Pharmacological Management of ADHD in Women Across Perimenopause, Menopause and Post-Menopause

Attention-deficit/hyperactivity disorder (ADHD) in women is frequently underdiagnosed and undertreated, particularly during midlife when the neuroendocrine changes of perimenopause, menopause and post-menopause can exacerbate or unmask underlying symptoms. Clinical presentations of ADHD in the (peri)menopause often include worsening inattention, emotional dysregulation, and heightened anxiety or depressive symptoms, accompanied by vasomotor disturbances, sleep disruption and subjective cognitive complaints such as brain fog and memory impairment. This narrative review integrates current evidence concerning the pharmacological management of ADHD in women across the final reproductive hormonal transition. We outline diagnostic complexities arising from a symptomatic overlap between ADHD and (peri)menopausal symptoms. Evidence for the efficacy and safety of stimulant and non-stimulant medications in this population is limited, with no randomised controlled trials specific to (peri)menopausal women. Current practice relies on expert consensus, extrapolation from younger cohorts and small observational studies. Practical clinical guidance is provided for initiating and adjusting ADHD pharmacotherapy during hormonal transitions, incorporating individualised dosing, cardiovascular monitoring and consideration of comorbidities. The potential role of menopausal hormone therapy as an adjunctive strategy for mood, sleep and cognitive symptoms is discussed and practical guidance is provided for clinicians initiating pharmacotherapy in (peri)menopausal and post-menopausal women with ADHD, with an emphasis on interdisciplinary and collaborative patient-centred care. Research priorities include controlled trials evaluating stimulant-menopausal hormone therapy combinations and optimal dose adjustment protocols.