ADHD & Perimenopause
- kickistromberg
- Dec 2
- 4 min read
As an ADHD coach specialising in supporting women through midlife transitions, I often hear from clients who suddenly feel their ADHD has become more intense or unpredictable. Tasks that were once manageable now feel heavy. Emotional responses feel sharper. Focus seems harder to access. Many women describe this as a very confusing shift, especially if they’ve previously built strong systems and coping strategies.
One of the most influential factors behind this experience is perimenopause - a stage of life that brings significant hormonal changes with direct effects on attention, emotional regulation, energy, sleep, and executive functioning. Below is a clear overview of what happens in the brain during this time, why these changes affect ADHD, and what kinds of support many women find helpful.
Understanding why your ADHD may feel different right now
Many women who have managed their ADHD for years notice a shift in their 40s. Focus feels harder to hold. Tasks take more energy. Emotional responses feel stronger than they used to. You may find yourself wondering why familiar strategies suddenly require more from you.
There is a straightforward reason. Midlife brings significant hormonal changes, and these changes interact directly with the systems involved in attention, motivation, emotional steadiness and memory. When hormones fluctuate, ADHD can feel markedly different.
Why many women receive an ADHD diagnosis during perimenopause
A large number of women reach perimenopause and begin to realise that the challenges they are facing are not simply “hormonal changes” but part of a lifelong pattern that has gone unrecognised. Perimenopause often exposes ADHD that was previously masked or manageable. There are several reasons for this:
Hormonal impact on ADHD symptoms
Oestrogen and dopamine: Oestrogen plays a key role in regulating dopamine - a neurotransmitter essential for attention, executive functioning and motivation.
Symptoms worsening: When oestrogen fluctuates and declines during perimenopause, dopamine availability drops. This can lead to a noticeable worsening of ADHD symptoms, including forgetfulness, inattention, emotional dysregulation and brain fog.
Masking is lifted: For many women, stable oestrogen levels earlier in life helped them compensate for their ADHD symptoms. When oestrogen drops, those compensatory strategies lose their effectiveness.
Unmasking ADHD: Women who have always “held it all together” may suddenly find that familiar coping mechanisms are no longer enough. This is often the point at which ADHD is finally recognised.
Other contributing factors
Life stress: Perimenopause often overlaps with high-pressure life stages - caring for ageing parents, children becoming more independent, career transitions, or increased workload.
Diagnostic bias: ADHD diagnostic criteria were historically based on boys and men. Women often internalise symptoms, overcompensate or mask, making ADHD difficult to recognise earlier in life.
What’s happening in the brain during perimenopause
Perimenopause is the transitional period before menopause. During these years, oestrogen and progesterone levels move unpredictably before gradually declining.
These hormones influence:
attention and concentration
working memory
planning and organisation
emotional regulation
sleep
the dopamine and serotonin systems involved in ADHD
When hormone patterns become less stable, the brain can feel less consistent too. For many ADHD women, this creates a noticeable shift in how daily life is experienced.
Common changes women report during this stage
Increased forgetfulness
More difficulty keeping track of tasks, appointments, or where things have been placed.
Heavier mental fatigue or “fog”
Finding words more slowly, struggling to switch between tasks, or feeling less mentally sharp.
More intense emotional responses
Irritability, tearfulness, or feeling overwhelmed more easily. Many women also describe heightened anxiety, increased stress sensitivity, and emotional instability that feels unfamiliar or harder to regulate.Research shows that women with ADHD or a history of mood changes can be more vulnerable to low mood, intrusive thinking, or suicidal ideation during perimenopause because hormonal shifts influence dopamine and serotonin - both central to mood regulation.
A drop in executive functioning
Planning, organising, and initiating tasks can feel less accessible.
Disrupted sleep
Night waking, hot flashes, night sweats, and lighter sleep that impacts concentration the next day.
Reduced tolerance for stress
Situations that once felt manageable may now feel draining or overstimulating.
This isn’t a loss of ability - it’s a shift in internal conditions
Perimenopause can change the “background setting” your ADHD has been operating within.Your skills have not disappeared.Your insight is still fully intact.Your capacity hasn’t gone anywhere.
The brain simply has new biological pressures acting upon it, and the type of support it responds to may evolve during this phase of life.
What can help during this phase
1. Steady, simplified routines
Reliable touchpoints throughout the day that ease mental load.
2. External supports
Visual reminders, written plans, predictable weekly patterns, and reducing the number of steps in everyday tasks.
3. Supporting sleep
A cooler room, gentle wind-down routine, and reducing stimulation in the evenings.
4. Reducing cognitive pressure where possible
Breaking tasks into realistic steps, minimising unnecessary detail, and being mindful of transitions.
5. Emotional regulation practices
Grounding techniques, reflective exercises, and compassionate internal dialogue.
Medical conversations
Many women choose to explore medical support during perimenopause. This might include reviewing ADHD medication, discussing hormone therapy (HRT), or exploring non-hormonal options.
HRT can be truly helpful for some women, but it isn’t suitable for everyone. If HRT isn’t the right fit, there are other approaches — including non-hormonal medications for menopausal symptoms, lifestyle-based interventions, and adjustments to ADHD treatment.
There is no single route that works for all women. Speaking with a clinician who understands both ADHD and menopause can help you explore the options that align with your health, values and lived experience.
A wider perspective
Perimenopause is a significant stage of life. For many women with ADHD, it brings long-standing patterns into clearer focus and creates an opportunity to reassess what genuinely supports their wellbeing.
If you’re feeling the impact of perimenopause on your ADHD symptoms and would value a supportive space to explore what’s going on, you’re welcome to book a free discovery call.
You’ll find the link just below this post.
Warmly, Kristina
Comments