ADHD does not look the same in everyone. Increasingly, research is helping us understand how sex differences may influence the way ADHD presents, how symptoms can fluctuate, the physical and mental health conditions that may occur alongside ADHD, and how an individual responds to treatment.
For women, these differences can be particularly important. ADHD has historically been under-recognised in girls and women, who may be less likely to be referred for assessment or may receive another diagnosis before ADHD is identified. NICE specifically highlights the risk of under-recognition and misdiagnosis in girls and women. [1]
At The Somerville Clinic, we recognise that understanding ADHD in women requires more than simply working through a list of symptoms. We consider the wider picture — including hormonal changes, menstrual cycles, reproductive health, physical health, mental health, medication and the individual's experience of ADHD across different stages of life.
This more individualised approach can help us understand not only whether someone meets the criteria for ADHD, but how ADHD affects that particular person and what may be influencing their symptoms and functioning.
ADHD and physical health: looking beyond the diagnosis
ADHD does not exist in isolation. People with ADHD may also experience a range of physical and mental health conditions, and understanding these alongside ADHD can be important when planning assessment and treatment.
A large Danish population study published in the Journal of Attention Disorders in 2026 examined more than 800,000 people born between 1984 and 1995. The researchers investigated associations between ADHD and 13 categories of physical disease and found that people with an ADHD diagnosis generally had a higher or similar hazard of physical disease compared with those without ADHD. Differences became particularly apparent from adolescence onwards. [2]
Importantly, the relationship between ADHD, physical health and sex was not straightforward. The study found that ADHD diagnosis modified some of the differences in physical-disease risk observed between males and females.
For example, among people without ADHD, females in young adulthood had a substantially higher risk of endocrine, nutritional and metabolic diseases than males. Among those with ADHD, this difference was smaller. The researchers also found that the pattern of risk for eye and related conditions differed according to ADHD status. [2]
These findings reinforce an important clinical principle: ADHD should be considered in the context of the person's overall physical and psychological health.
At The Somerville Clinic, this is why we consider physical health, existing medical conditions, medication and other symptoms alongside ADHD. Understanding the whole person can help inform a more comprehensive assessment and treatment plan.
Hormones can influence ADHD symptoms
For many women, ADHD symptoms are not static. They may fluctuate at different points in the menstrual cycle and during major hormonal transitions.
Research into the relationship between reproductive hormones and ADHD is still developing, but there is growing evidence that changes in ovarian hormones may influence ADHD symptoms in some women.
An influential 2018 study followed 32 regularly menstruating young women and assessed ADHD symptoms alongside daily measurements of reproductive hormones. The researchers found that lower estradiol in combination with higher progesterone or testosterone was associated with increased ADHD symptoms on the following day, particularly among women with higher trait impulsivity. They also identified periods of increased symptoms around parts of the early follicular and early luteal phases of the cycle. [3]
More recent work has reviewed the evidence linking the menstrual cycle and ADHD and proposed that changes in oestrogen may influence executive functioning, attention, impulsivity and emotional regulation. However, the evidence remains limited and individual experiences vary considerably. [4]
This is clinically relevant.
If someone's concentration, emotional regulation, impulsivity, motivation or executive functioning changes substantially at particular points in their cycle, that information may be useful when assessing their ADHD and considering treatment.
It also means that a woman may have periods when her usual coping strategies feel much less effective. What appears to be an inconsistent presentation of ADHD may, in some cases, reflect fluctuations associated with hormonal changes.
However, hormones are only one part of the picture. Sleep, stress, mood, physical health, medication, life circumstances and other conditions can all influence ADHD symptoms.
A cyclical pattern should therefore be explored rather than automatically attributed to hormones.
ADHD across different stages of a woman's life
A woman's hormonal environment changes considerably throughout her life. Menstruation, pregnancy, the post-partum period, perimenopause and menopause can all involve significant physiological and psychological changes.
Research specifically examining ADHD across these reproductive stages is still relatively limited, but emerging evidence suggests that women with ADHD may experience more difficulties around some reproductive and menopausal stages than women without ADHD. A 2026 cross-sectional study of 602 females, including 377 with self-reported ADHD, reported higher levels of menstrual irregularity, premenstrual symptoms and menopausal symptoms among participants with ADHD. The authors emphasised the need for further research, particularly because the study relied on self-reported ADHD and cross-sectional data. [5]
This is one reason why an assessment that considers when symptoms occur and how they change over time can be more informative than looking at symptoms in isolation.
At The Somerville Clinic, we may therefore explore questions such as:
Do your ADHD symptoms change at particular points in your menstrual cycle?
Have your symptoms changed since starting or stopping hormonal contraception?
Did your ADHD symptoms change during pregnancy or after having children?
Have difficulties with attention, organisation, emotional regulation or executive functioning changed during perimenopause or menopause?
Are sleep, anxiety, mood or physical symptoms affecting your ADHD?
Are there other physical or mental health conditions that need to be considered alongside ADHD?
How do your symptoms respond to your current treatment?
These questions can help build a more complete picture.
Perimenopause, menopause and ADHD
For some women, perimenopause can be a particularly important period for understanding changes in ADHD symptoms.
Perimenopause involves fluctuating ovarian hormone levels and can be accompanied by changes in sleep, mood, concentration and energy. These symptoms can overlap with aspects of ADHD, making it difficult to determine what is contributing to a change in functioning.
A woman who has successfully managed ADHD symptoms for many years may find that strategies which previously worked well are suddenly less effective. She may experience greater difficulty organising tasks, maintaining concentration, regulating emotions or managing competing demands.
It is important not to assume that these changes are simply "part of ADHD" or "just menopause". Both may be contributing, alongside other factors such as sleep disruption, anxiety, depression, physical health or changes in life circumstances.
NICE recommends an individualised approach to menopause care, with management decisions based on the person's symptoms, circumstances, preferences and potential risk factors. [6]
For women experiencing significant changes during perimenopause or menopause, considering both ADHD and menopause can therefore be valuable.
Treatment should be personalised
Recognising sex differences does not mean that there is one specific treatment for women with ADHD. Instead, it highlights the importance of personalised treatment.
Medication decisions need to take into account an individual's ADHD symptoms, medical history, other medications, physical health, potential side effects and changing circumstances.
For some women, hormonal changes may also be relevant when monitoring symptoms and treatment response. This does not mean that hormonal treatment is an ADHD treatment, but rather that reproductive and menopausal health may form part of the wider clinical picture.
Psychological treatments and practical strategies may also need to be tailored to the individual's circumstances.
Recent research into cognitive behavioural therapy (CBT) illustrates why a one-size-fits-all approach may not always be appropriate. A 2026 analysis of data from 200 adolescents aged 12–18 who had participated in randomised trials in Norway and the Netherlands found that CBT reduced ADHD symptoms overall, but outcomes varied according to sex, internalising symptoms and treatment format. Girls with elevated depressive symptoms showed a smaller reduction in ADHD symptoms than boys with similar depressive symptoms. Among girls, symptom improvement was greater with individual CBT than group CBT in this analysis. [7]
The study was conducted in adolescents, so its findings should not simply be applied to adult women. Nevertheless, it illustrates an important principle: the context surrounding ADHD matters when considering how best to support an individual.
Assessment should look beyond a checklist
A thorough ADHD assessment should consider more than whether someone experiences difficulties with concentration, organisation or impulsivity.
NICE recommends that ADHD diagnosis should be based on a full clinical and psychosocial assessment, including developmental and psychiatric history, symptoms across different settings, functional impairment and consideration of coexisting conditions and physical health. A diagnosis should not be based solely on rating scales. [1]
This is particularly relevant for women, whose ADHD may not always have been recognised earlier in life.
Some women may have developed extensive strategies to compensate for their difficulties. Others may have experienced anxiety, depression or exhaustion without the underlying ADHD being identified.
Understanding a person's history — including how they functioned at school, at work, in relationships and at different stages of life — can therefore be an important part of the assessment.
At The Somerville Clinic, we look at the whole picture
At The Somerville Clinic, our approach is to understand the individual rather than treating ADHD as a single, uniform condition.
That means considering not only whether you have ADHD, but also how ADHD affects you, how your symptoms change, your hormonal and reproductive health, your physical health, your mental health and what treatment approach is most appropriate for you.
As research continues to develop, this more personalised approach may help women receive assessment and treatment that better reflects their individual needs and experiences.
References
1. National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). Updated 2025.
https://www.nice.org.uk/guidance/ng87
2. Villumsen MD, Bilenberg N, Steinhausen HC. Sex Differences in the Association Between Attention-Deficit Hyperactivity Disorder and Physical Diseases in Childhood and Adolescence Using Nationwide Birth Cohorts. Journal of Attention Disorders. 2026. doi:10.1177/10870547261448260. PMID: 42109088.
3. Roberts B, Eisenlohr-Moul T, Martel MM. Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology. 2018;88:105–114. doi:10.1016/j.psyneuen.2017.11.015. PMID: 29197795.
4. Eng AG, Nirjar U, Elkins AR, et al. Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior. 2024;158:105466. doi:10.1016/j.yhbeh.2023.105466. PMID: 38039899.
5. Bramham J, et al. ADHD and the female reproductive stages: menstruation, perinatal and menopause. 2026. PMID: 42207323.
6. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Updated April 2026.
https://www.nice.org.uk/guidance/ng23
7. Hanes TK, Andersen AC, Boyer BE, Wagner K. Gender Differences in Cognitive Behavioral Therapy Outcomes for Adolescents With ADHD: Examining the Impact of Internalizing Symptoms. Journal of Attention Disorders. 2026;30(7):945–954. doi:10.1177/10870547251415431. PMID: 41588643.
This article is intended for general information and does not replace an individual medical assessment or treatment plan.
