassion, and effective coping strategies for dealing with uncertainty and emotional fluctuations.

• Interpersonal Therapy (IPT): As hormonal changes affect mood and relationships, IPT focuses on improving communication, strengthening social support, and navigating life transitions, such as changes in identity, roles, and relationships during menopause.

Therapy can also help you advocate for your healthcare needs, recognize the impact of hormonal changes on mental health, and develop self-compassion during a time when self-doubt and frustration may be high. By addressing both emotional and cognitive challenges, therapy provides a foundation for greater stability, confidence, and resilience.

How to Manage ADHD During Perimenopause and Menopause

If ADHD symptoms have worsened during this transition, there are ways to adapt, support your brain, and regain control:

• Work with a knowledgeable doctor – A healthcare provider who understands both ADHD and hormonal changes can explore hormone replacement therapy (HRT), ADHD medication adjustments, or other medical interventions.

• Adjust ADHD strategies for this stage of life – Routines that once worked may need to shift. Try:

  • Using visual reminders instead of relying on memory.

  • Breaking tasks into smaller, structured steps to reduce overwhelm.

  • Setting external accountability to help with motivation.

• Support brain health with nutrition – Foods rich in protein, healthy fats, and omega-3s support dopamine and serotonin function. Limiting processed foods and sugar can also help stabilize energy and focus.

• Exercise for focus and mood – Movement helps regulate dopamine and serotonin, improving both focus and emotional balance. Even short walks can make a difference.

• Prioritize sleep like never before – Hormonal changes disrupt sleep, which makes ADHD symptoms worse. Improve sleep by:

  • Sticking to a consistent bedtime.

  • Limiting screen time before bed.

  • Using relaxation techniques to calm the nervous system.

• Therapy and emotional support – A therapist who understands ADHD and menopause can help navigate emotional shifts, provide coping tools, and reinforce self-compassion.

You’re Not Alone in This

ADHD during perimenopause and menopause can feel like a sudden storm—one that disrupts focus, motivation, and emotional balance. But you are not alone, and there are ways to adapt and regain clarity.

If this stage of life feels overwhelming, support is available. Understanding the connection between hormones and ADHD is the first step toward reclaiming your focus, confidence, and mental well-being. Feel free to reach out to me here.

Seanna Crosbie, LCSW-S, The Menopause Society, Member

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