In my early 30s, I started having unexplained hot flashes, night sweats, and irregular periods. My doctor said I was in early perimenopause.
Thanks to my daily workout routine, I turned my health around. The night sweats and hot flashes went away and my monthly cycle became so regular I could predict it with accuracy.
When perimenopause returned, it seemed to come out of the blue, and it hit hard in ways I wasn’t expecting.
Suddenly all the tricks and hacks I’d developed to manage my ADHD stopped being as effective, including my medications.
Through discussions with other women and my own research, I’ve learned that perimenopause hits harder for women with ADHD.
Even as perimenopause and ADHD are discussed more publicly in our culture, there is less public discussion of the seventh circle of hell that is the confluence of ADHD and perimenopause.
If you are a woman with ADHD who is going through perimenopause, understanding why you seem to be suffering more than your friends can be helpful.
What Happens in Perimenopause
First, let’s start with understanding what’s happening during perimenopause.
Think of your body as a house equipped with a lot of smart technology. Every device and system that runs your house — windows, lights, thermostat, ovens, even faucets and toilets — is connected to a timer and automated. You never have to flip a switch or flush a toilet.
Imagine what would happen if the central clock that controls all the different timers went on the fritz. Suddenly, everything starts turning on and off at the wrong times. Your lights go on in the middle of the night, the thermostat spikes unexpectedly, the toilets flush at weird times.
This is essentially what happens in the body during perimenopause.
Perimenopause is a long period of time marked by a confluence of hormonal changes that impact the body’s rhythms. There’s no clear starting line or threshold at which you cross into perimenopause.
Perimenopause is often thought about as the end of the reproductive cycle of a woman’s life. But it isn’t just about the ending of the menstrual cycle.
Every organ and system in the body — from your heart to your liver to your lungs, operates on a rhythm. The hormonal fluctuations that occur in perimenopause knock the body’s systems out of their respective rhythms.
Understanding perimenopause as a dysregulation of the body’s rhythms helps give context to what’s happening.
After all, if you sweat profusely during a hard workout, you don’t call it a hot flash. It’s the sweating profusely at night, or at random times during the day, that turns a normal physiological response into a symptom of something else.
5 Reasons Why Perimenopause Hits Harder for ADHD Women
One of the challenges of both ADHD and perimenopause is that no two women have the exact same signs, symptoms, or experiences. That said, there are some basic factors that help explain why perimenopause can be especially destabilizing for ADHD women.
Here are some reasons why it hits harder for ADHD women.
(1) Harder to Discern the Onset of Symptoms
Missed or delayed periods and hot flashes are not the only signs and symptoms of perimenopause.
Perimenopause also brings other physical symptoms, such as joint pain and fatigue, as well as cognitive symptoms like brain fog and forgetfulness.
Many of these perimenopause symptoms mirror common ADHD symptoms.
Symptoms like brain fog, working memory lapses, trouble focusing, unexplained physical pain, and extreme fatigue are part of the “normal” ADHD experience.
Because many of the most common perimenopause symptoms mirror ADHD, ADHD women might be slower to seek treatment, which means we are suffering longer on our own.
(2) Deficit of Interoception
Many ADHD brains have low interoceptive awareness — we miss our bodies’ internal cues. This is why we often skip meals until we are famished, or we push too hard in a workout — we just don’t realize we’re hungry or that we’ve hit our limit.
One of the challenges of perimenopause in general is that many of the signs and symptoms are easy to attribute to other causes, like stress.
For ADHD women who already have trouble feeling physiological cues like hunger or workout fatigue, catching these other subtle changes is extremely difficult.
When we don’t notice the changes, we can’t seek help.
(3) ADHD Meds May Mask Perimenopause Symptoms
The stimulant medication that many women with ADHD take can mask the symtoms of perimenopause.
In the summer of 2024, I had a stretch of time when I couldn’t get my ADHD medications because of shortages. It was the longest period of time I had been without my meds since I started taking meds in my mid–20s. And it was only then that I started to see the profound difference of life without my meds.
In retrospect, I had been experiencing symptoms prior to then, but I had attributed those symptoms to the fact that my meds may have been losing effectiveness after 20 years.
It turns out to be both/and. My medication likely masked earlier onset of symptoms, and it began losing effectiveness as symptoms ramped up.
(4) The Estrogen Factor
One of the hallmarks of perimenopause is the fluctuation and decline of estrogen.
Estrogen isn’t just a “reproductive” hormone. It also plays a crucial role in creating and stabilizing dopamine and norepinephrine —the neurotransmitters responsible for motivation, attention, focus, and pain inhibition.
ADHD brains are already deficient in these chemicals.
In all women, the fluctuation and decline of estrogen that happens during perimenopause results in issues like brain fog, memory lapses, and increased joint pain.
But for ADHD women, who start with a deficit of dopamine and norepinephrine, estrogen decline removes the shaky floor we’ve been standing on. Motivation and focus fall off a cliff, pain skyrockets, and compensatory hacks we’ve relied on for years simply stop working.
(5) Loss of Identity
For all women, perimenopause is a transition to a new phase of life—we lose the person we’ve been as we step into this new stage.
For women with ADHD, this transition is often marked by profound loss of identity. As we lose the structure that kept us functioning, we also lose the “self” we knew who was capable of implementing hacks and compensations to get things done.
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