ADHD and perimenopause: why symptoms can feel so much worse
ADHD is often seen as a condition that primarily affects children, but for those who have lived with it all their lives, it’s a constant presence. Women, in particular, often remain undiagnosed until later in life, masking their symptoms or attributing them to other causes. The coping mechanisms they've developed—whether effective or not—may carry them through their teens, twenties, and thirties. But as they enter perimenopause, many women experience a significant worsening of their ADHD symptoms, leaving them struggling to understand what’s happening and, often, feeling like they’re falling apart.
Living with ADHD: A lifelong balancing act
For women who have always had ADHD, life can feel like a constant balancing act. ADHD impacts executive functioning—the brain's ability to plan, organise, and regulate emotions. Women may find themselves easily distracted, forgetful, or unable to complete tasks. These challenges can manifest as struggles in school, difficulties maintaining relationships, or a constant feeling of being "behind" in life.
Despite this, many women with ADHD learn to cope in ways that may mask their symptoms. They might work extra hard to stay on top of things, lean on routines, or avoid situations that push their executive functioning to its limits. Society’s expectations for women to be organised, nurturing, and capable can lead them to internalise their struggles as personal failings rather than recognising them as ADHD traits. Over time, this can build into a pervasive sense of shame, guilt, or inadequacy.
Perimenopause and ADHD: The perfect storm
Perimenopause—often beginning in a woman’s forties—brings about hormonal changes that can drastically impact ADHD symptoms. Oestrogen, a hormone that plays a key role in regulating dopamine and serotonin (both essential for attention and emotional regulation), begins to fluctuate and eventually declines. For women with ADHD, these hormonal shifts can feel like their coping strategies have been ripped away.
Symptoms that may have been manageable before—forgetfulness, poor focus, emotional dysregulation—can now feel overwhelming. Many women report:
Increased brain fog: Struggling to recall even simple information or stay present in conversations.
Emotional overwhelm: Feeling more irritable, anxious, or tearful, often without an obvious reason.
Loss of structure: Struggling to maintain the routines that once helped keep life manageable.
Heightened exhaustion: As perimenopause brings sleep disturbances and fatigue, ADHD symptoms like procrastination or time blindness become even harder to manage.
These changes are not just physical but deeply emotional. Women often feel a profound loss of confidence. They might start questioning their competence at work, their abilities as a parent, or even their value as a person. The combination of worsening ADHD symptoms and perimenopause can lead to feelings of despair, isolation, and frustration.
How this affects self-perception
For many women, the worsening of ADHD symptoms during perimenopause amplifies the negative feelings they've carried for years. The guilt of being "messy" or "forgetful" becomes a heavier burden. Shame may creep in as they feel less capable of meeting the expectations placed on them by society, their families, or even themselves.
Many women begin to question their identity. They've spent years juggling the responsibilities of work, family, and relationships while quietly battling the challenges of ADHD. When those challenges intensify, it can feel like they’ve lost the ability to keep it all together.
Society often reinforces these feelings. Women are expected to take on the invisible load of family management while also excelling in their careers and social lives. When ADHD and hormonal changes disrupt this balance, women can feel like they’re failing—not just themselves, but everyone around them.
Moving forward: awareness and support
Understanding the interplay between ADHD and perimenopause is a vital first step in helping women navigate this challenging time. It’s essential for women to know that the worsening of their symptoms is not a personal failing but a result of hormonal and neurological changes.
Here are some steps that can help:
Education: Learning about how ADHD and hormonal changes intersect can be empowering. Women can seek resources or connect with professionals who specialise in this area.
Professional support: ADHD coaching or therapy can help women develop new strategies to manage their symptoms. Hormone replacement therapy (HRT) may also be an option to explore with a healthcare provider.
Self-compassion: It’s crucial for women to reframe their struggles as challenges rather than failings. Practising kindness towards themselves can alleviate some of the guilt and shame that often accompanies worsening symptoms.
Community: Connecting with other women who share similar experiences can reduce feelings of isolation and create a sense of belonging.
While the worsening of ADHD symptoms during perimenopause can feel like a crisis, it can also be an opportunity. Many women find that this period of life pushes them to seek a diagnosis or support for the first time. With the right understanding and tools, it’s possible to not only manage these challenges but also redefine how they view themselves and their ADHD.
ADHD is not a flaw or a failing—it’s a difference in how the brain works. And while perimenopause can make it harder to manage, it’s also a chance to step into a new chapter with the self-awareness and strategies needed to thrive.
For women navigating this stage of life, the most important message is this: You are not alone, you are not broken, and with the right support, you can feel like yourself again—perhaps even for the first time.
Wondering how ADHD coaching can work for you?
Book your FREE 15 minute discovery call and I’ll be happy to chat about your options.