I’m being increasingly asked about ADHD during perimenopause and to be honest, I’m really happy that these questions are being asked. Because it tells me that awareness about these two ‘conditions’ is growing amongst people in the broader community. That can only be a good thing as there is considerable misinformation about each on its own, let alone when they present together.

When does this question pop up? Well, I get referrals from GP’s asking for my opinion as to the relevance of either (or both) for their patients and my clients, colleagues and friends ask if I think they are ‘ADHDers or if it’s just perimenopause’. On top of that, it's also a question I’m frequently asked during most of my guest podcast experiences (podcasts on menopause, midlife and/or ageing). 

I’m happy to share my perspective, because I am both.  I am a perimenopausal woman and an ADHDer. Not only that, I am what is referred to as ‘late diagnosed’ (I was diagnosed nearly 4 years ago at 46 years of age) AND a clinical psychologist. The lived and (now) professional experience means I can offer a professional perspective based within ‘real life’.

But before I go any further, let’s get clear with what I’m talking about when it comes to perimenopause and ADHD.

Perimenopause: The Basics

 The term ‘menopause’ describes the time in a woman’s life where she is no longer fertile. The average age for menopause is around 51. Women reach menopause when they have not had a period for 12-months. Some exceptions are those of us who’ve had a hysterectomy but kept our ovaries. And it’s not the indicator used for women who have entered menopause due to surgery (oophorectomy) or medication. The term ‘post-menopausal’ is used to describe the stage of life AFTER this ‘day’ on which a woman has reached menopause. 

Until recently, most women only really knew about menopause and post menopause. However, it’s important to know that there is a period of significant change in the years prior to menopause. This is referred to as perimenopause and can begin as early as the late 30’s/early 40’s. The perimenopausal period can last between 4 to 10 years and is a time where women’s hormones (particularly oestrogen and progesterone, but also testosterone) fluctuate but overall, decline.

Due to these changes in our hormones, women can experience a range of symptoms. Some of the better known symptoms include hot flushes, night sweats, weight gain, vaginal dryness and sleep disturbance. However, there are many other symptoms that women can experience such as mood disturbance (depression and/or anxiety), cognitive issues (brain fog, memory issues) as well as joint and muscle pain, reduced libido, fatigue and migraines. What’s not known by many, is that the changes in mood often occur before those ‘better known’ symptoms. In fact, challenges like hot flushes and night sweats tend to appear in the latter stages of the perimenopausal years

Perimenopause is more than these symptoms even though it is often talked about as if it’s an isolated experience that occurs in a vacuum.. Perimenopausal women have lived full lives before they reach this stage which means that they ‘bring’ that history to their perimenopausal experience. Pre-existing health conditions as well as prior mental health issues impact perimenopause and need to be considered, when determining how best to navigate these years.

Other factors such as the type of support available to them as well as their roles and responsibilities, the nature and demands of their employment and the workplace itself, their financial circumstances as well as their access to accurate information, informed health care providers and the full range of management approaches / treatments, all influence how the menopausal years are experienced.

On top of that, while some women enter perimenopause earlier than is ‘typical’ (due to premature ovarian insufficiency, medical or surgical menopause or hysterectomy), most women experience perimenopause during their midlife. The relevance of this is that midlife is full of life events that bring stress/strain, loss, grief etc.. such as caring for or the passing of elderly parents, partners / friends / siblings becoming ill, the breakdown of relationships, teenagers / young adults experiencing their own life challenges and/or moving out of home and increased responsibilities at work given the decades of experience in their chosen fields. 

So while peri/menopause is a neuroendocrine event, there are many additional factors that have their own (often) significant influence at the same time. As such, it's important that we take a ‘whole woman in context’ approach to wellbeing throughout these years. It’s also important that our health care providers also take a holistic approach. This does not  necessarily mean one healthcare professional provides all the support / intervention but instead, that all healthcare professionals provide the expertise they possess and encourage / guide / support women in the additional pathways that would also support and improve their wellbeing. 

ADHD: The Basics

In diagnostic systems, ADHD refers to Attention Deficit Hyperactivity Disorder. However, the ADHD community typically reject the notion that ADHD is a ‘disorder’ and instead are of the firm perspective that ADHD reflects a difference. Despite this, the ADHD community also recognises that modern day life is set up to best support those who are ‘neurotypical’. And that the challenges ADHDers tend to experience are caused by the ableist social structure they have to live within, rather than any inherent deficit within them.

Keeping this in mind, ADHD reflects a difference in neurology that affects attention, thinking, processing and impulse. ADHD results from an individual’s brain developing differently during key stages of development before they were born or as a very young child. ADHD is not a ‘state of mind’ but instead, a reflection of the individual’s ‘normal’ self. 

The primary hallmarks (and diagnostic criteria) of ADHD include challenges with attention / concentration and hyperactivity / impulsivity. Individuals can be a combined presentation (both inattentive and hyperactive), predominantly inattentive presentation or predominantly hyperactive/impulsive presentation. However, it’s important to know that the diagnostic criteria for ADHD is based upon how it tends to show up in boys. This is largely because like for most health, mental health and neurodevelopmental conditions, the research that identified their aetiology and informed assessment and treatment, was based on males. In the case of ADHD, it was based on boys. As a result, Attention Deficit Hyperactivity Disorder (ADHD) in women is often underdiagnosed or misdiagnosed. However, over the past few years, our understanding of ADHD has broadened such that we now know how it can ‘show up’ in females.

Women with ADHD typically experience symptoms related to inattention, such as difficulty maintaining focus, disorganisation, and a tendency to overlook details that can lead to errors at work or in managing home life. Unlike their male counterparts, who may display more overt symptoms like physical hyperactivity and impulsiveness, women often exhibit less noticeable signs. For women, impulsivity can often show up by a consistent pattern of interrupting others, finishing their sentences, adding their own comment and/or making blunt and/or ‘inappropriate’ comments (i.e. often described as “foot in my mouth’). Their hyperactivity can be far more subtle in that they twirl their hair, bite or tap their nails, move frequently in their chair or jiggle their leg while sitting. It can also manifest internally as endless thinking. This thinking doesn’t tend to be ruminative (i.e. the same thought again and again and again) but instead manifests as thoughts, leading to other thoughts, to other thoughts etc…. 

The impact of ADHD on women stretches far beyond a bit of daily disarray—it can deeply influence their emotional well-being too. It's a tough gig, especially since women are often diagnosed later than men, if at all. Imagine constantly feeling misunderstood and hearing whispers that you're just not trying hard enough or that you're a bit scattered. Many women with ADHD battle with feelings of low self-esteem, anxiety, and depression. These emotional roller coasters often stem from repeated frustrations and perceived failures at school, work, or in social circles. It’s like being in a game where no one has explained the rules to you let alone the fact that those rules favour the other players! 

Want to Know More?

Raising awareness and deepening the understanding of perimenopause and ADHD is crucial—not just important—for timely and effective support. If you suspect you might be one of the many perimenopausal women with ADHD, check out the other articles in this ADHD and Perimenopause Series www.allabouthercentre.com.au and/or seek out a healthcare provider who knows this space well. Feel free to reach out to me via www.allabouhercentre.com.au if you need guidance as to how to go about being assessed or ongoing support.