Researchers Explore ADHD Drugs as a Possible Fix for Perimenopausal Brain Fog

Brain fog is one of the most common complaints during perimenopause, the stage before menopause when hormone levels can swing dramatically. According to the Menopause Society, 40% to 60% of women report some degree of cognitive difficulty during this time. These symptoms may rise and fall with hormonal changes and often improve after menopause.

Specialists refer to this as perimenopausal executive dysfunction. “It’s a measurable decline in the mental skills that let us plan, focus, hold information in mind, and switch between tasks, appearing during the menopause transition,” says Pallavi Khanna, M.D., professor of obstetrics and gynecology at the College of Medicine at the University of Tennessee Health Sciences. “It overlaps heavily with ADHD: inattention, disorganization, and poor working memory.”

That similarity has led researchers to examine whether medications used for ADHD could also help with perimenopausal executive dysfunction. If so, the effect could be significant for menopause care. “We see brain fog constantly in clinic, there’s no FDA-approved treatment, and hormone therapy has an inconsistent cognitive benefit,” Dr. Khanna says.

At the Menopause Society’s annual meeting, Dr. Khanna and her coauthors presented a review of the available evidence on ADHD medications and perimenopausal executive dysfunction. Their conclusion: the early evidence is encouraging, though still limited, and suggests the drugs may ease some symptoms.

Ahead, Dr. Khanna explains the key points from the review.

How are perimenopausal executive dysfunction and ADHD connected?

Both conditions have been linked to changes in the brain’s prefrontal cortex, which supports executive function. “The prefrontal cortex runs on dopamine and norepinephrine, and it works best when those levels are just right.” Estradiol, the strongest form of estrogen, helps maintain dopamine signaling in that ideal range. During perimenopause, estradiol levels fall. “You get the same pattern seen in ADHD: trouble focusing, holding information, and staying organized,” Dr. Khanna says. “That shared mechanism is why ADHD medications, which raise dopamine and norepinephrine, are a logical candidate.”

What did the review show?

The amount of data was small—only three minor trials, all from the same research group—but the findings hinted that ADHD medications could help treat certain symptoms of perimenopausal executive dysfunction. In particular, lisdexamfetamine (Vyvanse) and atomoxetine (Strattera) made women feel they were functioning better, even though their scores did not improve on objective testing.

Why the disconnect? “Objective tests measure performance on specific tasks in a quiet lab over a short session. Executive function in daily life means juggling work, family, and interruptions for hours,” Dr. Khanna says. “Self-report scales capture that real-world struggle; lab tests often don’t. A woman can score normally on a memory test and still feel she’s drowning at work. Tests may also be too short or too easy to detect subtle change, and the trials were small.”

Researchers also found that women with more ADHD symptoms tended to report worse menopause symptoms overall.