ADHD medications offer promise in managing menopausal brain fog

A scoping review found preliminary evidence that two attention-deficit hyperactivity disorder medications, lisdexamfetamine and atomoxetine, may improve self-reported executive function during the menopause transition. Across the studies reviewed, participants receiving either drug showed marked reductions in total Brown Attention Deficit Disorder Scale (BADDS) scores compared with placebo. The findings therefore point to a possible improvement in how women experience everyday executive difficulties, not a demonstrated gain in measured cognition.

The review is relevant to an estimated 44% to 60% of perimenopausal women who report cognitive changes such as forgetfulness and trouble concentrating, commonly described as brain fog. These symptoms can affect productivity, work, daily routines and quality of life, and no FDA-approved pharmacological intervention is currently available specifically for them. Researchers who conducted the review cautioned that the evidence is too limited to recommend either ADHD medication for menopausal brain fog.

Larger studies would be needed first to establish whether the drugs are safe and effective for this use, and the review does not establish that the benefits reported by participants were caused by changes in their underlying cognitive ability. To assess the potential role of existing ADHD treatments, the researchers conducted a scoping review of original research involving lisdexamfetamine, a stimulant, and atomoxetine, a non-stimulant. The eligible population consisted of biological women aged 45 to 60 whose last menstrual period had occurred less than 10 years earlier.

Studies were excluded if they involved transgender women, disordered sleep, surgical menopause, primary ovarian insufficiency, premature or early menopause, or a previous or current cancer diagnosis. These criteria were intended to focus the evidence on women experiencing the natural menopause transition, but they also restricted the size and composition of the evidence base and limit how widely its findings can be generalized. The biological rationale proposed by the researchers centers on the substantial decline and fluctuation in estrogen during menopause.

The menopause transition is associated with quantifiable deficits in working memory, attentional control and processing speed, and these domains overlap with core symptoms of ADHD. The authors suggested that ADHD medications may influence signaling pathways disrupted during the transition in a way that improves subjective executive function. Neuroimaging findings from a subset of women taking lisdexamfetamine were described as further supporting this interpretation, although the research release did not provide the sample size or detailed methods of that imaging analysis.

Evidence linking ADHD symptoms with menopausal experiences remains incomplete. Cross-sectional data showed a positive correlation between ADHD symptom severity and the intensity of menopause symptoms, indicating an association in the populations studied rather than proof of a causal relationship. Findings were inconsistent about whether a formal ADHD diagnosis was associated with somatic or psychological complaints.

Those limitations, together with the minimal or nonsignificant effects of both medications on objective cognitive measures, mean the review cannot demonstrate that lisdexamfetamine or atomoxetine improves cognition during menopause.

Subject of Research: Scoping review of ADHD medications for self-reported executive dysfunction during the menopause transition

Article Title: ADHD medications offer promise in managing menopausal brain fog

Article References: ADHD medications offer promise in managing menopausal brain fog. Original publication (Bibliographic details unavailable.)

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Keywords: menopause, brain fog, ADHD, lisdexamfetamine, atomoxetine, executive function, cognition, perimenopause, scoping review, medications, offer, promise