Unmasking ADHD: Australian Women’s Experiences Through the Menopause Transition

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Unmasking Attention-Deficit Hyperactivity Disorder (ADHD): Australian Women’s Experiences Through the Menopause Transition

Authors: Sherri Murphy¹, Dr. Kelli MacMillan^{1, 2}, Dr. Danielle Mathersul¹ and Dr. Renita Almeida¹.

Affiliation: 

1.  Murdoch University, Perth, Western Australia
2. Curtin Medical School, Curtin University
3. Women and Newborn Health Service of Western Australia

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Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) has historically been under-recognised in women, with many females remaining undiagnosed until adulthood or midlife. Traditionally, ADHD research and diagnostic frameworks have focused predominantly on male presentations characterised by hyperactivity and externalising behaviours. However, women are more likely to present with inattentive symptoms, emotional dysregulation, internalised distress, and compensatory “masking” strategies that can conceal difficulties for many years. At the same time, growing recognition of women’s health across the lifespan has highlighted the significant cognitive and emotional changes associated with the menopause transition. Perimenopause and menopause are characterised by fluctuating and declining ovarian hormone levels, particularly oestrogen, which plays an important role in neurotransmitter systems involved in attention, executive functioning, memory, and emotional regulation. Many women report increased cognitive difficulties during this period, including forgetfulness, distractibility, mental fatigue, reduced concentration, and emotional overwhelm. Importantly, these experiences substantially overlap with core ADHD symptom domains. Emerging evidence suggests that women with ADHD may experience worsening symptom severity during hormonally dynamic periods, particularly during perimenopause and menopause. Some women report that increasing cognitive and emotional difficulties during midlife led them to first recognise possible ADHD traits or seek diagnostic assessment. Others describe menopause as amplifying longstanding ADHD-related challenges that had previously been managed through compensatory strategies.
Despite increasing clinical and public interest, research directly examining ADHD during the menopause transition remains limited. Existing studies have largely focused on earlier reproductive stages such as the menstrual cycle, pregnancy, and postpartum periods, with comparatively little research investigating midlife women. As a result, there remains limited understanding of how menopause-related hormonal changes may influence ADHD symptom severity, daily functioning, and psychological wellbeing.

This Australian study aims to investigate women’s experiences of ADHD symptom changes during the menopause transition. Using an anonymous online survey, the study will explore whether women diagnosed with, or seeking assessment for, ADHD perceive changes in symptom severity across the lifespan, with particular focus on perimenopause and post-menopause. The findings aim to improve understanding of ADHD in women across midlife and support more informed, gender-sensitive approaches to recognition, assessment, and care.

Abstract

Aims: This study investigates whether Attention-Deficit Hyperactivity Disorder (ADHD) symptoms intensify or become more disruptive during the menopause transition, including perimenopause and post-menopause. It explores how hormonal changes may influence the severity and expression of ADHD symptoms in women aged 35 and over, either diagnosed with ADHD, or seeking diagnosis.  
 

Methods: A cross-sectional, mixed-methods anonymous survey will be distributed to women residing in Australia via an online survey.  Quantitative items will assess symptom changes across life stages, particularly during perimenopause and menopause. The qualitative response will undergo thematic analysis, informed by constructivist and feminist frameworks, to explore perceived changes in cognitive, emotional, and daily functioning.  
 

Expected Results: It is anticipated that hormonal shifts will influence the presentation and perceived impact of ADHD symptoms. Participants may report increased adverse impacts during menopause, particularly perimenopause, including increased difficulties with attention, memory, or emotional regulation. These changes may prompt recognition of previously undiagnosed ADHD and initiation of diagnostic assessment, while for others, they may compound existing ADHD-related challenges. 

Conclusions: Findings will contribute to improved clinical recognition of how hormonal transitions affect ADHD symptoms in women, supporting more gender- and age-sensitive approaches to diagnosis and treatment. 
 

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