Women across the world are experiencing a profound revelation in midlife. As hormonal shifts of perimenopause begin, many suddenly find themselves struggling with focus, organization, and memory in unexpected ways.
But whilst you might think this is simply “menopause brain,” for many women, it’s more significant than that. It’s the unmasking of ADHD that’s been present all along, disguised by well-honed coping mechanisms, estrogen’s protective effects, and a huge lack of understanding about how ADHD presents in women.
Before we delve into the science behind it, let’s first explore why ADHD in women is so often missed during early life in the first place.
The hidden ADHD epidemic in women.
For decades, ADHD has remained largely undiagnosed in women, with studies showing they receive diagnoses years later than men, often not until their 30s or 40s.
A significant factor in this disparity stems from outdated stereotypes. ADHD was long considered a “boys’ condition” characterized by hyperactivity and disruptiveness in classroom settings. Similar to the issue with male-biased autism stereotypes, the research that established diagnostic criteria primarily studied young boys, creating a template that many girls and women simply don’t fit.
In women and girls, ADHD often manifests as inattentiveness rather than hyperactivity, for example, daydreaming, zoning out, being easily distracted, quietly doodling, and being forgetful, rather than being overtly “disruptive”. It’s also worth noting that whilst many people think of ADHD as an inability to focus, ADHD-ers are actually quite exceptional at hyperfocusing on things that interest them, so much so that they lose all track of everything going on around them.
In addition to the inattentiveness that women and girls with ADHD often display, the hyperactivity may still be there, but it’s often internalized from an early age because of societal expectations placed on girls and women. From early childhood, girls are typically rewarded for being helpful, compliant, and organized. For being “good girls”. This creates intense pressure to hide any struggles with attention or impulse control that they are experiencing. As with autism, research shows that many ADHD-ers spend their formative years observing neurotypical peers and both unconsciously and consciously mimicking their behaviors to fit in. Many develop “rejection sensitive dysphoria” – an intense fear of disapproval that drives elaborate masking behaviors.
As a result, their traits frequently appear as anxiety, a racing mind, restlessness (being unable to relax), emotional reactivity, time blindness, or feeling scattered and overwhelmed. All while appearing relatively “together” on the outside. Women with ADHD frequently describe an internal chaos that they’ve been masking their entire lives.
And even despite the pressure to be compliant, some girls and women with ADHD experience difficulties with impulse control that result in binge eating, eating disorders, an “addictive personality,” and risky behaviors, particularly in the teenage years and beyond.
The presentation becomes even more complex when ADHD co-occurs alongside autism (AuDHD), which we now know is very common. When both neurological differences exist together, they create an almost entirely different profile, with the autistic traits often masking some of the ADHD traits and vice versa. As a result, traditional diagnostic approaches often miss it completely, particularly in girls, for the reasons we’ve already mentioned.
But regardless of whether ADHD occurs alone or with autism, as life transitions and hormones shift, the carefully constructed masks that girls and women wear begin to slip. And for many women, perimenopause in particular, combined with the stresses of midlife, means the mask falls off altogether.
Understanding perimenopause: more than hot flashes.
In their mid-30s to late 40s, women begin experiencing the hormonal transition known as perimenopause, which can last anywhere from 2 to 10 years before menopause officially begins. Despite affecting half the population, perimenopause remains surprisingly under-discussed and poorly understood, even among healthcare providers.
The most significant changes during this time involve fluctuations in estrogen and progesterone. Unlike the gradual decline many expect, hormone levels during perimenopause can swing dramatically, with estrogen sometimes surging higher than in previous years before plummeting unexpectedly. These wild hormonal roller coasters create unpredictable effects throughout the body and brain.
While hot flashes and night sweats might be the best-known symptoms, perimenopause affects virtually every system in the body. Cognitive changes are particularly common but rarely discussed. Perimenopausal women frequently report new difficulties with concentration, memory, and mental clarity that can significantly impact daily functioning.
Your sleep patterns often change dramatically during this transition, too, with many women experiencing insomnia or disrupted sleep that further impacts cognitive function. Brain fog, word-finding difficulties, and reduced ability to multitask frequently appear, even in women who previously excelled in these areas. Something I can certainly attest to from a personal perspective.
And these cognitive challenges extend far beyond simple forgetfulness. Executive function—the brain’s ability to plan, organize, initiate tasks, and regulate emotions—often becomes noticeably impaired. For women who were previously relying on exceptional compensatory strategies to manage their unidentified ADHD traits, this sudden change can be particularly devastating.
The demands of midlife also tend to intensify precisely when perimenopause begins. Many women in their 40s find themselves simultaneously managing career advancement, parenting challenges, aging parents, and complex household logistics. These escalating external demands collide with diminishing cognitive resources, making previously manageable ADHD traits suddenly problematic.
The estrogen-dopamine connection.
Menopause specialist, Dr Louise Newson, tells us that the hormonal underpinnings of this phenomenon lie in the intimate relationship between estrogen and dopamine in the brain. Estrogen doesn’t just regulate reproductive functions—it profoundly influences neurotransmitter systems, particularly dopamine, which plays a critical role in attention, motivation, and executive function.
When estrogen binds to receptors in the brain, it increases dopamine production and slows its breakdown, effectively boosting dopamine availability. It also enhances the sensitivity of dopamine receptors, making the existing dopamine work more efficiently.
For people with ADHD, whose brains already struggle with dopamine regulation, estrogen can act as a natural compensatory mechanism. During reproductive years when estrogen levels are relatively stable and cycling predictably, this hormonal support may partially mask ADHD traits or make them manageable enough to fly under the diagnostic radar.
As perimenopause begins, however, this protective effect becomes increasingly unreliable. The unpredictable fluctuations and eventual decline in estrogen translate directly to instability in dopamine function. Tasks that once required effort but were doable may suddenly feel impossible. Executive functions, such as organization, time management, and emotional regulation, often deteriorate noticeably.
Indeed, research shows that for women who were already diagnosed with ADHD before perimenopause, the majority found that ADHD had the greatest impact on their daily lives between 40 and 59 years of age. What’s more, many diagnosed ADHD women report that their ADHD medications seem less effective at certain times of the month (i.e., their traits are more significant), and research confirms this. It’s the estrogen-dopamine mechanism at play again.
This hormonal buffering effect helps explain why many women with unidentified ADHD report their traits were somewhat manageable until perimenopause, especially during times of steady estrogen levels. Many women even report experiencing their clearest thinking during pregnancy, when estrogen levels remain consistently high. Conversely, ADHD traits often become more intense during puberty, postpartum, and perimenopause—all periods of significant hormonal fluctuation.
When coping mechanisms fail.
Throughout their lives, women with unidentified ADHD develop elaborate systems to manage their challenges. Their compensatory strategies often become so integrated into daily life that they don’t recognize them as accommodations for a neurological difference.
Some create extensive reminder systems—sticky notes, calendar alerts, and meticulous routines. Others might hyperfocus on organization, becoming almost obsessively structured to prevent the chaos they sense lurking beneath the surface. Many lean heavily on their exceptional crisis management skills, producing their best work under deadline pressure when adrenaline temporarily boosts focus. As we’ve mentioned, for AuDHD-ers, the presence of autism (whether identified yet or not) can also compensate for some of the ADHD challenges.
But the effectiveness of these strategies depends largely on consistent brain function and predictable life demands. But when perimenopause disrupts both simultaneously, the carefully constructed scaffolding can collapse dramatically. For many, this collapse often triggers the realization that something more than hormones is at play.
What’s more, existing coping mechanisms might also require cognitive resources that are simply no longer available when hormonal fluctuations intensify. The extra mental effort once devoted to compensating for ADHD becomes harder to sustain amid perimenopause’s cognitive challenges.
When these systems fail, many women report a profound sense of confusion and self-doubt. They often blame themselves for suddenly “not trying hard enough” when their previously effective strategies stop working. But soul-crushing though this feeling is, it’s often what provides the crucial push toward seeking evaluation and understanding.
The revelation frequently arrives during apparently routine activities that suddenly become overwhelming. A woman who previously managed her household’s complex schedule flawlessly may find herself missing appointments. Another who built a successful career through working twice as hard as colleagues might suddenly struggle with basic tasks. These dramatic shifts expose the underlying ADHD that was always present but previously compensated for through sheer effort and hormonal support.
Even high intelligence, which experts say helps many ADHDers compensate for their struggles, becomes a less effective buffer during perimenopause. The cognitive reserve that once allowed these women to develop workarounds for executive function challenges diminishes as hormonal fluctuations affect processing speed and working memory.
So, how do you know if it’s “just” perimenopause, or ADHD too?
The significant overlap between perimenopause symptoms and ADHD traits creates genuine diagnostic challenges. Both can cause problems with memory, focus, sleep, emotional regulation, and organization. As such, healthcare providers unfamiliar with ADHD may attribute all symptoms to hormonal changes, missing the underlying neurodevelopmental component. In contrast, they may inaccurately attribute symptoms caused solely by perimenopause to ADHD.
For accurate assessment, timing and pattern recognition become crucial. ADHD represents a lifelong difference with traits present since childhood, though it’s important to note they may have been overlooked or masked for the reasons we’ve discussed. If you think you may have ADHD, it’s worth examining your childhood school experiences (or reports if you have them), any organizational challenges throughout your life, longstanding difficulties with impulsive behavior (such as eating, shopping, alcohol, drugs, frequently interrupting people or oversharing), and whether there might be a family history of ADHD, autism, or other neurodivergence (since there are strong genetic links).
A key differentiating factor involves the consistency of traits. While perimenopause symptoms often fluctuate with hormonal changes, core ADHD traits tend to remain relatively stable, though their impact may vary with hormonal status. Indeed, a recent study by menopause and ADHD expert Dr Jeanette Wasserstein and colleagues found that for already diagnosed ADHD women, it was only the cognitive difficulties associated with ADHD that worsened during perimenopause (e.g., brain fog, memory, time keeping, procrastination, etc). In contrast, their complaints about impulsivity, hyperactivity, social struggles, and perfectionism remained fairly constant over the lifespan. The traits had always been there; they just hadn’t connected them to ADHD until perimenopause made the cognitive difficulties unmanageable.
What’s more, though many women who discover their ADHD during perimenopause report that addressing the hormonal component helps to some extent, others find it’s simply not enough, which is why they seek formal evaluation and subsequent treatment for ADHD..
But unfortunately, seeking proper evaluation often requires persistence. Many women report being dismissed with vague reassurances about “brain fog” or being prescribed antidepressants without a thorough assessment. Finding providers knowledgeable about both adult ADHD and women’s hormonal health may require significant self-advocacy.
Finding relief and moving forward.
Despite the challenges, discovering your ADHD during perimenopause offers meaningful opportunities for understanding and improvement. The relief of finally having an explanation for lifelong struggles can be profoundly healing, even later in life. It can also allow you to identify and harness the strengths that ADHD brings, and there are many, such as hyperfocus, cognitive flexibility, creativity, high energy, spontaneity, and courage.
Many women report that this understanding, whether they pursue formal diagnosis or not, brings a transformative shift in self-perception. Years of self-blame for perceived failures or character flaws can be reframed through the lens of neurological difference. This reframing often allows women to develop more compassionate relationships with themselves and more effective strategies for managing their unique brain wiring.
If you’ve recently discovered your ADHD during perimenopause, connecting with others sharing similar experiences can provide invaluable support. Online communities offer spaces to share strategies and find understanding from others navigating the same intersection.
And while diagnosis in midlife may feel late, research on neuroplasticity suggests our brains retain the capacity for positive change throughout life. The strategies and treatments that become available after identification can substantially improve quality of life regardless of when they begin.
Looking back with new understanding often reveals how ADHD shaped earlier life experiences. Many women report suddenly recognizing patterns in their academic achievements, career choices, and relationships that reflect undiagnosed ADHD. This retrospective clarity can help make sense of seemingly disconnected life events—the jobs abruptly quit, difficulties with weight, diet, alcohol or drugs, relationships that faltered due to communication differences, or periods of inexplicable burnout.
For some women, this midlife diagnosis brings grief for opportunities missed and struggles unnecessarily endured. Yet it simultaneously offers liberation from the burden of not understanding their own minds. This recognition often marks the beginning of authentic self-acceptance after decades of trying to fit neurotypical expectations.
