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Perimenopause or ADHD? Why It Might Be Both (and What I Wish I'd Known Sooner)
I was diagnosed at age 42 with ADHD during the pandemic. I had conditioned myself to live by a calendar, a to-do list, and a regimented schedule. All of a sudden, that was gone. I used medication to get me through for years, and have now weaned myself off of them. But then, my estrogen keeps lowering, and I am finding it difficult to focus again.
I'd walk into a room and forget why. I'd lose words in the middle of a sentence. I was irritable, exhausted, and overwhelmed by things I used to handle without thinking.
I assumed it was stress. Or age. Or that I just needed to try harder.
It turned out to be two things at once: perimenopause and ADHD. I've now navigated both, and I've taken medication and gone without it. Here's what I wish someone had told me at the beginning.
Why perimenopause and ADHD overlap so much
Estrogen does a lot more than most of us were taught. One of its jobs is helping regulate dopamine, the brain chemical closely tied to focus, motivation, and memory. As estrogen starts to drop and swing during perimenopause, ADHD traits that were manageable (or carefully masked) for decades can suddenly get louder.
That's a big reason so many women are receiving their first ADHD diagnosis in their 40s. It isn't that ADHD appeared out of nowhere. It's that the hormonal support that helped us cope started to fade.
The symptoms overlap in ways that make it genuinely confusing: brain fog, forgetfulness, losing words mid-sentence, irritability, poor sleep, and that constant feeling of overwhelm. No wonder so many of us don't know where to start.
10 things I wish I'd known sooner
1. It might be perimenopause. It might be ADHD. It might be both.I like to say it's two problems wearing a trench coat. Don't let anyone (including yourself) assume it has to be one or the other. Ask to be evaluated for both.
2. "Suddenly" may not be sudden.If you've become forgetful, scattered, and overwhelmed in your 40s, it may not be new at all. You may have simply run out of the estrogen and energy it took to mask it for all those years.
3. Track your symptoms.For a few months, jot down how you feel alongside where you are in your cycle: focus, mood, sleep, energy, irritability. Bring those notes to your appointment. Data gets taken far more seriously than "I just feel off."
4. Losing your words doesn't mean you're losing your mind. Word-finding trouble is common in perimenopause, and it's a real symptom worth mentioning to your doctor. You don't have to panic about it in silence.
5. You're not lazy. This one took me the longest to believe. You're running a brain that needs a different operating manual than the one you were handed. That's not a character flaw.
6. Medication is a tool, not a moral test.Taking medication isn't cheating. Not taking it isn't failing. I've done both, and I've learned that what matters is what works for your brain in this season of your life, decided together with your doctor.
7. Build systems, not willpower. Willpower runs out. Systems don't. Keys go in one bowl. Bills get paid on one day each month. Alarms and reminders aren't embarrassing; they're brilliant tools. Every decision you automate is energy you get back.
8. Unexpected rage deserves curiosity, not shame. If you've snapped over something small and wondered where that came from, you're not alone. Shifting hormones, dopamine, and plain exhaustion can all light that fuse. Instead of beating yourself up, get curious about what's underneath it.
9. Stop comparing your behind-the-scenes to someone else's highlight reel. The women who seem to "have it all together" may have a team, a nanny, a prescription, or a very good filter. You're seeing their best angle while living your full reality.
10. Find a doctor who actually listens, and support for what happens between appointments. If your doctor brushes off both perimenopause and ADHD in the same visit, you're allowed to find a new one. And even the best doctor only sees you a few times a year. The daily work of building habits, managing energy, and creating routines that fit your brain happens in between.
Where coaching fits in
Here's what I noticed once I finally had answers: knowing what was going on didn't automatically change my days. I still had to figure out how to sleep better, eat in a way that supported my energy, move my body, and build routines that worked with my brain instead of against it.
That's the gap a health coach fills. Not replacing your doctor, but helping you turn "I know what I should do" into habits that actually stick.
That's exactly why I created THRIVE Through Midlife, a program for women ready to feel clear, strong, and like themselves again, with systems designed for midlife hormones and busy, beautiful, sometimes scattered brains.
You're in a new season.
If any of this sounds familiar, I want you to hear this: nothing is wrong with you. Your body and brain are changing, and you deserve support that reflects that.
Start by tracking your symptoms. Ask your doctor the direct questions. Build one small system this week. And if you'd like guidance along the way, I'd love to help.
This post reflects my personal experience and is not medical advice. Please talk with your healthcare provider about diagnosis and treatment options.
With love,
Sara
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