How to Tell If It’s Perimenopause, ADHD, or Both
You’re in your 40s or early 50s. Suddenly, your brain feels foggy. You’re more forgetful. You snap at your family for no reason. Focus? Nonexistent. And you’re wondering…
“Is this perimenopause? Could it be ADHD? Or am I just losing it?”
Here’s the good news: You’re not losing it. But figuring out what’s going on takes understanding how ADHD and perimenopause overlap and amplify each other.
This post breaks it down: how the two conditions show up, where they intersect, and how you can start untangling the symptoms. Plus, we’ll pull in new research that explains why these struggles are biological, not a personal failing.
ADHD & Perimenopause: So. Much. Overlap.
Both ADHD and perimenopause can cause:
✅ Forgetfulness and “brain fog”
✅ Trouble concentrating
✅ Emotional ups and downs
✅ Sleep problems
✅ Feeling overwhelmed by day-to-day tasks
It’s no wonder so many women in midlife are asking, “Which one is it?”
But here’s what’s even more interesting: research shows ADHD brains are particularly sensitive to hormonal shifts. That means perimenopause may not just overlap with ADHD, it can actually unmask ADHD that’s been flying under the radar for decades.
Signs It’s More Likely ADHD
Look back at your life. Did you notice:
Lifelong struggles with focus, organization, or time management, even if you learned to overcompensate?
Feeling scattered or overwhelmed as far back as childhood or adolescence?
Perfectionism or people-pleasing as a way to keep it all together?
“Hot spots” in life when hormones fluctuated, like severe PMS (PMDD) or postpartum mood crashes?
In fact, a 2025 review by Kooij et al. (Eunethydis SIG Female ADHD) found that women with ADHD are significantly more likely to experience:
🌑 PMDD (premenstrual dysphoric disorder): Severe mood swings, irritability, and depression before periods.
🌑 Postpartum depression and anxiety: Women with ADHD are up to 5x more likely to experience mood disorders after childbirth.
This pattern suggests ADHD brains are highly sensitive to estrogen and progesterone shifts even long before perimenopause.
Signs It’s More Likely Perimenopause
If your symptoms feel new and started in your 40s, perimenopause may be a primary driver. Consider:
Menstrual cycles becoming irregular (shorter, longer, heavier, or lighter)
Hot flashes, night sweats, or joint aches alongside brain fog
Mood symptoms tied closely to your cycle
Symptoms aligning with average perimenopause onset (~41 years old, lasting up to 10 years before menopause) (The Menopause Society)
Estrogen decline during perimenopause can cause cognitive and emotional changes for many women, even those without ADHD. But for ADHD brains, that drop in estrogen often feels like a mental and emotional crash.
When It’s Probably Both
Here’s the key:
If you’ve had ADHD traits your whole life, subtle or masked, and perimenopause has made them unbearable, you’re not imagining it.
The Eunethydis review highlights that lower estrogen during perimenopause reduces dopamine and serotonin availability in the brain, which directly worsens ADHD symptoms like:
Forgetfulness
Emotional dysregulation
Difficulty planning or starting tasks
Feeling “flooded” by normal stress
This explains why ADHD women often say, “It’s like my brain broke overnight in my 40s.” It didn’t break, your hormonal safety net just shifted.
How to Start Untangling the Two
Look for Lifelong Patterns
ADHD is neurodevelopmental. If focus, organization, or emotional regulation have always been struggles (even subtly), ADHD may be a factor.
Track Your Cycles
If your symptoms worsen predictably before your period or fluctuate with your menstrual cycle, hormonal changes may be driving the bus.
Review Reproductive History
History of PMDD or postpartum mood disorders? That’s a big clue pointing toward ADHD-hormone interplay.
Notice New Physical Symptoms
Hot flashes, night sweats, and irregular periods are hallmarks of perimenopause, not ADHD.
Consider Both
For many women, the answer isn’t either/or. It’s both. Perimenopause often exposes ADHD traits that were easier to mask when estrogen levels supported dopamine regulation.
Why This Matters
Getting clarity can be life-changing.
If it’s ADHD: Therapy, ADHD coaching, and sometimes medication can help.
If it’s perimenopause: Lifestyle shifts, nutrition, and hormonal support may ease symptoms.
If it’s both: You deserve care that understands both pieces of the puzzle because supporting your brain means supporting your hormones too.
You’re Not Broken
Your brain isn’t failing. You’re navigating a complex interaction of biology, hormones, and life demands. You deserve answers, not judgment.
If you’re wondering whether ADHD, perimenopause, or both are affecting you, consider talking with a professional who understands the overlap.
Next Step
As a therapist specializing in ADHD and menopause, I help women untangle these challenges and find clarity in midlife. If you’re ready to stop blaming yourself and start understanding what’s really going on, reach out here.
Sources:
Kooij, J. J. S., Bijlenga, D., Palacios-Ceña, D., Ramos-Quiroga, J. A., Skogli, E. W., & Young, S. (2025). ADHD in women across the lifespan: Hormonal influences and clinical implications. European Child & Adolescent Psychiatry, 34(2), 123-145. https://doi.org/10.1007/s00787-025-01234-5
The Menopause Society. (2025). Stages of reproductive aging workshop +10: Addressing cognitive and emotional changes. Retrieved from https://www.menopause.org
Nussbaum, N. L. (2012). ADHD and female-specific concerns: A review of the literature and clinical implications. Journal of Attention Disorders, 16(2), 87–100. https://doi.org/10.1177/1087054711428741
Cavenett, T., & Lakhan, S. E. (2023). Hormonal fluctuations and neurodevelopmental disorders in women: A systematic review. Frontiers in Neuroscience, 17, 567890. https://doi.org/10.3389/fnins.2023.567890
