Perimenopause hit me like a freight train. Sleepless nights, night sweats, brain fog, and anxiety, and not my usual anxiety either. I'd wake up anxious for no reason at all. Nothing had happened, nothing had set me off. My nervous system was apparently screaming "WE HAVE A PROBLEM!" the moment I opened my eyes, except there wasn't one.
Then came the heart palpitations and the abdominal weight gain, despite eating well and exercising regularly. (Before anyone jumps in: yes, bodies change, there's nothing inherently wrong with gaining weight, and I'm firmly in the health-at-every-size camp. That doesn't mean I have to enjoy feeling uncomfortable in my own body.) My skin lost elasticity, my hair thinned, the wrinkles showed up, and I was tired in a way that had me wondering where my energy had gone and whether it was ever coming back.
None of that is what most of us picture when we hear "perimenopause." We picture hot flashes, maybe irregular periods, maybe mood swings. I didn't even get the classic hot flashes. I got night sweats, and I had no idea what was happening to me.
Brain fog and trouble concentrating are actually really common during the menopause transition, and research points to a tangled mix of hormonal shifts, sleep, mood, and other factors behind them. 2026 systematic review on cognition during perimenopause
And then there's ADHD
If you already have ADHD, perimenopause can feel like someone updated the operating system on your brain and didn't bother with the release notes. The strategies that used to hold everything together aren't enough anymore, and the systems you spent years building to work around executive functioning challenges suddenly feel like they've lost their grip. You find yourself thinking, what the hell happened to me?
There's a real reason for that. Hormonal fluctuations, including the ones in perimenopause, may make ADHD symptoms and mood changes worse, and estrogen interacts with the dopamine systems involved in attention and executive functioning. 2025 review on female ADHD and hormonal fluctuations ADHD already makes executive functioning harder. Stack hormonal changes that affect cognition, mood, sleep, and attention on top of that, and it's no surprise some of us experience this transition as especially disruptive.
To be fair, the research is still catching up to what women are living. A 2025 systematic review found just 11 studies looking at ADHD and sex hormones in females, mostly small and hard to compare, and the authors specifically called for more research on milestones like menopause. 2025 systematic review of ADHD and sex hormones in females But I didn't need a 20-year study to know something had changed in my own body, and neither do you.
Feeling like an alien in my own body
I didn't have an older generation of women to call and ask, "Hey, is this normal?" So I did what I always do when something doesn't make sense: I researched the hell out of it.
The more I learned, the more misinformation I found, and the more women I met who thought they were somehow failing at life when their bodies were going through a massive transition. That's eventually what led me to become a Menopause Society Certified Practitioner, and it's why I'll talk about this with pretty much anyone who'll listen. Women deserve to have their health concerns taken seriously.
It took three providers
It took three providers before I found one willing to work with me on hormone therapy.
My primary care provider checked a basic hormone level and told me everything was fine, while I sat there with a laundry list of symptoms that very clearly did not feel fine. The catch is that hormones swing all over the place during the transition, so one blood draw doesn't tell you much. In typical midlife perimenopause, clinicians can usually identify what's going on from your symptoms, cycle changes, age, and history. ACOG even notes that hormone testing generally isn't recommended before starting hormone therapy for menopausal symptoms, precisely because levels change so much. ACOG: Hormone testing before hormone therapy ACOG: Hormone testing during perimenopause
Next I saw a naturopath who wanted to treat me with supplements and wouldn't discuss hormone therapy. Okay. I gave it about eight months (read: suffered for eight more months).
Then I saw another naturopath who wanted to implant hormone pellets in my ass that same day. That was a hard no. My big issue with pellets is that you can't adjust them. Once they're placed under the skin of your buttock or hip, you can't decide tomorrow to lower the dose or stop, the way you can with a patch. If you're having a bad reaction, that matters a lot.
Eventually I found a provider who actually sat down and talked with me about my symptoms, my options, and the risks and benefits. That's all I'd wanted from the start, someone who would listen.
Hormone therapy isn't for everyone
I'm not here to tell every woman to take hormones. Hormone therapy isn't right for everyone, and the decision should depend on your symptoms, health history, risks, preferences, and the type and route being considered. For people who are good candidates, it's still the most effective treatment for bothersome hot flashes and night sweats, and it helps protect against bone loss and fractures. The Menopause Society: Hormone Therapy There are also nonhormonal medications for hot flashes and night sweats, plus ways to support sleep, mood, nutrition, movement, and overall health. The Menopause Society: Position Statements
A lot of us grew up hearing that hormones were dangerous. Much of that fear traces back to the Women's Health Initiative studies released starting in the early 2000s, which changed how everyone viewed hormone therapy almost overnight. Researchers have kept digging into that data since, and the picture now is a lot more nuanced: age, timing, formulation, route, dose, and your individual risk all shift the balance of benefits and risks. The Menopause Society: Hormone Therapy Position Statement overview The Menopause Society: WHI and hormone therapy discussion
Hormone therapy isn't risk-free. The conversation is just far more complicated than the headlines were, and you deserve a provider who's keeping up with it.
Yes, you can still have periods
One misconception I hear constantly is that you can't be in perimenopause if your periods are still regular. Symptoms can start while you're still menstruating. Cycles usually get less predictable as things progress, but there's no day when your body announces, "Congratulations! You are officially in perimenopause." ACOG: Perimenopausal bleeding and menopause And yes, you can still get pregnant. Menopause is only confirmed after 12 straight months without a period. ACOG: Reproductive life planning and menopause
So if you're in your 40s, or even younger, and your body, mood, sleep, or thinking suddenly feels really different, it's worth bringing up with a knowledgeable provider.
When your ADHD strategies stop working
This is the part I most want neurodivergent women to hear.
If you've spent years figuring out how your ADHD brain works, you've probably built a whole system to get through the day: calendars, timers, lists, medication and exercise routines, someone who holds you accountable. Maybe you've even gotten to where you're working with your ADHD instead of fighting it all the time. Having good strategies doesn't mean your ADHD went away, though. It means you've gotten really good at compensating for it, and compensating takes energy, even when it feels like second nature.
Perimenopause can change that equation. Executive functioning gets harder, attention gets slipperier, emotions hit differently, and systems that used to run on autopilot suddenly take real effort. That's demoralizing, especially when you worked so hard to get here.
So before you decide you've become lazy, unmotivated, or "bad at ADHD," consider whether something else has changed. You're running the same systems on a brain that's going through a major hormonal shift. That isn't a failure, and the answer usually isn't building a better system or pushing harder. It might be revisiting your medication with your prescriber, talking with a provider about hormone therapy, asking for real accommodations at work or at home, or letting some things go for a while. You've been carrying this on your own. You're allowed to get help with it.
Buckle up, buttercup
Perimenopause can be a lot, and for neurodivergent women it can feel like the rules changed halfway through the game. You're not imagining it, and you don't have to white-knuckle your way through it. There are providers who will take you seriously, hormonal and nonhormonal options worth exploring, and support for the emotional and executive-functioning changes that tend to come along for the ride. Feeling like an alien in your own body doesn't have to be the new normal.
If you're in your mid-30s or beyond, you have ADHD, and the things that used to work suddenly don't, it's worth asking whether perimenopause could be part of the picture. The fix may have less to do with trying harder and more to do with getting new information, better support, and a little grace while your brain and body figure out the new rules.
So yes, buckle up, buttercup. Just don’t white-knuckle the wheel alone. If you want someone in the passenger seat, I’m here for that.
Please note: This article is intended for educational purposes and is not a substitute for individualized mental health care. Reading this blog does not establish a therapeutic relationship. If you need personalized support, please reach out to a licensed mental health professional.
