When Perfectionism and People-Pleasing Stop Working: ADHD Unmasked in Perimenopause
For so long, you held it all together.
You were the organized one. The responsible one. The one everyone could count on at home, at work, in every relationship. You managed the calendar, the carpool, the presentations. You anticipated needs before anyone spoke them.
But now?
It feels like everything is slipping through your fingers.
You can’t remember what you walked into the room for.
Emails pile up unanswered.
You cry at commercials.
And the old strategies…working harder, staying up later, pushing through, aren’t cutting it anymore.
If this is you, it’s not because you’re failing. It’s because your brain and your hormones are asking for a new kind of support.
ADHD in Disguise
For many women, ADHD doesn’t look like the little boy bouncing off the walls in the classroom. It looks like a woman who’s high achieving, perfectionist, and deeply attuned to others’ needs. A woman who’s learned to mask her ADHD symptoms so well that even she doesn’t recognize them.
Masking can look like:
✔️ Overpreparing to avoid mistakes
✔️ People-pleasing to escape rejection or criticism
✔️ Hypervigilance and multitasking to manage constant overwhelm
✔️ Exhausting yourself trying to meet everyone else’s expectations
This isn’t about weakness. It’s survival. Women and girls with ADHD are often socialized to hide their struggles and overcompensate. Researchers have long noted how this can lead to “hidden ADHD” where symptoms are overlooked because a woman seems to be functioning well externally (Quinn & Madhoo, 2014).
But masking is costly. It burns through emotional, physical, and cognitive reserves, reserves that aren’t limitless.
Why Perimenopause Changes Everything
For years, you’ve been running a mental marathon on sheer willpower. But during perimenopause, the terrain changes.
As estrogen and progesterone fluctuate and decline, they take with them crucial support for your brain’s neurotransmitters, dopamine and norepinephrine, already in short supply for ADHD brains. Dopamine is especially important for focus, motivation, and emotional regulation (Haimov-Kochman & Hochner-Celnikier, 2014).
The result? ADHD symptoms often intensify:
😵💫 Forgetting appointments and tasks
💥 Emotional outbursts or mood swings
📉 Losing the ability to “push through” the fog
💔 Feeling like you’re failing at things that used to feel second nature
This isn’t because you’re lazy or not trying hard enough. It’s a neurological and hormonal shift that unravels the coping scaffolding you’ve relied on for decades.
“I Don’t Recognize Myself Anymore”
I hear this all the time from women in their 40s, 50s and 60s.
“I’ve always been able to hold everything together. Now it feels like I’m drowning in my own life.”
“Was I always this disorganized? Or is something happening to my brain?”
“I thought I was just tired. But no amount of rest fixes this.”
For many, perimenopause is the first time their ADHD becomes undeniable. The mask slips, not because you’re weaker, but because your brain needs different care in this season of life.
So What Can Help?
✨ 1. Get Educated
Learn about the intersection of ADHD and hormonal shifts. Understanding why this is happening is the first step toward dropping the shame. www.chadd.org is a great starting place for information.
🩺 2. Seek Medical Support
Talk with providers who understand ADHD and perimenopause. For some women, ADHD medication, menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT), or both can make a profound difference. You may have to find two providers. It’s ok to have two.
🛠️ 3. Build Gentler Systems
You don’t need to double down on rigid productivity hacks. You need systems that work with your brain…not against it. Start small:
Visual reminders
Time-blocking with breaks
Lowering the bar (yes, really)
Saying no more often than feels comfortable
💬 Therapy with a clinician who understands ADHD in women can help you unlearn perfectionist patterns and create a life that feels sustainable.
You’re Not Broken
You’ve been running uphill for years in shoes two sizes too small.
Perimenopause didn’t break you, it revealed the effort it’s been taking to hold it all together.
This isn’t the end of your story. It’s the beginning of one where you’re finally allowed to rest, recalibrate, and build support systems that fit you.
You deserve care that sees your whole picture: ADHD, hormones, and the amazing human navigating both.
❤️ You’re not failing. You’re adapting. And that’s strength.
References:
Quinn, P. O., & Madhoo, M. (2014). A Review of ADHD in Women and Girls. Primary Care Companion for CNS Disorders.
Haimov-Kochman, R., & Hochner-Celnikier, D. (2014). Hormone replacement therapy in menopause and ADHD. Climacteric.
Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: ADHD in Adult Women. Journal of Attention Disorders.
