ADHD fenotipo femminile e menopausa: evidenze scientifiche, impatti e strategie nutrizionali e di medicina funzionale

The menopausal transition represents a moment of great neuroendocrine change in a woman's life. For women with ADHD (Attention Deficit/Hyperactivity Disorder), this phase can have a significant impact on symptoms and quality of life, but the scientific literature is still developing and presents results that are not entirely convergent.

1. Female ADHD: an often underestimated profile

Several studies and reviews show that ADHD in women is often diagnosed late compared to men, due to less obvious symptoms and a phenomenon of behavioral “masking.” This diagnostic delay can lead to years of unrecognized suffering and an increase in psychological comorbidities, such as anxiety and depression. 

2. Sex hormones and ADHD: what we know

A recent systematic review highlighted that:

• Female sex hormones (such as estrogen and progesterone) are strongly implicated in variations of ADHD symptoms during different life stages, particularly during puberty and the menstrual cycle;

• however, direct evidence on the impact of menopause is still lacking and requires further research. 

In other words, there is a plausible relationship between hormonal fluctuations and ADHD symptoms, but robust longitudinal studies specifically focused on menopause are still lacking.

3. Menopause: overlapping symptoms and interpretation difficulties

Many studies observe that the typical symptoms of menopause—such as difficulty concentrating, emotional lability, disturbed sleep, and brain fog—can overlap with ADHD symptoms. This makes it difficult to distinguish what is due to the hormonal transition from what is the effect of ADHD itself. 

4. Specific studies on ADHD and menopause

4.1 Perimenopause and symptom burden

A population-based study of over 5,000 women found that:

• ADHD women report a significantly higher prevalence of severe perimenopausal symptoms compared to women without ADHD;

• symptoms include fatigue, anxiety, irritability, sleep disturbances, and overall psychophysical difficulties, more intense even at a relatively younger age (35–39 years), suggesting a possible early onset of hormonal transition. 

This study suggests a greater vulnerability during the perimenopausal period, with symptoms that not only overlap, but are more frequent and severe in women with ADHD.

4.2 ADHD-menopause relationship: conflicting data

Another study published in the Journal of Attention Disorders found that, in a comparison between women with and without ADHD, there is no significant difference in the severity of menopausal symptoms based on menopausal status. However, it was found that the association between ADHD symptoms and menopausal symptoms exists in both groups, suggesting that the two sets of symptoms influence each other but not always in a simple or linear way. 

These results do not necessarily contradict the idea of a hormone-ADHD interaction, but indicate that clinical manifestations vary greatly among women, and not all experience a marked worsening.

5. Possible neurobiological mechanisms

Estrogens interact with crucial neurotransmitter systems in ADHD, particularly dopamine and noradrenaline, which influence attention, motivation, and emotional regulation. In conditions of low estrogen levels (as in menopause), it is plausible that these pathways become less efficient, worsening ADHD symptoms and associated cognitive disorders. 

Moreover, studies related to the menstrual cycle show that ADHD symptoms tend to worsen when estrogen is lower, such as in the premenstrual luteal phase, suggesting a hormonal sensitivity of the female ADHD phenotype. 

6. Clinical implications

6.1 Diagnosis and awareness

• Late recognition of ADHD in women can lead to the discovery of the diagnosis precisely in perimenopause or menopause, when symptoms emerge or worsen. 

• The overlap between menopausal and ADHD symptoms can also lead to misdiagnoses of mood disorders or cognitive disorders not correctly attributed to ADHD.

6.2 Integrative treatment

Given the complexity of hormonal interaction, a multidisciplinary approach is advisable that considers:

• endocrinologist/gynecologist to assess hormonal transitions;

• neurologist/psychiatrist for ADHD support and pharmacological treatment if indicated;

• nutritionist or functional doctor for personalized dietary and integrative strategies.

7. Nutrition and functional medicine: evidence-informed strategies

Although there are currently no specific guidelines based on randomized clinical trials for ADHD in menopause, some interdisciplinary strategies are supported by general evidence for brain, metabolic, and inflammatory health:

7.1 Glycemic stability

• balanced meals with protein, fiber, and healthy fats at every meal to reduce glycemic spikes and cognitive “crashes”;

• low glycemic index carbohydrates to support energy and attention.

7.2 Key nutrients

• Omega-3 (EPA/DHA): support for systemic inflammation and cognitive function;

• Vitamin D: often deficient in menopause, relevant for mood and immune system;

• Magnesium (glycinate/threonate): support for sleep and stress regulation;

• B vitamins: cofactors for energy metabolism and neurological function.

7.3 Microbiota and the gut-brain axis

• diet rich in prebiotic fibers;

• fermented foods if tolerated;

• targeted psychobiotics in cases of dysbiosis associated with emotional stress.

7.4 Sleep and circadian rhythm

Regular routine, sleep hygiene, limiting caffeine in the afternoon, and attention to sleep-wake patterns can reduce the impact of brain fog and emotional dysregulation.

8. Conclusions

Current research indicates that:

• hormonal fluctuations and menopause are a critical period for many women with ADHD;

• evidence suggests an association between sex hormones and ADHD symptoms/manifestations but more specific research on menopause is needed;

• there is a wide spectrum of individual response, with some women experiencing significant worsening of symptoms and others less so.

A personalized and multidisciplinary approach is essential, taking into account both the neurobiology of ADHD and female hormonal transitions.

Krebs & Donnellan-Fernandez (2025) – Integrative literature review: impact of ADHD in different stages of female life, including menopause — highlights the exacerbation of symptoms related to hormonal fluctuations and the importance of early diagnosis and targeted treatment.

Smári et al. (2025) – Population study on perimenopause and symptoms in women with ADHD — shows a higher and more severe prevalence of perimenopausal symptoms in women with ADHD compared to the control group. 

Chapman et al. (2025) – Analysis of the association between ADHD symptoms and menopause — suggests significant correlations but not necessarily greater severity based on isolated menopausal status.

Osianlis et al. (2025) – Systematic review on ADHD and hormones — highlights relationships between sex hormones and variability of ADHD symptoms in women, albeit with methodological limitations.