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A scoping review of five studies found lisdexamfetamine and atomoxetine improved self-rated executive function among women without prior ADHD diagnoses, but neither improved objective cognitive test scores. The evidence is limited, and researchers say larger independent trials are needed before the drugs can be considered for menopausal brain fog.
A small scoping review found that lisdexamfetamine and atomoxetine improved how some women rated their executive function during menopause, but the drugs did not significantly improve performance on objective cognitive tests. The findings, presented by Pallavi Khanna, MD, and colleagues at the Menopause Society annual meeting, are preliminary and do not establish ADHD medications as a treatment for menopausal brain fog.
The review included five studies: three crossover randomized trials involving 60 participants in total, and two cross-sectional studies covering 6,048 people in Iceland and the United Kingdom. The trials examined women without a prior ADHD diagnosis and measured executive function using the Brown ADD Scales, alongside objective cognitive tests. Lower Brown scale scores indicate less reported executive dysfunction.
In the lisdexamfetamine trial, average Brown scale scores fell from 35.7 to 21.2, compared with a fall to 29.8 among participants given placebo (P<0.001). In the atomoxetine trial, scores fell from a baseline of 38.6 to 25.5, compared with 30.1 for placebo (P=0.009). The researchers said neither medication produced a significant improvement on objective cognitive testing.
The two observational studies also found an association between more ADHD symptoms and worse menopause symptoms. In the Icelandic study, women with ADHD diagnoses had higher menopause symptom scores than women without diagnoses, 18.0 versus 13.0 (P<0.01). Severe menopause symptoms were reported by 54.2% of women with ADHD and 30.1% of those without it. The U.K. study found that higher scores on an ADHD symptom questionnaire were associated with worse menopause symptoms, while diagnosis alone was not.
What the Early Results Suggest
Brain fog and difficulties with attention or memory can affect daily life, yet the source report says there are no FDA-approved treatments specifically for menopausal brain fog. The review raises the possibility that some symptoms may overlap with executive-function difficulties associated with ADHD, and that this overlap could be relevant when patients discuss cognitive changes with clinicians.
But the distinction between self-reported improvement and objective test results matters. Participants felt their executive function improved, while standardized cognitive tests did not show significant gains. The evidence therefore does not show that ADHD drugs restore cognitive performance, nor does it establish that they are appropriate or safe for routine use for menopause-related symptoms. Any decision about medication requires an individual clinical assessment.
ADHD medication for menopause brain fog
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Why Researchers Examined ADHD Drugs
Khanna and colleagues searched Embase, PubMed, Scopus, PsycINFO and CENTRAL for studies combining menopause-related terms with executive function, ADHD or ADHD medications. Their rationale drew on changes during menopause: as estradiol levels decline, dopamine and norepinephrine also decline, Khanna explained. ADHD is associated with differences involving these same neurotransmitters, providing a biological rationale to investigate whether ADHD medications might affect some menopause-related cognitive complaints. That rationale is not proof that the drugs work for this purpose.
Khanna told MedPage Today that brain fog is a frequent complaint in her menopause clinic and can resemble ADHD symptoms. She said the review was prompted in part by a need to take those complaints seriously. Menopausal hormone therapy has had inconsistent cognitive findings, according to the report, and the review did not compare either ADHD medication directly with hormone therapy.
“This study is purely hypothesis-generating and needs to be replicated.”
— JoAnn E. Manson, MD, MPH, DrPH, of Harvard Medical School, who was not involved
Lisdexamfetamine for cognitive support
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Key Limits of the Evidence
The review is based on a small evidence base. All three randomized trials came from one research group at a single institution, involved only 60 participants altogether and excluded women diagnosed with ADHD. The observational findings show associations, not evidence that ADHD symptoms cause more severe menopause symptoms or that medication will help.
The studies did not examine methylphenidate, commonly sold as Ritalin, and did not compare ADHD medications with hormone therapy. The results also do not establish long-term effectiveness, safety for this use, or which patients might benefit. The source report provides no basis for treating the drugs as an approved or proven therapy for menopausal brain fog.
Atomoxetine for executive function
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Larger Trials Are Needed
Khanna said larger, independent trials are needed to test whether the reported improvements can be replicated. Manson also called for larger randomized studies, including comparisons with menopausal hormone therapy. Until such research is available, the findings remain preliminary; the report does not identify a next trial or provide a timeline.
For readers experiencing cognitive symptoms during menopause, the study supports raising those concerns with a health professional, not starting or changing ADHD medication without medical guidance. Whether these medicines offer a reliable benefit for menopausal brain fog remains unsettled.
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Key Questions
Did the review show that ADHD drugs treat menopausal brain fog?
No. It found preliminary improvements in self-rated executive function in small trials, but no significant improvement on objective cognitive tests. The review does not establish these drugs as a treatment for menopausal brain fog.
Which medications were studied?
The randomized trials examined lisdexamfetamine and atomoxetine. The review did not include studies of methylphenidate.
How strong is the evidence?
The evidence is limited: three trials included 60 participants and came from one research group at one institution. The authors and an outside expert called for larger, independent studies.
Does having ADHD mean menopause symptoms will be worse?
The observational studies found associations between higher ADHD symptom scores and worse menopause symptoms. They do not prove that ADHD causes more severe symptoms, and one U.K. study found that symptom scores, rather than diagnosis alone, tracked with menopause burden.
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