Hormones matter. ADHD matters too.
Recently, an email from Dr Louise Newson landed in my inbox and stopped me in my tracks. In the email, she spoke about ADHD and hormones, sharing her concern that some women may be receiving ADHD diagnoses and being prescribed medication when changing hormone levels haven’t been properly considered first.
As somebody who works at the intersection of menopause and neurodivergence, I found myself reading it with mixed feelings.
On one level, I completely agree with her. Hormones matter enormously. We know that fluctuating and declining levels of oestrogen, progesterone and testosterone can affect concentration, memory, emotional regulation and executive functioning. Many women find that everyday life becomes noticeably harder during perimenopause, and I have seen first-hand how appropriate hormone replacement can make a significant difference.
However, the more I reflected on the email, the more I realised that my discomfort wasn’t with the idea that hormones matter. My concern was that conversations like these can sometimes unintentionally suggest that hormones are the whole story.
For some women, they may well be. For others, they are only part of a much bigger picture. My own experience falls firmly into the second category. I was already taking HRT when I discovered my ADHD. Like many women, I had noticed a worsening of symptoms during perimenopause. My ability to juggle multiple responsibilities seemed to deteriorate, my emotional regulation became more difficult, and tasks that I had somehow managed for years suddenly felt overwhelming. HRT helped. It genuinely did.
What it didn’t do was explain a lifetime of experiences that stretched back decades before my hormones began to fluctuate. It didn’t explain the school reports. The constant feeling that life seemed harder for me than it appeared to be for other people. The overwhelm, the emotional intensity, the struggles with organisation, the unfinished projects, the chronic exhaustion that came from trying to keep all the plates spinning.
When I eventually discovered my ADHD, it wasn’t something new. I was finally finding an explanation for something that had always been there. And that distinction feels important.
One of the challenges with discussions about ADHD and menopause is that the symptoms can overlap significantly. Difficulties with concentration, memory, emotional regulation and executive functioning can all be affected by hormonal changes. It is absolutely right that healthcare professionals consider hormones when assessing midlife women.
At the same time, I think we need to be careful not to assume that every woman experiencing these challenges is simply experiencing the effects of menopause.
Menopause does not create ADHD. What it often seems to do is expose it.
Many late-discovered women describe spending years compensating for their difficulties through perfectionism, anxiety, people-pleasing, over-preparation and sheer determination. These coping mechanisms may not have been particularly healthy, but they often allowed life to keep moving forwards.
Then perimenopause arrives. Sleep becomes disrupted. Stress tolerance decreases. Executive functioning becomes less reliable. The strategies that have quietly held everything together for years begin to require far more effort, and suddenly the cracks become visible.
From the outside, it can look as though the difficulties have appeared out of nowhere. For many women, however, they haven’t appeared at all. They have simply become impossible to ignore.
I also think there is another important point that sometimes gets lost in these conversations. An ADHD diagnosis is not simply a route to medication. For some women, medication is life-changing. For others, it isn’t the right choice. Some choose stimulant medication, some choose non-stimulant medication, and some decide not to take medication at all.
The value of diagnosis extends far beyond a prescription. For many women, a diagnosis provides understanding, validation and self-compassion. It helps them make sense of decades of confusion, self-blame and frustration. It can open the door to workplace accommodations, coaching, support groups and more effective ways of navigating everyday life.
Some women pursue assessment knowing full well that they may never take medication. They simply want answers. They want to understand why life has felt the way it has. They want to stop seeing themselves as lazy, disorganised or failing. And they want a framework that finally makes sense of their experiences.
That is why I sometimes worry when conversations around hormones and ADHD become overly simplified.
For years, many neurodivergent women were told that their difficulties were anxiety, stress, depression or simply a failure to cope. As awareness of the relationship between hormones and ADHD grows, I occasionally find myself wondering whether we risk creating a different version of the same problem.
Instead of asking whether something might be ADHD, we may begin assuming that everything is hormones. The reality, of course, is far more nuanced. Hormones matter. Neurodivergence matters.
For many women, both are influencing their experience at the same time. The challenge is not deciding which one is responsible but recognising that they often interact with one another in complex and individual ways.
The more women I speak to, the more convinced I become that there is rarely a single explanation. Some women find that optimising their hormones dramatically improves symptoms that had previously been causing significant distress. Others discover that HRT helps enormously but does not fully explain a lifetime of feeling different. Many find themselves somewhere in between.
Perhaps the most helpful question is not whether hormones or ADHD are responsible, but whether we have considered both. Because women deserve access to conversations that acknowledge the complexity of their experiences rather than reducing them to a single explanation. And sometimes the most important thing we can do is remain curious enough to keep asking questions.