How Perimenopause Unmasks ADHD in Mid-Life Women
When Everything You've Been Holding Together Starts to Fall Apart
I was 39 when my body started doing things I didn't understand.
First came the rapid weight gain. Then the bone-deep fatigue that had me lying down for a nap every afternoon, no matter how much I'd slept the night before. But what really terrified me was what started happening in my therapy sessions.
I'd be sitting with a client, listening to them share something important, and suddenly I'd realize I had no idea what they'd just said. The thread of the conversation had completely slipped away. Or I'd reach for a word—a common, everyday word I'd used a thousand times—and it just wasn't there.
I didn't know what was happening to me.
I was working at an eating disorder treatment center at the time, in a Health At Every Size environment, which made the weight gain particularly confusing to navigate. I felt self-conscious but also felt bad about feeling bad. Like I had to be very careful because I was under a microscope at work. How could I process my own body changes when my job was helping others accept theirs?
The internal berating was constant. What's wrong with you? Why can't you focus? Why are you so tired all the time? Why can't you just push through like you used to?
I had no idea I was in perimenopause. I wouldn't discover I was actually fully menopausal until years later, after doing my own research and asking my doctor to test my hormone levels.
And I had no idea I had ADHD.
It took a friend suggesting I get screened for ADHD at 44 for the pieces to finally start coming together. When the screening came back indicating I had it, I wasn't sad. I was excited. I wanted to tell everyone.
Suddenly, so much of my past made sense. My high sensitivity, my special interests, my ability to hyperfocus on something I was completely absorbed by, my constantly hyperactive brain, and my tendency to ruminate. All the things I'd thought were character flaws or personality quirks were actually my neurodivergent brain doing exactly what it was designed to do.
What I didn't understand then was that perimenopause had been unmasking my ADHD all along. The symptoms I'd been managing unconsciously for decades had become impossible to ignore because my hormones were no longer helping me compensate.
Your Coping Strategies Were Built on Estrogen You Don't Have Anymore
Here's what nobody tells you about ADHD and perimenopause.
Many women spend decades successfully managing undiagnosed ADHD through compensatory strategies they don't even realize they're using. We build elaborate systems. We say yes to everything to avoid disappointing people, then have to back out at the last minute. We rely on deadline panic and last-minute adrenaline to finally get things done. We use our people-pleasing tendencies to berate ourselves into productivity, even when facing a big multi-step process that completely paralyzes us.
These strategies often work well enough to keep us functional. Until perimenopause.
Estrogen plays a crucial role in dopamine regulation in the brain. For women with ADHD, who already have challenges with dopamine regulation, estrogen essentially acts as neurological scaffolding that helps executive function, working memory, and emotional regulation stay somewhat intact.
During perimenopause, estrogen levels don't just decline. They fluctuate wildly and unpredictably. One week, you might have relatively normal estrogen levels. The next week, they've crashed. This creates a neurological roller coaster that makes previously manageable ADHD symptoms suddenly unmanageable.
What's happening isn't that you're getting worse or losing your mind. The hormonal support system that was quietly helping your ADHD brain function is being pulled away, revealing the neurodivergent wiring that was always there.
But most doctors don't make this connection. They see a woman in her 40s complaining of brain fog, memory issues, emotional dysregulation, and fatigue, and they diagnose perimenopause, depression, or anxiety. They rarely think to screen for ADHD.
And most women don't think to ask about ADHD either, because we've internalized the myth that ADHD looks like hyperactive little boys who can't sit still. We don't recognize it in ourselves. The sensitive woman who's always been "too much." The creative soul who can hyperfocus for hours on special interests. The people-pleaser who's constantly overwhelmed by multi-step tasks but forces herself to push through.
We think our struggles are personal failures. We think we just need to try harder, be more disciplined, and get more organized. We don't realize we're trying to function with a neurodivergent brain that's losing its hormonal scaffolding.
This is why so many more women are receiving their first ADHD diagnosis in their 40s and 50s.
Perimenopause finally makes it visible.
There’s More to the Story
The shift that changed everything for me was this: what felt like falling apart was actually unmasking.
For decades, I'd been unconsciously compensating for ADHD in ways I didn't even recognize. I'd built my entire identity around being capable, reliable, productive. Even when it meant saying yes to everything and then backing out last minute when I couldn't follow through. Even when it meant riding waves of stress until the last-minute panic finally gave me the dopamine hit I needed to focus.
I thought these patterns were character flaws. Lack of willpower. Poor time management. Selfishness for disappointing people. The constant internal voice was brutal. Why can't you just be normal? Why is this so hard for you?
But I wasn't falling apart.
The mask was falling away.
All those compensatory strategies I'd developed weren't signs of moral failing. They were evidence of a brilliant, creative brain trying to function in a neurotypical world without a user manual.
When perimenopause pulled away the hormonal support that had been quietly helping me maintain those strategies, it didn't reveal someone broken. It revealed someone neurodivergent who'd been working twice as hard as everyone else just to appear normal.
The exhaustion I felt wasn't laziness. It was the accumulated cost of decades of masking.
The brain fog wasn't early dementia. It was what happens when your ADHD working memory loses its estrogen support.
The emotional intensity wasn't being too sensitive. It was ADHD emotional dysregulation without hormonal buffering.
The paralysis around complex tasks wasn't a lack of discipline. It was executive dysfunction finally becoming visible.
Once I understood this, everything shifted.
Instead of asking "What's wrong with me?" I started asking, "What does my neurodivergent brain actually need?" Instead of forcing myself to function like a neurotypical person, I started building systems that worked with my ADHD.
The diagnosis didn't just explain my present. It reframed my entire past. All those moments I thought I was failing? I was actually succeeding against enormous odds, using creativity and determination to navigate a world not designed for my brain.
If you see yourself in anything I’ve shared above, keep reading to get some relief.
Start Connecting the Dots
Here's what you can do this week. Start mapping the intersection between your symptoms and your history.
This isn't about diagnosing yourself—that requires a professional assessment. This is about gathering information so you can have more informed conversations with healthcare providers who might be missing the ADHD piece.
Make Two Lists
List 1: What's Changed Since Your Late 30s/Early 40s
Write down everything that's felt different, harder, or more overwhelming since perimenopause began. Cognitive changes like memory, focus, word-finding, task completion. Emotional changes like mood swings, irritability, emotional intensity. Physical changes in energy levels, sleep, appetite. Behavioral changes like procrastination, backing out of commitments, social withdrawal.
List 2: What's Always Been True (But You Thought Was "Just You")
Now look back at your 20s and 30s. What patterns were already there, but manageable? What did you chalk up to personality flaws or character defects? Time blindness, always running late. Rejection sensitivity, taking criticism very personally. Hyperfocus on interests, losing hours to projects you love. Difficulty starting tasks, especially multi-step ones. Emotional intensity, being told you're too sensitive or too much. Sensory sensitivity, overwhelmed by noise, textures, bright lights.
Look for the Amplification Pattern
Put the lists side by side. Do you see symptoms from List 2 showing up in a more intense way in List 1? This pattern—where lifelong traits suddenly become unmanageable—is the hallmark of perimenopause unmasking ADHD.
You've always been forgetful, but now you're losing track of entire conversations. You've always needed deadlines to motivate you, but now even deadlines don't help. You've always been emotionally sensitive, but now your emotions feel completely overwhelming.
Talk to Someone Who Knows
If you're seeing this pattern, talk to your doctor about ADHD screening. Don't let them dismiss you because you've "always functioned fine before."
That's the whole point. You were functioning by working twice as hard as everyone else and relying on compensatory strategies supported by hormones you no longer have in the same way.
Bring both lists with you. Show them the lifelong patterns and the recent amplification. If your doctor won't take it seriously, find one who will.
Find Your People
Whether you pursue a formal diagnosis or not, connecting with other women who understand this intersection can be life-changing. When I finally started talking to other women with ADHD who'd been through perimenopause, I felt less alone for the first time in years.
When I finally understood that my struggles weren't personal failures but the intersection of ADHD and perimenopause, it didn't just change how I saw my present. It gave me permission to grieve for my past self.
All those years of thinking I was lazy, undisciplined, too sensitive, too much. All that internal berating. All that shame. It wasn't necessary. I was never failing.
I was neurodivergent, trying to function in a neurotypical world without knowing I needed different tools.
If you're in your 40s or 50s and suddenly feeling like you're falling apart—losing words, forgetting conversations, paralyzed by tasks that used to be manageable, exhausted in ways sleep doesn't fix—please consider that you might not be falling apart at all.
You might finally be seeing yourself clearly for the first time.
And that clarity, as uncomfortable as it is, is the beginning of real understanding.
What is being revealed deserves understanding, not shame.
xo,
Maggie
