ADHD drugs may ease perimenopause brain fog, early review suggests

Many women say their thinking gets cloudy in the years before menopause. Now a team of doctors has looked at whether drugs normally used for ADHD (attention-deficit/hyperactivity disorder) might help. Their answer, based on very little data, is a cautious maybe.¹

At the Menopause Society’s recent annual meeting, Dr. Pallavi Khanna and her coauthors presented a review of the available research on ADHD medications and what doctors call perimenopausal executive dysfunction. Khanna described the evidence as “promising but early.”¹

What happened

Perimenopause is the stretch before menopause when hormone levels can swing widely. Brain fog is among its more common symptoms. According to the Menopause Society, 40 to 60% of women report thinking problems during this time. The symptoms can rise and fall with hormone shifts and may improve after menopause.¹

Khanna, a professor of obstetrics and gynecology at the College of Medicine at the University of Tennessee Health Sciences, described the condition this way:¹

“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.”

She added that it “overlaps heavily with ADHD: inattention, disorganization, and poor working memory.” That overlap is why researchers began asking whether ADHD treatments might help.¹

Part of the interest is that doctors have few options. Khanna said: “We see brain fog constantly in clinic, there’s no FDA-approved treatment, and hormone therapy has an inconsistent cognitive benefit.”¹

Why doctors looked at ADHD drugs

Both ADHD and this midlife brain fog have been tied to changes in the prefrontal cortex, the front part of the brain linked to planning and focus. Khanna explained that this area “runs on dopamine and norepinephrine,” two chemical messengers, “and it works best when those levels are just right.”¹

Estradiol, the strongest form of estrogen, helps keep dopamine signaling in that range. During perimenopause, estradiol levels drop. “You get the same pattern seen in ADHD: trouble focusing, holding information, and staying organized,” Khanna said. Because ADHD medications raise dopamine and norepinephrine, she called them “a logical candidate.”¹

This idea that falling estrogen can worsen ADHD-like symptoms also circulates outside research settings. In a June 2025 podcast episode, Dr. Jolene Brighten, who describes herself as a naturopathic endocrinologist and Menopause Society Certified Practitioner, argued that ADHD symptoms can “skyrocket” when estrogen drops in perimenopause and menopause.² Readers should know that the episode is sponsored in part by her own supplement brand, Dr. Brighten Essentials, which is advertised with a discount code; the episode page lists specific supplements under that brand’s name; and Brighten is described as Lead Researcher for the Brighten Essentials Research Division.² The episode is opinion and education, not a study.

The evidence so far

The review had little to work with: just three small trials, all run by the same research group. Even so, the authors said it was enough to suggest ADHD medications might help with some symptoms.¹

Two drugs were named. Lisdexamfetamine (sold as Vyvanse), a stimulant, and atomoxetine (sold as Strattera), a non-stimulant ADHD drug, both helped women feel they were functioning better. But their performance did not improve on objective tests.¹

The researchers also found data showing that women with more ADHD symptoms had worse menopause symptoms overall.¹

An earlier study gave a more upbeat summary

One earlier study shows what this kind of research looks like, though the sources do not say whether it is one of the three trials in the review. In 2015, a team led by Dr. C. Neill Epperson at the University of Pennsylvania gave lisdexamfetamine once a day for four weeks to 32 healthy women aged 45 to 60 who did not have an ADHD diagnosis but had thinking difficulties linked to menopause. Each woman also spent four weeks on a placebo (a dummy pill), in random order, so she served as her own comparison.³

On a questionnaire about attention and organization, women improved 41% overall while on the drug, compared with 17% on the placebo. They also improved on four of five sub-areas, including attention and concentration and working memory.³

Here the sources do not fully agree. The university’s 2015 announcement said the drug improved both subjective and objective measures.³ The new review, as described by Khanna, found that performance did not improve on objective tests across the trials it looked at.¹ The sources given here do not explain the difference in detail.

What it does not show yet

The gap between how women felt and how they scored is the review’s biggest open question. Khanna offered possible reasons:¹

“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.”

She said self-report scales capture that real-world struggle while lab tests often do not, that tests may be too short or too easy to pick up subtle change, and that the trials were small.¹

Other limits are plain from the sources:

• Few trials, one group. All three trials came from the same research team, so no independent group has confirmed the results.¹
• Short treatment in the studies described. The 2015 Penn study gave the drug for four weeks. Epperson said at the time that long-term studies in menopausal women taking the drug were needed.³
• Not a review in a journal yet. The work was presented at a meeting; the sources do not say whether it has been published.¹

Research in other groups hints at why these drugs are of interest but does not answer the menopause question. A 2021 placebo-controlled study of 38 adults who already had ADHD, along with a related pattern called sluggish cognitive tempo, found lisdexamfetamine improved ratings of attention, planning skills and daily functioning over four weeks of treatment.⁴ Those were people with diagnosed ADHD, not women in perimenopause.

Who is behind the research

The new review was presented by Khanna and coauthors at the Menopause Society meeting.¹ The sources do not say who funded it.

The 2015 Penn study was funded in part by Shire Pharmaceuticals, a drug company, as well as the National Institute of Mental Health, the National Institute on Aging and the National Institute on Drug Abuse.³

What the authors caution

Khanna warned against using these drugs for every case of brain fog. She said she would first try to rule out other causes, such as sleep problems, and would consider hormone therapy if a patient had other perimenopause symptoms it might help. “If cognitive complaints persist after that, or she screens positive for ADHD symptoms, I’d refer her to psychiatry for a full evaluation and a decision about medication,” she said.¹

Epperson made a similar point in 2015, saying doctors should confirm that a woman’s memory complaints are tied to the menopause transition and are not a sign of another condition causing thinking problems.³

What to watch next

• Whether the review is published in a peer-reviewed journal, with full details on the three trials.
• Larger trials from research groups other than the one behind the existing studies.
• Longer studies, which the Penn lead author called for in 2015.³
• Better tests that can capture the everyday thinking problems women describe, a gap Khanna pointed to.¹

For now, the picture is of women reporting that they felt better on ADHD drugs in a few small studies, while objective tests in the review did not show a gain. This is news, not medical advice.