Section - Expert Consultations

02. ADHD in Women: Earlier Menopause and Perimenopausal Cardiovascular Risk

Published on May 19, 2026 Certification expiration date: May 19, 2029 DOI: 10.64239/PI-EC100

Guest

Key Points

Women with ADHD have higher rates of early perimenopause. Symptoms can appear in the late 30s or early 40s.
When in doubt, start women on lower stimulant doses than men, then titrate to response. Guidelines were built on male research, and women may reach a good response with fewer side effects at lower doses.
Treat ADHD and perimenopausal symptoms actively, since both induce chronic stress on the heart, blood pressure, sleep, and mood.

To unlock this audio you need to become a Silver, Gold, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Audio File (MP3)

Text Version

Common Prescribing Mistakes in Women With ADHD

Flavio Guzman, M.D.: What are the most common prescribing mistakes you see, and what should clinicians do differently?

Sandra Kooij, M.D., Ph.D.: Women may need lower dosages than men. We are all educated to dose according to guidelines tailored to men and based on research in men.

There has been little or no research on women. The cyclical fluctuations in hormone levels and their impact on medication blood levels or interactions have not been studied, so we are largely unaware of the right dosage for women.

It may be true that lower dosing for women is better to start with than intermediate or high doses. Women may unnecessarily experience more side effects when they could achieve good blood levels and a good response with lower dosages.

This is a rule of thumb for women, but there are always exceptions. There are women who

Unlock this Expert Consultation and earn 0.50 CMEs
Become a Silver, Gold, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Table of Contents

Learning Objectives:
After completing this activity, participants should be able to:

Explain the neurobiological interaction between estrogen and dopamine and its clinical relevance to premenstrual, postpartum, and perimenopausal worsening of ADHD symptoms in women.
Apply a structured hormonal history and two-month symptom monitoring strategy to identify cyclical ADHD and mood exacerbations and guide treatment decisions, including premenstrual stimulant dose adjustment, SSRIs, or continuous oral contraceptives.
Assess cardiovascular and perimenopausal risk in women with ADHD and integrate multidisciplinary care, including timely consideration of transdermal hormone replacement therapy.

Original Release Date: May 19, 2026
Expiration Date: May 19, 2029

Expert: Sandra Kooij, M.D., Ph.D.
Medical Editors: Flavio Guzmán, M.D.

Relevant Financial Disclosures:
Sandra Kooij declares the following interest:

ADHD Powerbank: Owner

All the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:
Participants must complete the activity online within the valid credit period noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post-Activity Evaluation to provide the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement
Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Artificial Intelligence (AI) Use DisclosureArtificial intelligence (AI) tools may have been used in limited stages of developing this activity (e.g., drafting or language refinement). The specific tool, version, and date of use are documented internally.AI does not determine clinical recommendations. All content is reviewed, verified, and approved by the listed faculty and medical editors, and reflects independent human clinical judgment consistent with ACCME Standards for Integrity and Independence in Accredited Continuing Education.

Sandra Kooij, M.D., Ph.D.

Flavio Guzmán, M.D.

Key Points

Downloads for Offline Access

Text Version

Common Prescribing Mistakes in Women With ADHD

CME Information

Unlock up to 155 CME Credits, including 40 SA CME Credits.