The Questions Nobody Funded: ADHD in Women and the Hidden Economics of Medical Research
What one rejected study reveals about research funding, hormones, perimenopause and why some of medicine's most important questions remain unanswered.
“If someone gave you unlimited funding tomorrow,” I asked Professor Sandra Kooij, “what study would you run?”
She didn’t hesitate. Researchers already knew the study they wanted to do. The proposal was simple. The study would compare three approaches for women with ADHD entering perimenopause: stimulant medication, hormone replacement therapy (HRT), and the combination of both to answer the questions:
Which treatment works best?
Which symptoms improve?
When should one be preferred over another?
Then she told me something I wasn’t expecting. They had already applied for the funding but the proposal had been rejected. When I asked why, she paused before giving the answer she had been given.
“It was considered not relevant for society.”
I kept coming back to those five words, not because I doubted that research funding is competitive; every year, excellent ideas fail to receive support. What I couldn’t understand was something much simpler. How does a scientific question become important enough to deserve an answer? That was the question I found myself trying to wrap my head around.
Not whether the study was right or whether the study would succeed, but something more fundamental: who decides which research questions matter?
Over the past few weeks, this series has followed a simple question.
Why are women with ADHD still entering a healthcare system that struggles to meet their needs?
In Part One, we traced that story back to diagnosis itself. ADHD became defined around the behaviour of hyperactive boys, leaving generations of girls to grow up without recognising themselves in the condition.
In Part Two, we followed the story beyond diagnosis. Women were finally being recognised, but they were entering a treatment system that had been developed largely without considering the biological questions unique to women.
That led me to a conversation with Professor Sandra Kooij, one of the world's leading experts on ADHD in women and lead author of a landmark 2025 international review on hormonal transitions and ADHD across the female lifespan. I wanted to understand why these gaps still existed. Instead, I left our conversation thinking about something else entirely: the reason she had been given when the study was rejected:
“Not relevant for society.”
It takes hours each week to research, write, and produce at this level. Consider becoming a free or paid subscriber to support my work. Thank you.
One possibility for the rejection was that the funding committee was right. Perhaps studying treatment options for women with ADHD simply is not an important scientific question, although the evidence suggests otherwise.
ADHD affects an estimated 2–5% of adults, and increasing numbers of women are receiving ADHD diagnoses in adulthood, many only in their thirties, forties or fifties after years of going unrecognised. Increasingly, clinicians have also begun to notice another pattern: many of these women report that their symptoms fluctuate during periods of hormonal change.
That observation is no longer confined to individual consulting rooms.
Research has shown that women with ADHD are substantially more likely to experience premenstrual dysphoric disorder (PMDD), postpartum depression and more severe menopausal symptoms than women without ADHD. These are not isolated conditions. They represent recurring stages of a woman’s life where changing hormone levels appear to interact with attention, mood and executive functioning.
The scientific community has already recognised this.
Earlier last year, an international collaboration led by Professor Sandra Kooij reviewed the state of knowledge on ADHD in girls and women across the lifespan. The authors concluded that hormonal transitions—including puberty, the menstrual cycle, pregnancy and perimenopause—appear to exacerbate ADHD symptoms and mood disturbances.
At the same time, they found that pharmacological research addressing these hormonal changes remains limited and called for longitudinal, sex-specific studies to develop more individualised care.
That is an important distinction. Researchers are no longer asking whether hormones matter in women with ADHD. They are asking how that knowledge should change diagnosis, treatment and care.
Professor Kooij’s proposed study was not attempting to answer a speculative question. It was attempting to answer a recognised one.
Weekly capital intelligence on women’s health. Summer Special 20%
The assumption most of us make is that once medicine recognises an important question, the search for an answer simply begins. In reality, there is another step in between. Questions do not become evidence on their own.
Before a single patient is recruited, before the first blood sample is taken and before the first result is published, a question must first survive a very different process. Someone has to write the grant application. Experts have to review it. Funding bodies have to decide whether it deserves support and only then can the science begin.
This is easy to overlook because we tend to think of scientific knowledge as something that accumulates naturally over time. In reality, every clinical trial exists because, at some point, a group of people decided that one question was more important than the hundreds of others competing for the same resources.
Evidence, in other words, is not produced by science alone. It is also shaped by the decisions that determine which science gets done.
That was what made Professor Kooij’s story so striking. The scientific question already existed. The study had already been designed. The researchers were ready to begin. What stood between the question and the answer was not another scientific breakthrough. It was a funding decision.
During our conversation, Professor Kooij said something that stayed with me.
“A real taboo is something you don’t even realise is there.”
At first, I thought she was talking about ADHD.
She wasn’t.
She was talking about something much larger: what it means to be a woman living with hormonal fluctuations that influence almost every organ system throughout life, and how little of that reality is still reflected in medical knowledge, diagnosis and treatment.
ADHD is one place where that gap becomes visible. Research tells us that women with ADHD are substantially more likely to experience worsening mood, anxiety and emotional symptoms during the menstrual cycle and in the days leading up to it. Yet many women assume these experiences are simply part of being a woman. They often do not realise that what they are experiencing is part of a pattern increasingly recognised in the scientific literature.
As Professor Kooij explained, many women cope with these symptoms quietly. They continue working. They reorganise their lives around them. They also rarely compare experiences with other women and therefore don’t recognise that millions of others are describing remarkably similar patterns.
The result is that what is, in reality, a widespread clinical phenomenon is often experienced as millions of separate personal and individual struggles. The problem exists at population scale, but it is lived in isolation.
That matters because problems that remain largely invisible can also appear less urgent. When the true burden is dispersed across individual experiences rather than recognised collectively, the need to investigate it can be underestimated.
Professor Kooij believes this is one reason that research into the interaction between ADHD and women’s hormonal transitions has progressed so slowly. Not because the symptoms are uncommon, but because much of the burden has remained hidden in plain sight.
Professor Kooij challenged another assumption. Many people think of ADHD as a psychiatric condition. She doesn’t.
Increasingly, she sees it as a condition that affects—and is affected by—many different biological systems. Hormones, the immune system, connective tissue, cardiovascular health and reproductive health all appear to interact with ADHD throughout a woman’s life.
That has an important consequence. Women do not experience these systems separately. A woman going through perimenopause is not experiencing hormones one day, ADHD the next and cardiovascular changes the day after. They are happening at the same time, in the same person, and influencing one another.
Medicine, however, is organised differently. Psychiatrists specialise in ADHD. Gynaecologists specialise in reproductive health. Cardiologists specialise in the heart. Immunologists specialise in the immune system. Each specialty is essential. But some of the most important questions in women’s health sit at the intersection of several of them.
Take Professor Kooij’s proposed study. On the surface, it was about ADHD medication. But it was equally about hormonal changes during perimenopause and how those hormonal changes influence treatment response. It wasn’t purely a psychiatry question or purely a gynaecology question. It belonged to both.
And that is where the difficulty begins.
Research funding is organised in much the same way as medicine itself. Most grants are reviewed within specialist fields, and questions that fit neatly within a single discipline have a natural place to be evaluated. Questions that span several disciplines often do not.
Perhaps that is one reason important questions in women’s health can remain unanswered for so long—not because they lack scientific merit, but because they do not fit neatly into the way scientific research is organised.
I spend much of my time thinking about capital allocation. Most people assume that capital allocation in healthcare begins when investors decide which companies receive funding.
In reality, it begins much earlier. Long before venture capital backs a new therapy or a pharmaceutical company develops a new treatment:
Someone has to decide which scientific questions are worth answering.
Someone has to fund the laboratory, and the (pre-) clinical trial.
Someone has to generate the evidence
and only then can new knowledge emerge for entrepreneurs to build new products and for investors to finance them.
Seen through that lens, research funding is not simply an administrative exercise. It is the first capital allocation decision in healthcare. Every grant awarded is an investment in one possible future. Every grant declined is a decision that another question will have to wait.
Over the past few weeks, this series has followed the same story from three different perspectives. First, we saw how generations of women with ADHD were overlooked because the condition was defined around the behaviour of boys. Then we saw that, even after women began receiving diagnoses, many entered a treatment system that still lacked evidence for the questions their biology raised.
Now we arrive at a deeper conclusion.
Sometimes the missing evidence is not the result of scientific disagreement. Sometimes researchers know exactly which questions need answering. The harder question is whether we choose to invest in answering them.
Perhaps the greatest blind spots in medicine are not created by what science fails to discover. Perhaps they are created by the questions society never chooses to fund.
These ideas sit at the heart of my new book, The Billion Dollar Blindspot. The book explores how outdated assumptions shaped research, innovation, and investment in women’s health and why some of the most important opportunities in healthcare may emerge when those assumptions begin to break down.
I’m grateful that the book reached #1 New Release on Amazon in its category, a sign that more readers are beginning to engage with these ideas. Because this conversation is ultimately about much more than menopause, hormones, or even women’s health.
It is about what happens when we finally start looking at the world as it is, rather than as it used to be. If you’d like to explore these ideas more deeply, you can find The Billion Dollar Blind Spot on Amazon.
Key Takeaways
Researchers already recognise that hormonal transitions—including the menstrual cycle, pregnancy and perimenopause—can worsen ADHD symptoms in women, but sex-specific treatment evidence remains limited.
Women with ADHD have higher rates of premenstrual dysphoric disorder (PMDD), postpartum depression and more severe menopausal symptoms than women without ADHD.
Medical evidence is shaped not only by scientific discovery but also by research funding decisions that determine which clinical questions become studies.
Women’s health research can be disadvantaged because many clinically important questions span multiple specialties, while medicine and research funding are organised into disciplinary silos.
The greatest gaps in healthcare may arise not because researchers fail to identify important questions, but because those questions are never adequately funded.
References
Faraone SV, et al. The World Federation of ADHD International Consensus Statement. Neuroscience & Biobehavioral Reviews. 2021. DOI: 10.1016/j.neubiorev.2021.01.022.
Young S, et al. Females with ADHD: An Expert Consensus Statement. BMC Psychiatry. 2020. DOI: 10.1186/s12888-020-02707-9.
Dorani F, Bijlenga D, Beekman ATF, van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021.
Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health. 2025. DOI: 10.3389/fgwh.2025.1613628.
Ter Beek, L. S., Böhmer, M. N., Wittekoek, M. E., & Kooij, J. J. S. (2023). Lifetime ADHD symptoms highly prevalent in women with cardiovascular complaints. A cross-sectional study. Archives of women's mental health, 26(6), 851–855. https://doi.org/10.1007/s00737-023-01356-7
Personal interview with Professor J.J. Sandra Kooij, July 2026.
Disclaimer & Disclosure
This content is for informational and educational purposes only. It does not constitute financial, investment, legal, or medical advice, or an offer to buy or sell any securities. Opinions expressed are those of the author and may not reflect the views of affiliated organisations. Readers should seek professional advice tailored to their individual circumstances before making investment decisions. Investing involves risk, including potential loss of principal. Past performance does not guarantee future results.
It sounds as if you have described my whole life and I appreciate finally being seen. The fun part is calling it ADHD from the outset is flawed thinking- it is not a deficit, or a disorder- and in women generally not even hyperactive- it is a superpower and a different way of thinking about life. If seen as a positive rather than a negative, a gift to be supported rather that pathologised, so much more could have been accomplished without shame.Unrecognized potential results ultimately in depression or rejection, lost opportunities- because- why even bother?
Medical research doesn't want to fund it simply because it was recognized as a problem women have,as we well know if it had have been for or about men, there would have been funding. It is still such a shame that the concern for the wellbeing of half of society is just not there.
When is the medical establishment, the research establishment, the whole GODDAMN world-going to stop treating women like we are not relevant to society? You just described my entire life. And not once has the female-bodied primary care doctor I've seen for 25 years recognized that I have ADHD. Of course, she also missed the h-EDS and lipedema that I fought her to diagnose. I hate it here.