Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects millions worldwide, yet its impact on women often goes unrecognized. The condition frequently remains undiagnosed because women tend to display inattentiveness and internalized symptoms rather than the hyperactivity and impulsivity often observed in men. These less visible behaviors can be mistaken for anxiety, mood disorders or simply personality traits, leaving many women without proper support.

Hormonal changes throughout life can further complicate the picture. Shifts during the menstrual cycle, pregnancy and menopause can influence attention, mood and cognition, sometimes amplifying ADHD symptoms or creating overlap with other conditions. This makes detection and treatment even more challenging and contributes to the gaps we see in care.

“Because ADHD was historically considered a condition that mainly affected boys, many issues specific to females have been overlooked, including associations between ADHD and times of hormonal change,” said Dr. Jessica Agnew-Blais, a senior lecturer in psychology at Queen Mary University of London.

This article examines how ADHD manifests in women, how hormonal fluctuations intersect with symptoms and the implications for diagnosis, management and support across a lifespan.

Differences in ADHD diagnosis and symptoms in women

Women with ADHD often face significant delays in diagnosis compared to men. A study involving 900 adults found that, despite exhibiting symptoms at a similar age, women are typically diagnosed about five years later.

“By the time of diagnosis, they showed more severe symptoms, worse functioning in daily life and higher rates of depression and anxiety,” said lead author Dr. Silvia Amoretti, a postdoctoral researcher at the Vall d’Hebron Research Institute.

The presentation of ADHD symptoms also differs between genders. Men are more likely to display hyperactivity and impulsivity, leading to disruptive behaviors. In contrast, women often exhibit inattentiveness, which may be less noticeable and more challenging to diagnose.

The consequences of these delays are significant. Women may go untreated for years, missing out on early interventions that could improve their quality of life.

“This has clear implications for earlier screening and sex-sensitive diagnostic tools,” Amoretti added.

“Up until recently, ADHD was thought to be a ‘boys’ disorder due to the presence of overt hyperactivity. However, we are now more aware of inattentive symptoms, which are more commonly present in females, and more females are getting diagnosed,” said Dr. Ryan S. Sultan, a board-certified psychiatrist and an assistant professor of clinical psychiatry, told Technology Networks.

Recognizing the differences in ADHD diagnosis and symptom presentation between men and women is essential for improving outcomes and providing appropriate support for women with ADHD.

“The nature of the condition leads to poorer diagnosis in women everywhere, meaning that women can lose on average five years of treatment, 5 years of a better life,” said Amoretti.

ADHD and the menstrual cycle

Women with ADHD may experience heightened sensitivity to hormonal fluctuations during their menstrual cycle, particularly in the days leading up to menstruation. A study from Queen Mary University of London found that women with ADHD, whether diagnosed or not, are more likely to experience premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome characterized by mood swings, irritability, fatigue and sleep disturbances.

The study surveyed 715 women aged 18–34 years in the UK and revealed that 31% of those with a clinical ADHD diagnosis met the criteria for provisional PMDD, compared to 10% in the non-ADHD group. Among women who scored high on the Adult ADHD Self-Report Scale but had no formal diagnosis, the rate rose to 41%. The risk was over four times greater for women with ADHD who also had depression or anxiety.

This increased vulnerability may be linked to hormonal changes that affect brain chemistry. Estrogen, which fluctuates throughout the menstrual cycle, plays a role in regulating dopamine, a neurotransmitter involved in attention and mood. As estrogen levels drop before menstruation, dopamine activity can decrease, potentially worsening ADHD symptoms and contributing to PMDD.

“Our findings emphasise the need to consider issues affecting adult women with ADHD, and more specifically how females with ADHD may be at higher risk for experiencing PMDD,” said senior author of the study Agnew-Blais.

ADHD and menopause

Menopause involves long-term hormonal shifts, including a steady drop in estrogen that can alter dopamine levels. For women with ADHD, this hormonal transition can add another layer of complexity to symptoms that already fluctuate with daily stress and life stages.

Researchers at King’s College London recently examined how ADHD and menopause interact. Their study included 656 UK women aged 45–60 years, grouped by ADHD diagnosis and medication use. Participants completed a series of validated questionnaires that measured ADHD symptoms and various aspects of menopause, including physical, cognitive and emotional health.

The researchers found that menopause did not appear to worsen ADHD overall. However, women with more severe ADHD symptoms tended to report stronger menopausal complaints, particularly those not taking medication. In medicated women, higher ADHD scores were linked to more mood changes, memory problems and daily disruption from hot flushes.

“Research on ADHD to date has failed to capture the most long-lasting hormonal changes that occur during a woman’s lifespan, that is, when she transitions out of her reproductive years,” said the authors.

Senior author Dr. Ellie Dommett, professor of neuroscience at King’s College London, said the study “demonstrates that the presence of ADHD may impact how women perceive and attribute their experiences during the menopause.” She added that “this has implications for how women are supported during this time, both with their ADHD and the menopause.”

These findings suggest that for midlife women, perception may matter as much as biology. Clinicians should consider both ADHD and menopausal status when evaluating symptoms to guide more accurate support and treatment.

The future of ADHD research and women’s health

Despite growing recognition of ADHD in women, many questions remain about how the condition interacts with hormonal changes across the lifespan. Current research highlights correlations with menstrual cycles and menopause, but long-term studies tracking symptom fluctuations over decades are scarce.

Future research should examine diverse populations and consider how medications, lifestyle and hormonal transitions influence symptom perception and daily functioning. Such studies could clarify how ADHD and hormonal changes overlap, helping refine sex-sensitive diagnostic tools and personalized treatment strategies.

By addressing these gaps, the scientific community can move beyond reactive care and toward proactive support tailored to women’s experiences. This approach has the potential to shorten delays in diagnosis, reduce associated mental health burdens and improve quality of life.

Focusing on these unanswered questions ensures that ADHD research and clinical practice better reflect the needs of women across all stages of life.