Standing in Tesco. Milk aisle.
You've been here for eight minutes staring at semi-skimmed and whole milk like it's a life-or-death decision. Your brain has buffered. Someone's trolley nearly hits you and you don't even notice because you're trying to remember why choosing milk feels this impossible.
Last week you forgot your best friend's birthday. You've known her since you were fourteen.
This morning you found your phone in the fridge next to the butter and your car keys in the bathroom cabinet.
Yesterday at the work meeting you nodded along while your colleague explained the new project timeline, but you retained absolutely nothing. You'll need to ask someone else what was actually said.
Your periods are all over the place.
You're Googling "perimenopause brain fog" at 2am (again), reading about oestrogen and memory problems and how this is all completely normal.
But the articles talk about forgetting the odd word or losing your train of thought.
They don't mention this paralysis. This overwhelming inability to do things that used to be automatic. This feeling like someone's swapped your brain for a faulty one.
And there's this nagging thought you keep pushing away.
What if some of this was always there? Not this bad, but there. The chaos you've managed so carefully for decades. The elaborate systems. The constant exhaustion from just trying to appear normal.
What if it's not just perimenopause?
We see you.
Here's something you need to know: research shows around 50-75% of women with ADHD remain undiagnosed.
Many don't discover it until perimenopause, when the coping mechanisms that worked for years suddenly collapse.
Learn more about how ADHD and menopause interact
Not because you're suddenly broken. Because your brain chemistry has fundamentally shifted, and the compensatory strategies you've built your entire life around can't keep up anymore.
Why Perimenopause Unmasks the ADHD That's Been There All Along
You're thinking one of two things right now.
Either "I can't have ADHD, I was never hyperactive as a child" or "surely someone would have noticed by now?"
Both make complete sense. And both are based on outdated understanding of how ADHD presents in women.
Women DisplayHave Different ADHD differently
Women typically have inattentive ADHD rather than hyperactive. That means daydreaming, zoning out, forgetting things, struggling with organisation. Not bouncing off walls. Just quietly struggling while everyone assumes you're fine.
Recent UK data shows women now screen positive for ADHD more than men, suggesting decades of missed diagnoses are finally being recognised.
Your Elaborate Scaffolding
Think of it like this: you've been building elaborate scaffolding around your brain differences for decades.
Lists upon lists. Phone alarms for everything. Working twice as hard as everyone else to get the same results. People-pleasing your way through social situations that felt baffling. Internalising every failure as proof you were broken rather than recognising you had a neurological condition making certain things genuinely harder.
Your compensatory strategies have been working.
Then perimenopause kicks the scaffolding away.
The Oestrogen-Dopamine Connection
Here's what nobody tells you about perimenopause and ADHD:
Oestrogen has been propping up your dopamine levels your entire adult life.
Research shows oestrogen directly influences dopamine production and regulation in the brain. Dopamine is the neurotransmitter already naturally lower in people with ADHD. It's crucial for focus, motivation, memory, and executive function—your ability to plan, organise, and actually get things done.
When oestrogen starts declining during perimenopause, dopamine drops further.
For neurotypical women, this causes the brain fog everyone talks about as a "normal" perimenopause symptom.
But for women with undiagnosed ADHD who've been compensating all their lives?
Catastrophic.
Your mental scaffolding collapses. The coping strategies stop working. Tasks you could manage before become impossible.
What the Research Shows
A 2024 survey of over 1,500 women found something striking: 94% said their ADHD symptoms grew more severe during perimenopause and menopause.
But here's the part that should make every GP sit up and pay attention: 83% experienced ADHD symptoms for the first time during this period.
That doesn't mean they suddenly developed ADHD at 47. It means the hormonal changes made their underlying ADHD impossible to ignore anymore.
Studies examining ADHD symptoms across the menstrual cycle confirm that attention and executive function worsen when oestrogen levels drop. Women with ADHD often notice their symptoms fluctuate with their cycle—worse during low-oestrogen phases, slightly better when oestrogen rises.
In perimenopause, instead of predictable monthly fluctuations, you get erratic and generally declining oestrogen. Unpredictable dopamine availability on top of already-low baseline levels.
No wonder everything feels harder.
We know you're probably worrying whether this means something's seriously wrong. (And yes, we know you've Googled "early dementia symptoms" at 3am this week.)
It doesn't mean that.
Your brain works differently, and it's been working differently all along. Perimenopause has just turned up the volume.
The Symptoms That Finally Sent You Googling at 2am
You know what your symptoms are because you're living them. But seeing them written down sometimes helps you realise you're not going mad.
Brain fog that's more than forgetting words
You lose entire thoughts mid-sentence. Read the same paragraph five times and retain nothing. Stand in rooms having no idea why you're there. Tasks that used to be automatic—making dinner, replying to emails, following a conversation—now require conscious effort you don't have.
Overwhelming overwhelm
Not just stress. Proper paralysis when faced with multiple tasks.
You know what needs doing but you cannot start. Your brain buffers. People tell you to make a list as if you haven't been making lists your entire life and they've stopped working.
Research describes this as executive dysfunction—the inability to initiate, plan, and complete tasks even when you desperately want to. It's one of the hallmark features of ADHD, and perimenopause makes it devastatingly worse.
Time blindness
Two hours passes in what feels like ten minutes. You genuinely cannot estimate how long things take. You're chronically late despite trying desperately not to be. Deadlines sneak up on you even when you've written them down.
Emotional dysregulation
You snap at people over tiny things. Cry at adverts. Feel everything more intensely than seems reasonable. You're exhausted from trying to regulate emotions that feel like they're running the show.
Studies show emotional dysregulation is a core feature of ADHD, not a personality flaw. Your nervous system is more reactive. Perimenopause, with its hormonal chaos, amplifies this tenfold.
Executive function problems
Starting tasks is impossible. Finishing them is worse. Your house is full of half-read books and abandoned craft projects. Deciding what to have for dinner feels genuinely difficult.
Memory problems that feel scary
Forget appointments you wrote down. Forget conversations from yesterday. Forget what you were doing thirty seconds ago.
(And yes, we get why you're Googling dementia. We'll come back to that.)
Sensory overload
Noisy environments are unbearable. You can't filter background noise. Certain textures or sounds trigger genuine distress. You need to leave social situations early because you're just done.
How Do You Know If It's ADHD or Just Perimenopause?
This is the question keeping you up at 2am, isn't it?
Around 70% of women going through menopause experience cognitive symptoms. The overlap with ADHD symptoms is massive. So how do you distinguish between them?
Timing matters
ADHD symptoms must have been present before age 12 for diagnosis.
You don't need to remember specific incidents at age 11. But there will have been signs. Maybe you daydreamed constantly at school. Maybe teachers said you weren't working to your potential despite trying harder than anyone realised. Maybe you had friendship difficulties because social cues felt like a foreign language. Maybe you were anxious or had low self-esteem.
Research shows girls with ADHD are often described as "bright but disorganised" or "capable but careless." Your school reports might reveal patterns you didn't recognise as ADHD at the time.
If symptoms appeared suddenly in your 40s alongside hot flushes and period changes, that's more likely perimenopause alone.
If you've had a lifetime of struggling with attention and organisation but it's got dramatically worse recently, that suggests undiagnosed ADHD being unmasked.
Your response to HRT tells you something
HRT alone may improve perimenopause cognitive symptoms for neurotypical women.
But if you're on HRT and you've got some relief from hot flushes and sleep problems but you're still struggling with focus, memory, and executive function, that's a strong indicator of underlying ADHD.
HRT restores oestrogen levels, which helps. But it doesn't address the fundamental dopamine dysregulation of ADHD.
ADHD isn't just attention problems
It comes with hyperactivity (in adults this looks like restlessness, difficulty relaxing, feeling internally wired) and impulsivity (interrupting people, making snap decisions you later regret, struggling to wait).
If you recognise yourself in these patterns alongside the cognitive symptoms, ADHD is more likely.
The frustrating truth?
You might have both. Perimenopause can absolutely be making genuine ADHD worse. It's not either/or. You've always had ADHD, you've been coping, and perimenopause has pushed you over the edge.
We get that the not-knowing does your head in. But understanding that what you're experiencing is real and has a name matters.
Why Diagnosis Happens in Your 40s and 50s
You're not alone in this late discovery.
Girls with ADHD are systematically missed
Diagnostic criteria were developed based on how ADHD presents in boys. Hyperactive, disruptive behaviour gets noticed. Quiet daydreaming doesn't.
A 2023 systematic review examining ADHD in adult women found that "women and girls have been systematically under-identified" and that "the majority of females with ADHD remain undiagnosed."
The review identified multiple factors: sex-biased diagnostic criteria, later age of diagnosis for women, and a tendency to attribute symptoms to other conditions like anxiety or depression.
Women develop elaborate coping mechanisms
You probably have systems for everything. Lists, reminders, colour-coded calendars. Notes stuck everywhere. Phone alarms for things you might forget. Careers chosen to play to your strengths. Constant people-pleasing to mask difficulties with social cues.
You've structured your entire life around managing symptoms you didn't know were symptoms.
These compensatory strategies work for years. Until they don't.
The point where they stop working often coincides with perimenopause.
Research describes this as the "triple threat" for women in mid-life: ADHD, hormonal changes, and increased life demands (caring responsibilities, career pressure, ageing parents) create a perfect storm.
Doctors don't always make the connection
Many GPs are more familiar with ADHD in children than adults. They might attribute your symptoms entirely to perimenopause without considering underlying ADHD.
Or they might diagnose depression or anxiety (which often coexist with ADHD) while missing the ADHD underneath.
A 2014 review examining ADHD in women noted that "clinicians may be less likely to recognise and diagnose ADHD in females" and emphasised the need for better awareness of how the condition presents differently in women.
Your child's diagnosis triggers recognition
This is incredibly common.
Your child gets assessed and as you're describing their symptoms, you have an uncomfortable realisation: you were exactly like this. You still are.
Time and again, we see women feel angry when they realise how long they've struggled with undiagnosed ADHD.
That's valid. You've spent decades thinking you were failing at things everyone else found easy.
But you've survived. Built a life despite these challenges. And now you have the possibility of understanding and support.
What's Happening in Your Brain
Understanding the neuroscience helps. It's not your fault. It's neurological.
The dopamine system
Dopamine is responsible for motivation, reward, pleasure, and executive function. It helps you start tasks, maintain focus, remember things, and regulate emotions.
People with ADHD have naturally lower dopamine levels or differences in how their brain processes it. That's not a character flaw. It's a measurable difference in brain chemistry.
The oestrogen connection
Research examining reproductive hormones and ADHD shows oestrogen influences dopamine production and receptor sensitivity throughout the brain.
When oestrogen is higher, your brain can produce and access dopamine more effectively. When oestrogen drops, dopamine availability drops too.
For neurotypical women, declining oestrogen during perimenopause causes the brain fog everyone recognises as a perimenopause symptom.
But for women with ADHD who already have lower dopamine, this further drop is devastating. Your dopamine-starved brain loses the oestrogen support it's been relying on.
Studies demonstrate that attention and executive thinking skills improve when oestrogen levels are higher but worsen when oestrogen levels are lower. This is why women with ADHD often notice symptom patterns across their menstrual cycle, with worse symptoms during low-oestrogen phases.
In perimenopause, instead of predictable fluctuations, you get erratic hormone levels. Some days you might have reasonable oestrogen levels and relatively okay dopamine function. Other days, almost nothing.
Why your medication might feel less effective
Many women report their ADHD medication seems less effective during perimenopause. Lower oestrogen can reduce how well stimulant medications work. Some women need dose adjustments. Others find adding HRT alongside ADHD medication provides better symptom control than either treatment alone.
Getting an ADHD Assessment in the UK
Your first step is talking to your GP.
What to say
"I think I might have ADHD. I've been struggling with [your specific symptoms] and I've had difficulties with attention and organisation since childhood, but they've got dramatically worse recently." Bring examples if it helps.
What happens next
Your GP cannot formally diagnose ADHD but can refer you for specialist assessment.
They may want to rule out other conditions first like thyroid function, vitamin deficiencies, other medical issues. That's standard practice, not dismissal.
The wait
You'll be referred to an ADHD specialist service.
NHS waiting times vary hugely by area. Be prepared: you might wait months or years.
Option: Ask your GP about the Right to Choose scheme, which allows you to choose where you're seen, including private clinics providing NHS-funded assessments. This can significantly reduce waiting times.
The assessment itself
The specialist will ask about current symptoms and your childhood.
Adult ADHD diagnosis requires evidence of symptoms present before age 12. This doesn't mean you need to remember specific incidents. It means there's evidence of ADHD-type difficulties in your developmental history.
If you don't have clear childhood memories, the specialist might want to speak with someone who knew you as a child (parent, older sibling, childhood friend) or review old school reports.
Many women discover comments like "bright but easily distracted" or "needs to focus more" or "doesn't work to potential" scattered throughout their school history.
Don't forget the menopause part
If you're experiencing menopausal symptoms, see a menopause specialist alongside pursuing ADHD assessment.
Menopause specialists have specific training in hormone health that many GPs don't. Ideally, you want healthcare professionals who understand both conditions and how they interact.
While you're waiting
Keep a symptom diary. Track when symptoms are worse, note patterns with your menstrual cycle if you're still having periods, and document how symptoms affect different areas of your life.
This information helps the specialist understand your presentation and can support diagnosis.
Learn more about how to find specialist support for ADHD
Treatment: HRT, ADHD Medication, or Both?
The answer for many perimenopausal women with ADHD is: both.
ADHD medication
First-line treatment is usually stimulant medication (methylphenidate or lisdexamfetamine). Research shows these medications improve memory, task management, and organisation by directly addressing dopamine dysregulation. Non-stimulant options like atomoxetine are alternatives if stimulants don't suit you.
HRT
If you're perimenopausal or menopausal, hormone replacement therapy might help both menopausal symptoms and ADHD symptoms by restoring oestrogen levels. But HRT alone typically isn't enough to treat ADHD.
The combination approach
Many specialists recommend both for perimenopausal women with ADHD. HRT provides hormonal stability. ADHD medication addresses the dopamine issues. The two treatments work through different mechanisms and complement each other.
Important: If you're already on HRT but still struggling with focus, memory, and executive function, mention this when discussing ADHD assessment.
Other support that helps
CBT (Cognitive Behavioural Therapy) develops coping strategies, manages emotional dysregulation, and addresses anxiety or depression that often coexist with ADHD.
ADHD coaching teaches practical skills: time management, organisation systems, task initiation strategies. This can be invaluable for building new compensatory strategies as old ones fail.
Lifestyle changes: Regular physical activity improves ADHD symptoms. Sleep hygiene helps (though sleep problems are common in both ADHD and perimenopause). Some women find reducing caffeine and alcohol helps, particularly as sensitivity increases during perimenopause.
Remember: Treatment is individualised. What works brilliantly for one woman might not suit another. Finding the right medication, dose, and combination of supports often takes time. That's completely normal and expected.
What This Means For You
You're standing in that uncomfortable space between "maybe it's just perimenopause" and "maybe there's something else." We get it.
If you've always struggled with focus, organisation, time management, or emotional regulation, but you coped reasonably well until perimenopause, it's entirely possible you have undiagnosed ADHD. The hormonal changes haven't caused it. They've revealed it.
This isn't about finding another thing wrong with you. It's about finally having an explanation for difficulties you've blamed yourself for. It's about accessing support that might actually help.
Getting an assessment doesn't commit you to anything. It's information gathering. You just need to take the next step. For most women, that's booking an appointment with your GP.
Please be kind to yourself. You're not failing. You're not lazy. You're not weak. You're dealing with a neurological condition that's been undiagnosed for decades, compounded by hormonal chaos.
You're not going mad. You're not developing dementia. Your brain works differently, and perimenopause has made that difference impossible to ignore. That's actually valuable information, even though discovering it this way is rough.
We see you. This is real. You deserve support.
¹- NHS. ADHD in adults. https://www.nhs.uk/conditions/adhd-adults/
²- NHS England Digital. Chapter 9: Attention deficit hyperactivity disorder - Adult Psychiatric Morbidity Survey 2023/24. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/attention-deficit-hyperactivity-disorder
³- Attoe DE, Climie EA. (2023). Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10173330/
⁴- Quinn PO, Madhoo M. (2014). A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. The Primary Care Companion for CNS Disorders. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4195638/
⁵- Eisenlohr-Moul TA, et al. (2017). Reproductive Steroids and ADHD Symptoms Across the Menstrual Cycle. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5803442/
⁶- Schechter JC, et al. (2024). Attention-Deficit/Hyperactivity Disorder and the Menstrual Cycle: Theory and Evidence. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10872410/
⁷- Menopause Care UK. ADHD and Menopause. https://www.menopausecare.co.uk/blog/adhd-and-menopause
⁸- ADDitude Magazine. (2024). ADHD Impairment Peaks in Menopause, According to ADDitude Reader Survey. https://www.additudemag.com/menopause-symptoms-adhd-survey/
⁹- NHS. Attention deficit hyperactivity disorder (ADHD) - Diagnosis. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/diagnosis/
