How Perimenopause Unmasked My ADHD
How Perimenopause Unmasked My ADHD
It was a hot Nashville summer evening. I sat on my couch and legitimately thought I was losing my mind.
At the time, I was 46 years old. I wasn't a "cancer survivor" yet. I was just a woman who had always been able to do hard things, suddenly feeling like the world was closing in on me.
I wasn't just "stressed." I was catastrophizing. I was convinced my plane would crash. I was certain someone was going to kidnap me. I nearly canceled a beach vacation because of it. I couldn’t start a simple work task, and when I did, I couldn’t stay focused long enough to finish it.
I was an "avoider" - hoping if I ignored a problem long enough, it would just evaporate. Spoiler: It never does.
At first, my doctors and I thought it was anxiety brought on by the hormone changes of perimenopause. I started HRT with estrogen patches and progesterone, but then life threw a massive curveball: a breast cancer diagnosis. I had to stop all hormone therapy immediately.
As my cancer treatment wrapped up, the "anxiety" was still screaming. It wasn't until I started cancer survivorship therapy that the pieces finally clicked.
My therapist recognized my symptoms and behaviors. I wasn't dealing with anxiety. She believed I was dealing with ADHD and combined with the hormone changes of perimenopause, it was presenting as anxiety.
She was right. After testing was complete, I was not diagnosed with anxiety. It was ADHD Combined Type, and the hormonal shifts of perimenopause had sent it into overdrive.
The Dopamine Connection: Why Now?
You might be wondering why so many women in our 40s are suddenly getting diagnosed with ADHD when we "seemed fine" as kids. Here is the science: Estrogen is a total rockstar when it comes to your brain. It helps modulate dopamine - the neurotransmitter responsible for focus, motivation, and reward.
When estrogen levels start to tank in perimenopause, your dopamine levels take a hit too. For women with "quiet" ADHD that we managed to mask for decades, the loss of estrogen is like pulling the rug out from under us. The symptoms go from "manageable quirks" to "I can't function."
We weren't diagnosed as kids because, back then, ADHD was seen as a "little boy's problem." We were missed because we were, on the surface, "succeeding". We are often high achievers. We are people pleasers. We do as we were told because making the people around us happy stimulates the dopamine that our ADHD is struggling to regulate.
But when perimenopause hits, the mask slips. We are irritable beyond reason. Relationships take a hit. Spouses don't understand what's happening to us. WE don't understand what's happening to us.
But now that we know better, we can do better.
Fighting Back with Systems
Getting the right ADHD medication was a game-changer for me. The catastrophizing stopped. But medication is only one tool. Now that I know why I am the way I am, I had to build systems to support my brain when my hormones couldn't.
Strength Training is Non-Negotiable: Being in perimenopause makes lifting heavy even more critical. As estrogen drops, we have to work harder to keep our bodies sensitive to insulin and keep our bone density strong. I am fighting to keep every ounce of muscle I have for the long haul.
The "Say It Out Loud" Rule: ADHD brains struggle with working memory. Now, I narrate my life. When I lock my car, I say out loud, "I locked my car." When I sit at my desk, I say, "I am going to write a new blog post." It sounds simple, but it "locks" the action in my brain.
The Protein Pivot: I don't love eating the same meal five days in a row, but I also can't handle the "decision fatigue" of cooking from scratch every night. I prep "plain" protein, like a mountain of chicken breast. Then, I can turn it into tacos, salads, or sandwiches depending on what my brain wants that day.
The Checklist Manifesto: If it isn't on a list, it doesn't exist. I use checklists for my business tasks so I don't "avoid" the hard stuff. Crossing things off gives my brain that little hit of dopamine it’s craving.
You Aren't Losing It
If you are a woman in your mid-30s, 40s, or 50s and you feel like you are reeling, please hear me: You aren't failing. You might just need a different set of tools. If these symptoms sound familiar, please reach out to your doctor. Don't settle for "it's just stress."
You will never regret being strong, but the day might come when you wish you were. That strength starts with taking care of your brain, too.
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You will never regret being strong.
