Menopause and ADHD start earlier than you were told

You describe the sleep that stopped working, and you're told you're too young

You know the conversation. You describe the sleep that stopped restoring you, the fog, the way the ADHD strategies that used to hold have quietly stopped holding. And you get told you're too young for it to be hormonal.

You're thirty seven.

There is now a cohort study with numbers on that exact conversation and it's worth walking through properly, because the details change what you might reasonably ask for.

What the researchers set out to compare

Smari and colleagues published in European Psychiatry in 2025. They took a population cohort and asked one thing, do women with ADHD report perimenopausal symptoms differently from women without ADHD and does that difference change with age?

They used the Menopause Rating Scale, which sorts symptoms into three groups: psychological, somatic (the physical end of it) and urogenital. 535 women with ADHD, 4,857 without. Both the ADHD status and the symptoms were self-reported.

That's the whole design. It wasn't testing a treatment and it wasn't looking for a cause.

What they found.

Of the women with ADHD, 54.2% reported severe symptoms overall. Of the women without, 30.1% did. Nearly double, though not quite.

Broken down by group, the ADHD figure first and the non-ADHD figure second:

Psychological symptoms: 58.6% against 36.0% Physical symptoms: 30.4% against 13.9% Urogenital symptoms: 43.2% against 27.5%

The physical symptoms show the biggest gap. In the ADHD group, just over twice as many women reported them.

That matters because physical symptoms are the ones most often explained away as something else. A thyroid question. Iron. Stress. Getting older.

The age finding.

The largest difference between the two groups turned up in women aged 35 to 39. On the total symptom score, 19.0 against 12.5.

The authors read that as perimenopause beginning earlier in women with ADHD.

So if you've been told you're too young for this, here's what the numbers say. The average age doctors use isn't the age this actually starts for women with ADHD.

Nobody withheld that from you on purpose. The research on how ADHD and the menopausal transition interact is thin and recent. A lot of women with ADHD weren't identified as having it until well into adulthood, which means the group most affected is also the group least likely to have had the label in the room when the question came up. You can't pattern-match to something nobody has described yet.

So is it menopause, or is it ADHD?

Most women arrive at this asking the same question - is this menopause, or is it my ADHD?

The honest answer is that this study can't tell you. It wasn't designed to.

What it does do is confirm you're not imagining the overlap. The two conditions look almost identical from the outside. Trouble holding attention. Losing the thread mid-sentence. Sleep that stopped working. A shorter fuse than you used to have. Being tired in a way that rest doesn't touch. Read that list without a label attached and you couldn't tell which one it describes.

That's why this is a job for a professional who knows to check for both. If your GP only considers one of them, that's the one you'll be assessed against and the other goes undetected. Not through anyone's carelessness. It's hard to look for something nobody has told you to look for.

The practical upshot is probably smaller than you'd like and still more useful than nothing.

You are allowed to raise both.

An appointment booked about hormones is allowed to include the question of attention and the reverse holds too.

What this study does not show.

It's a cohort study. It shows a pattern, not a cause. It doesn't say ADHD brings perimenopause on early and it doesn't say hormones produce ADHD. It shows two things sitting together more often than chance would predict, in one large group of women.

The ADHD status was self-reported and so were the symptoms. Self-reporting isn't a weakness here. A symptom is, by definition, something a person reports. It does mean the study describes what's happening rather than why.

And it doesn't tell you what to do about any of it. That part wasn't a research question.

What changes if this is you.

Not the treatment. Whether to look at MHT and what to do if you do, belongs with your GP or a women's health specialist. That's their room and I'm not in it.

What changes is what you've been comparing yourself against. If you've spent a couple of years concluding that you've gone backwards, that you used to be able to run your week and now you can't, this offers a different reading of the same evidence. The week got harder to run, on a brain that was already spending more than average to get through an ordinary day, and both of those things arrived in the same stretch of years with nobody there to separate them out for you.

That reframe is not a plan. But every plan you build on top of a wrong reading of yourself has to be rebuilt later and you've done enough rebuilding.

If you want the personal version of this, the September Footnote¹ goes there. And if you want the company of other people describing the same stretch of years, It's Not Just You is the page for that.

🔗 The study behind all of this is Smari et al, "Perimenopausal symptoms in women with and without ADHD: a population-based cohort study", published in European Psychiatry in 2025. If you want to read it yourself, and I'd encourage it because the authors are careful in exactly the ways I've tried to be here, you'll find it atdoi.org/10.1192/j.eurpsy.2025.10101.