International Journal of Innovative Technologies in Social Science · Jun 30, 2026

ATTENTION-DEFICIT/HYPERACTIVITY DISORDER IN PERIMENOPAUSAL WOMEN: THE IMPACT OF HORMONAL CHANGES ON SYMPTOM SEVERITY AND CLINICAL IMPLICATIONS – A LITERATURE REVIEW

By Ordyczyńska-Mardyła NA, Łęczycka A, Haduch K et al.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a lifelong condition; however, the impact of the menopausal transition on its symptomatic trajectory remains significantly under-researched. In females, ADHD is frequently masked by compensatory mechanisms until midlife, leading to diagnostic delays. This review examines the neurobiological and clinical intersection between fluctuating ovarian steroids and ADHD pathophysiology. Methods: A narrative synthesis of 20 selected scientific sources was conducted, incorporating neuroendocrinological reviews, clinical cohort studies, neuroimaging data, and qualitative research. Results: Evidence indicates a "double whammy" effect from the convergence of neurodevelopmental dopamine deficiency and perimenopausal estrogen withdrawal. 17β-estradiol acts as a critical neuromodulator of dopaminergic and serotonergic systems, exerting neuroprotective effects on the prefrontal cortex. Its decline during perimenopause unmasks previously latent ADHD symptoms, exacerbating executive dysfunction ("brain fog"), inattention, and emotional dysregulation. Women with hormone-related mood disorders such as PMDD exhibit heightened vulnerability. Additionally, "diagnostic overshadowing" frequently occurs, whereby ADHD symptoms are misattributed to menopausal depression or anxiety. The analysis highlights the efficacy of lisdexamfetamine in mitigating cognitive deficits in this demographic. Conclusions: The menopausal transition represents a period of significant clinical vulnerability for women with ADHD. Optimizing outcomes requires individualized, interdisciplinary strategies integrating stimulant pharmacotherapy with Hormone Replacement Therapy (HRT) and gender-sensitive psychoeducation. Future longitudinal research is essential to establish standardized clinical guidelines.

doi.org/10.31435/ijitss.2(50).2026.5500Open accessMechanisms