Women have long been told to expect brain fog, mood swings, disrupted sleep, and a creeping sense that they cannot cope with real life once they reach their forties. But what if perimenopause is only part of the story? For some, the hormonal upheaval of midlife may be exposing undiagnosed ADHD.
Menopause and the rollercoaster years leading up to it were once taboo subjects, discussed only in whispers. However, thanks in part to celebrities including Davina McCall and Jennifer Aniston speaking publicly about their experiences, many women have been encouraged to stop suffering in silence.
Dr Helen Wall, a GP and menopause specialist, told the Daily Mail that for many years she largely only saw women in their 50s, often after their periods had taken a back seat and hot flushes had taken their place. Thankfully, she says, we have moved on and now given women a voice to describe what happens in the run-up to menopause when hormones are fluctuating wildly and unpredictably.
Along with irregular periods and physical symptoms, perimenopause can lead to psychological distress caused by insomnia, intense brain fog, anxiety, depression, and mood swings. Dr Wall emphasises that these women are not falling apart because they are 40 with teenage children and too much mental load, although that plays a part. Their brains are changing because hormones impact how chemical messengers behave.
The Link Between Perimenopause and ADHD
ADHD is a lifelong developmental condition that can cause inattentiveness, restlessness, impulsiveness, and hyperactivity due to chemical imbalances in the brain affecting reward systems. These imbalances can lead people to crave new experiences or become hyper-focused on specific topics, only to lose interest quickly.
ADHD and autism were long misunderstood as conditions mainly affecting boys, but research increasingly shows that ADHD in girls and women has been underdiagnosed, partly because it often presents differently. Girls may mask to keep up appearances with peers, hiding behavioural quirks until they feel safe to relax or until adulthood when coping mechanisms fail.
Dr Wall notes that girls tend to have less external hyperactivity and more internalised hyperactivity such as overthinking and anxiety. As adults, many women rely on support scaffolding they unknowingly put in place growing up, including over-preparing, rehearsing, and overthinking. They often become perfect pupils or high-achieving but exhausted colleagues, with a lifetime of being told they are too much or not enough, or diagnosed with treatment-resistant anxiety and depression.
Thanks to increased awareness, thousands of women have realised that their struggles and feelings of otherness can finally be explained. Singer Annie Lennox was 70 when she was diagnosed last September.
The Hormonal Storm
Dr Wall explains that for many women, the shifting sands of perimenopause create the perfect hormonal storm for undiagnosed ADHD to come to the fore. During perimenopause, oestrogen does not simply decline in a straight line; it fluctuates dramatically before eventually falling after menopause. This affects how other hormones influence brain patterns, including dopamine, which drives attention, motivation, reward processing, and executive function. Oestrogen also influences serotonin and noradrenaline, which regulate mood, energy, focus, and pain.
The ADHD brain already has altered dopamine signalling. The impact of oestrogen fluctuation can be one reason why a woman's previous coping mechanisms fail, due to sheer neurobiological overwhelm. Studies have found that higher oestrogen levels lead to better cognitive function, improved focus, task orientation, mental clarity, and motivation. Conversely, when oestrogen is low or falling—before a period, after pregnancy, or in perimenopause—the brain can become increasingly distracted, leading to poor working memory, reduced concentration, mental fogginess, lower stress tolerance, and emotional dysregulation.
Emotional Regulation and Midlife
Dr Wall says one of the most under-recognised symptoms of ADHD is the increased challenge with emotional regulation. Most menopausal women will recognise the I cannot do this anymore feeling, which can also be linked to changes in brain chemicals. The accumulated life load of midlife means women, whatever their neurodiversity status, are left reassessing priorities, feeling less need to people-please, and saying so what to life. This is linked to dopamine receptors in the brain; things that once felt good simply do not land the same way.
Changing hormones do not cause ADHD, but they can significantly change how an ADHD brain functions. As oestrogen becomes erratic, the brain can struggle to maintain stability. For women with ADHD, this can mean a chronically dysregulated dopamine system colliding with the dopamine disruption caused by hormonal change, often resulting in burnout. Undiagnosed ADHD can be totally unmasked by the knock-on effect of hormonal flux and midlife mental load—a perfect storm.
Clinical Implications
Dr Wall is keen to state that not all women in perimenopause or menopause who complain of brain fog will have undiagnosed ADHD, but clinicians should start considering it. She admits that she has seen women in their 40s for years with perimenopausal symptoms, and sadly she too did not have the knowledge or voice to recognise it for what it was. Many left her room with a diagnosis of stress, anxiety, or medically unexplained symptoms, and they will have left others too.
The book Menopause and ADHD: How to navigate hormone flux and neurodivergence is out now.
