ADHD Medications for Managing Menopausal Brain Fog: Improvements in Subjective Executive Function | Psychiatric Times

ADHD Medications for Managing Menopausal Brain Fog: Improvements in Subjective Executive Function

Review finds ADHD drugs may ease perimenopause brain fog and improve daily focus, but objective cognition gains remain unclear; larger safety and efficacy studies needed.

According to a new review, attention-deficit/hyperactivity disorder (ADHD) medications may help improve brain fog in perimenopausal women.

Investigators underwent a scoping review to better understand the potential of ADHD medications as a novel, targeted therapy to improve executive dysfunction experienced during women’s perimenopause period. They specifically looked at original research studies involving the ADHD medications lisdexamfetamine and atomoxetine, and their effects on cognition and ADHD symptom severity. Inclusion criteria included biological women 45 to 60 years of age with a last menstrual period less than 10 years ago. Exclusion criteria included transgender women, disordered sleep, surgical menopause, primary ovarian insufficiency, premature or early menopause, and previous or current cancer diagnosis.

“Many women at perimenopause notice changes in focus, memory, and organization that look a lot like ADHD, and the two can be hard to tell apart. Our review found early signs that ADHD medications may help women feel more on top of their daily lives. While it is too early to recommend these medications, a quick screen for ADHD symptoms is a simple step that could help women get the right care,” says Jennifer Tat, lead author from the University of Tennessee Health Science Center in Memphis.

Investigators found preliminary evidence that both stimulant (lisdexamfetamine) and nonstimulant (atomoxetine) medications significantly improve self-reported executive function. This was shown by a marked reduction in total Brown Attention Deficit Disorder Scale (BADDS) scores compared with placebo. Additionally, neuroimaging data from a subset of women taking lisdexamfetamine further support these findings.

Despite improvements in subjective brain fog, the medications had little to no significant impact on objective cognitive measures, such as tests of working memory and sustained attention. Furthermore, while cross-sectional data suggests a positive correlation between ADHD symptom severity and the intensity of menopause symptoms, findings on the impact of a formal ADHD diagnosis on somatic and psychological complaints are inconsistent.

Conclusions

Investigators concluded that these ADHD medications may improve subjective executive function, but ultimately not cognition, by modulating catecholaminergic pathways that are often disrupted during the menopause transition. Additionally, cross-sectional evidence suggests that baseline ADHD symptom severity is associated with greater perimenopausal symptom burden.

“For most women, brain fog at menopause is a temporary condition that does not lead to permanent cognitive changes or dementia. However, it can last long enough to disrupt work and daily routines and cause significant stress and anxiety. That is why studies like this are important in helping to identify additional options for symptoms,” says Stephanie Faubion, MD, medical director for The Menopause Society.

These findings could lead to a nonhormone therapeutic option for addressing perimenopausal executive dysfunction. However, larger studies must first confirm whether these medications are safe and effective for this use before they can be recommended as a treatment option.

Unmet Need

Approximately 44% to 60% of perimenopausal women report cognitive changes like forgetfulness and trouble concentrating, or brain fog. During the menopause transition, there is a significant decline and fluctuation in estrogen which mediates catecholaminergic signaling within the prefrontal cortex. This neurobiological shift results in brain fog, involving quantifiable deficits in working memory, attentional control, and processing speed that mirror the core symptom domains of ADHD.

Despite this, there are currently no FDA-approved pharmacological interventions for brain fog.

Next Steps

Details of the study will be discussed as part of the presentation, “Brain Fog or ADHD? Executive Dysfunction in Perimenopause: A Scoping Review of the Role of ADHD Medications,” at the 2026 Annual Meeting of The Menopause Society in San Diego October 20-24, 2026.

References

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