ADHD and Perimenopause

Updated: 4 days ago

I am a late-discovered AuDHD female.

At 49 years old, I was diagnosed with both ADHD and Autism.

Before that, I had spent decades building a life that, from the outside, looked successful and “high functioning.”

I had a career, a husband, raised two boys, studied at university level and managed the demands of everyday life.

But internally, life often felt much harder than it seemed to be for everyone else.

The constant burnouts, mental noise, overwhelm and emotional exhaustion.

The feeling that I was always coping, but never truly thriving.

I masked. I adapted.

Then perimenopause arrived...and the brain fog, emotional dysregulation, exhaustion, sensory overwhelm, and executive dysfunction were impossible to ignore.

It felt like all the coping strategies I'd relied on for decades suddenly stopped working.

What I didn’t realise at the time was that many women first discover they have ADHD during perimenopause and menopause.

This is my experience of ADHD and Autism, the impact of perimenopause and my late diagnosis through the NHS Right to Choose pathway via Clinical Partners.

(DISCLAIMER: this is MY story and my experience. I’m not a medical professional and this post is not a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice on the topics covered in this post)

(And this post may contain affiliate links, meaning if you click on a product or service, and decide to purchase it, I may receive a small commission at no extra cost to you)

Why Autism and ADHD in Women Often Go Unnoticed

For almost 50 years, I had no idea I was neurodivergent.

Like many women with inattentive ADHD and Autism, I didn’t fit the stereotypical image.

I wasn’t disruptive.

I wasn’t outwardly hyperactive.

I was quiet, introspective, anxious, highly sensitive and constantly overthinking.

Instead of external chaos, I internalised everything.

Like many late-diagnosed women, I became exceptionally good at masking.

I learned how to appear capable, organised, calm, and ‘fine’, even when I was struggling.

This is what’s now widely recognised as ‘masking’.

And masking can work for years…until it suddenly doesn’t.

For so many women, that breaking point arrives during perimenopause.

ADHD Symptoms in Women Can Look Very Different

One reason ADHD in women is so often missed is because symptoms frequently present differently to the traditional male stereotype many people still associate with ADHD.

Instead of visible hyperactivity, ADHD symptoms in women often include:

Women with undiagnosed ADHD are often labelled as too emotional, disorganised, lazy or dramatic.

Many spend years blaming themselves for difficulties that were never character flaws in the first place.

The link between ADHD and Perimenopause

Perimenopause was the catalyst that finally brought everything to the surface for me.

Hormones, particularly oestrogen, play an important role in dopamine regulation within the brain.

Dopamine affects focus, motivation, attention, emotional regulation and executive functioning.

As oestrogen levels fluctuate during perimenopause and menopause, many women notice a dramatic worsening of ADHD symptoms.

For me, it felt like my brain had short-circuited.

The coping mechanisms I had relied on my entire life simply collapsed.

It suddenly felt impossible to continue masking.

What is AuDHD?

I am what’s known as AuDHD, meaning I am both Autistic and have ADHD.

Although Autism and ADHD are often misunderstood as opposites, they commonly co-exist.

Receiving an AuDHD diagnosis finally helped me understand myself with more compassion.

It explained patterns I had spent a lifetime criticising myself for.

The Problem With “High-Functioning”

Like many AuDHD women, I was considered ‘high-functioning’, a term that’s more damaging than helpful.

It meant I succeeded at work, masked well in social situations and didn’t cause ‘problems.’

But it also meant I was never seen as someone who might be autistic. Or ADHD. Or struggling.

Behind the scenes, I lived in a constant state of internal panic.

I needed recovery time after every social event.

I overcompensated with perfectionism.

I obsessed over details most people wouldn’t notice.

I pushed myself to exhaustion, again and again.

And when perimenopause hit, the system broke down.

My ADHD Diagnosis Through NHS Right to Choose and Clinical Partners

In late 2024, I was diagnosed with both ADHD and Autism through the NHS Right to Choose pathway using Clinical Partners.

The NHS Right to Choose ADHD and Autism pathways allows patients in England to request referral to approved providers for ADHD assessment, rather than remaining on extremely long local NHS waiting lists.

Like many adults seeking ADHD and Autism diagnoses in the UK, I was facing the reality of waiting years for assessment through standard NHS routes.

Using Right to Choose meant I could access an NHS-funded neurodevelopmental assessment much sooner. In 2024, it took around 9 months.

Receiving my diagnosis was both validating and emotional but it also raised difficult questions about what support comes next.

The Reality After an Adult ADHD Diagnosis in the UK

One thing that isn’t discussed enough is what happens after diagnosis.

Although I received my diagnoses through the NHS Right to Choose pathway, ongoing support was far less straightforward.

There was no immediate treatment pathway or structured follow-up support.

In fact, there was stone cold…silence.

Stimulant medication was recommended by my assessor, but my GP could not prescribe it because ADHD medication management sits outside their expertise.

I was left in a difficult position:

diagnosed, but untreated
validated, but still struggling
relieved to finally have answers, but unsure what came next

I was placed on yet another Right to Choose waiting list, this time for medication titration through Clinical Partners, and again this took nearly a year.

Titration is the process of starting medication safely and gradually, while monitoring how your body responds.

(At the time of writing, I started medication a few weeks ago. It’s early days so I will come back and update this blog).

During this time, I’m having regular contact with a prescribing nurse who monitors my progress and is adjusting my treatment where needed.

The aim is to help you reach a stable, or ‘optimised’, dose that offers the greatest benefit with the fewest side effects.

What's helped me so far

Hormone Replacement Therapy (HRT/MHT)

I'm a huge advocate for HRT and it has been extremely beneficial to me.

It's helped stabilise my mood, energy levels and cognitive clarity during perimenopause.

While HRT is not a treatment for ADHD itself, many women find that supporting hormonal health can reduce the intensity of worsening ADHD symptoms during menopause.

You can learn more about HRT on my blog where I share lots of information about all things menopause.

Supplements for ADHD and perimenopause

Alongside HRT, I’ve also explored nutritional support to help with the cognitive and emotional impact of both perimenopause and neurodivergence.

One supplement that has personally helped me is NuMind Menopause Support.

I’ve found the combination of ingredients particularly supportive during perimenopause, especially for stress resilience, mental clarity, emotional regulation, energy, and nervous system support.

The formula contains a broad blend of vitamins, minerals, adaptogens, and cognitive-support ingredients including magnesium glycinate, L-theanine, ashwagandha, rhodiola, bacopa, lemon balm, CoQ10 and B vitamins.

Many of these nutrients are commonly associated with supporting stress response, cognitive function, dopamine pathways, sleep and mental fatigue during periods of hormonal change.

They've helped me be calmer, improved my focus and given me a greater sense of resilience.

As with all supplements, what works for one person may not work for another and it’s always important to seek professional advice, particularly if you are taking medication, HRT or managing other health conditions.

(You can however get 20% off with my code JANE20)

BUY NUMIND MENOPAUSE HERE

The government scheme Access to Work

I also applied for Access to Work support, which provides funding and workplace assistance for people with disabilities and health conditions.

This helped me access coaching and practical tools tailored to how ADHD and Autism affect my work and daily functioning.

The support you get will depend on your needs.

You can apply for:

a grant to help pay for practical support with your work
support with managing your mental health at work
money to pay for communication support at job interviews

After explaining my specific needs and having an assessment, I was given funding for noise-cancelling headphones, meeting transcript software and 'workplace strategy coaching'.

FIND OUT MORE ABOUT ACCESS TO WORK HERE

Learning from experts and people with lived experience

I’ve found enormous comfort in learning from clinicians, advocates and other women sharing their experiences of ADHD in women and menopause.

Dr Helen Wall and Dr Emma Ping are doctors with a special interest in ADHD in women.

Books like “Unmasked” by Ellie Middleton and “ADHD an A to Z” by Leanne Maskell have helped me see how Autism and ADHD manifest in women.

There's also an incredible book “Rediscovered: A Compassionate and Courageous Guide for late discovered autistic women (and their allies) by Catherine Asta.

And 'Odd Girl Out' by Laura James has really helped me. Laura's story is so similar to my own.

Frequently Asked Questions - FAQS

Is ADHD worse during menopause?

Yes, ADHD symptoms can worsen during menopause due to fluctuating oestrogen levels, which impact dopamine production, a key neurotransmitter involved in focus and executive function.

Many women find their usual coping strategies less effective, leading to increased forgetfulness, brain fog, and emotional dysregulation.

Does HRT help with ADHD?

Hormone replacement therapy (HRT) may help some women with ADHD during menopause by stabilising oestrogen levels, which can improve cognitive function and emotional regulation.

HRT is not a direct treatment for ADHD but may offer relief for related symptoms like brain fog and mood swings.

What are ADHD symptoms in women?

ADHD symptoms in women often include difficulty with focus, disorganisation, impulsivity, emotional sensitivity, and struggles with time management.

Many women also experience chronic overwhelm, forgetfulness, and difficulties in maintaining routines, which can intensify during hormonal shifts like menopause.

What is ADHD masking in females?

ADHD masking refers to the unconscious effort women make to hide their symptoms by mimicking neurotypical behaviour, overcompensating or developing coping strategies that can be exhausting.

This can lead to anxiety, burnout, and a delayed or missed diagnosis as their struggles may be overlooked or mistaken for stress or emotional issues.

What makes ADHD worse?

ADHD symptoms can worsen due to stress, lack of sleep, poor diet, hormonal changes (such as menopause or menstrual cycles), and overstimulation.

Lifestyle factors like excessive caffeine, high sugar intake, and inconsistent routines can also exacerbate difficulties with focus, memory and emotional regulation.

Finding What Works for You

Managing ADHD in midlife, especially when combined with perimenopause, can feel overwhelming but understanding the connection is the first step toward regaining control.

The key is to experiment and find what works for you.

ADHD and Autism aren’t one-size-fits-all, and neither are the solutions.

Have you found a strategy that works for you? I’d love to hear about it, drop a comment below.