ADHD Assessments for Women in Perimenopause: What to Expect (and What to Avoid)
- Kiesa Kelly
- 4 days ago
- 8 min read
Perimenopause can crank up brain fog, sleep disruption, and stress, which makes an ADHD assessment for women feel confusing. If you’ve always “held it together” through high masking and over-functioning, the picture can get even blurrier.
In this article, you’ll learn:
Why midlife symptoms can be hard to sort out
What a thorough adult ADHD evaluation usually includes
How perimenopause changes the “timeline” conversation
What differential diagnosis looks like (and why it protects you)
Red flags to avoid in online ADHD testing
What you should leave the process with, including next steps
🧭 Key takeaway: A good evaluation is a process, not a quick quiz. It should connect symptoms to real-life impairment and offer a plan you can use. [1,3]
Why Midlife ADHD Assessments Can Feel Extra Confusing
Hormones, sleep, stress, and masking can blur the picture
During the menopause transition, many people notice changes in attention, word-finding, and memory that feel like “brain fog.” Cognitive complaints are common in perimenopause, and they’re often influenced by sleep and mood symptoms too. [4-6]
At the same time, ADHD is a neurodevelopmental condition, meaning symptoms typically show up earlier in life, even if they weren’t recognized until adulthood. [1,2]
When both are in play, a few things can happen:
Long-standing ADHD traits become harder to compensate for when sleep worsens or stress rises.
Perimenopause symptoms mimic ADHD (distractibility, forgetfulness, slowed processing).
High masking ADHD women may have built elaborate workarounds (lists, over-prepping, perfectionism) that quietly collapse under midlife load.
🧩 Key takeaway: “New” attention problems in perimenopause deserve a careful timeline, not assumptions. Both hormone-related changes and ADHD can be true. [3-6]
“I’m functioning” doesn’t mean you’re not struggling
Many midlife women say, “I’m successful on paper, so this can’t be ADHD.” But functioning can come with hidden costs: chronic overwhelm, late-night catch-up, emotional exhaustion, or constant self-criticism.
High-masking patterns can include:
Over-relying on anxiety to stay on track (“If I’m not stressed, I won’t do it.”)
Spending far more time/energy than peers to meet the same demands
Having a “fine” work life but a chaotic home life (or vice versa)
Misconception #1: “If you did well in school, you can’t have ADHD.”
Many people with ADHD did well academically by using structure, strong interests, or sheer effort. The cracks often appear when life gets more complex: career demands, parenting, caregiving, sleep changes, and health transitions. [3]
A good assessment is clarity + next steps, not just a label
A helpful assessment answers two practical questions:
Do your symptoms fit ADHD best, given your full history and current context?
What should you do next, regardless of whether ADHD is the final diagnosis?
High-quality standards emphasize linking the diagnostic conclusion to a clear discussion and next steps, not stopping at “yes/no.” [3]
✨ Key takeaway: The goal is usable clarity: what’s driving the struggle, what to rule out, and what support helps now. [3]
What a High-Quality ADHD Assessment for Women Typically Includes
Clinical interview + current concerns (real-life examples)
There is no single test that can diagnose ADHD. Clinicians rely on a detailed interview to understand symptoms across settings and how much they interfere with daily life. [1,3,8]
Expect questions like:
What tasks are hardest (emails, meetings, meal planning, paperwork, transitions)?
What do you avoid, and what do you over-control?
What are the downstream effects (missed deadlines, conflict, burnout, shame)?
Practical example #1
You can focus intensely on urgent client work, but you miss routine follow-ups and forget appointments unless there are multiple reminders. At home, you intend to “reset the kitchen,” then get stuck scrolling or reorganizing one cabinet for an hour.
Developmental history (how this showed up earlier, even subtly)
Because ADHD usually begins in childhood, your evaluator should explore earlier signs, including subtle ones that are common in girls and high-masking women. [1-3]
That might include:
Report cards (“bright but daydreamy,” “inconsistent,” “talks too much”)
Chronic lateness, lost items, messy backpacks/rooms
Social overwhelm, sensitivity to rejection, “too intense” friendships
Early anxiety that developed around performance or mistakes
Misconception #2: “ADHD always looks like hyperactivity.”
In adults (and often in women), it can look like internal restlessness, mental overdrive, time blindness, and chronic disorganization, not bouncing-off-the-walls behavior. [2,3]
Rating scales and (when helpful) collateral input
Most evaluations use standardized rating scales to quantify symptom patterns and impairment. Tools like the Adult ADHD Self-Report Scale (ASRS) can help screen and track symptoms, but they are not a stand-alone diagnosis. [1,9]
Collateral input (with your consent) may include:
A partner’s observations
A parent/sibling interview about childhood patterns
Past records (school reports, prior testing)
Misconception #3: “A short online quiz is enough to diagnose ADHD.”
Screeners can be useful starting points, but quality assessments involve history-taking, real-life examples, and an active review of alternative explanations. [1,3]
How Perimenopause Changes the Evaluation Conversation
Symptom timeline: what’s long-standing vs what’s new/worse
A key question in a perimenopause ADHD assessment is trajectory:
What did attention/executive function look like in your teens and 20s?
What changed in your late 30s, 40s, or early 50s?
Did symptoms worsen around cycle changes, postpartum periods, or major stress?
Practical example #2
You’ve always procrastinated and needed “panic energy” to start. But over the past year, sleep has become lighter and you’re waking up at 3 a.m. Now you’re forgetting words mid-sentence at work. The core pattern may be long-standing, while the intensity and fogginess are newer. [4-6]
Sleep and mood as major “attention disruptors”
Sleep disruption and mood changes can directly affect attention, working memory, and processing speed. They can also make coping strategies fail, which is why they matter so much in midlife evaluations. [4-6]
A good evaluator will ask about:
Insomnia, early waking, hot flashes/night sweats
Anxiety and depressive symptoms
Caffeine and other substances (often used to self-manage fatigue)
If you want quick, structured data to bring to a first appointment, brief screeners can help you describe what you’re noticing, such as the PHQ-9 depression questionnaire and GAD-7 anxiety questionnaire.
🌙 Key takeaway: If sleep and mood are driving attention problems, treating those can dramatically change “ADHD-like” symptoms, even if ADHD is also present. [4-6]
Why your evaluator should ask about cycle stage/HRT changes
Perimenopause isn’t a single moment. Hormone fluctuations can shift symptoms week to week, and medication or hormone therapy changes can affect sleep, mood, and cognition. [4-6]
Expect questions like:
Are cycles irregular, or have bleeding patterns changed?
Any hormone therapy changes, dose shifts, or side effects?
Any new medications (including antihistamines or sleep aids) that could affect focus? [7,8]
What “Differential Diagnosis” Looks Like (And Why It Matters)
ADHD vs anxiety/depression vs burnout vs trauma
Differential diagnosis means your clinician actively checks other explanations that can mimic ADHD, and also considers co-occurrence (it’s not always either/or). [1,7,8]
In practice, this can look like:
Anxiety: distraction from worry loops, reassurance seeking, perfectionism-driven overcontrol
Depression/burnout: slowed thinking, low motivation, reduced capacity
Trauma: hypervigilance, sleep disruption, attention that “snaps” to threat cues
Sleep disorders, thyroid/iron/B12, medication effects
Quality evaluations screen for sleep and medical factors that can look like ADHD, including sleep apnea, thyroid issues, anemia/iron deficiency, B12 deficiency, and medication side effects. [7,8]
If sleep is a primary issue, addressing it can be a high-yield step. Evidence-based insomnia care is outlined on our insomnia services page.
When ADHD + perimenopause can both be true
It’s common for ADHD to be “manageable” until midlife stressors, sleep changes, or hormonal shifts reduce your buffer. That doesn’t mean ADHD is new. It may mean the coping scaffolding finally isn’t enough. [3,6]
🧷 Key takeaway: Differential diagnosis protects you from two common errors: blaming everything on hormones, or labeling everything as ADHD. Either one can delay the right support. [1,3,7]
What to Avoid (Red Flags)
Diagnosis from a short quiz with no history-taking
Red flag: a provider (or platform) that offers a diagnosis after a brief questionnaire without a thorough interview or developmental history. Adult ADHD standards emphasize detailed interviewing with real-world examples. [1,3,8]
One-size-fits-all conclusions with no discussion of alternatives
Red flag phrases include:
“Your score is high, so you definitely have ADHD.”
“You seem anxious, so it’s not ADHD.”
A solid clinician explains how they ruled conditions in or out, and what’s still uncertain. [1,3,7]
No recommendations, no documentation, no follow-through
A report should not be a mystery document you never see. Quality standards emphasize clear documentation, results interpretation, and an actionable post-assessment plan. [3]
🚩 Key takeaway: If the process doesn’t include history, alternatives, and next steps, it’s unlikely to give you the clarity you’re paying for. [3]
What You Should Walk Away With
A clear summary: why ADHD fits or doesn’t fit (and what else might)
At minimum, you deserve:
A written summary of the data sources used (interview, scales, records)
The reasoning: why ADHD fits best (or why it doesn’t)
Any likely contributors (sleep, mood, perimenopause, medical factors)
Clear recommendations you can act on
Practical recommendations + referrals as needed
Depending on your needs, recommendations might include:
Medication consult with a qualified prescriber (if appropriate)
Targeted therapy for anxiety/depression or perfectionism
Workplace or school accommodations documentation
Skills support like executive function coaching
Follow-up medical labs or referrals through your primary care clinician
If you’re looking for a comprehensive process, our psychological assessments page explains what evidence-based testing can look like.
If you’re in Tennessee: how telehealth assessment logistics work
For many adults, telehealth reduces barriers like travel time and scheduling load. Telehealth ADHD testing Tennessee often includes:
Secure video appointments for the clinical interview and feedback
Online questionnaires completed between sessions
Requests for past records (school notes, prior evaluations) when available
A written report and follow-up plan
If you’d like to talk through fit and logistics, our contact page is the simplest starting point.
Conclusion
If you’re sorting out menopause brain fog vs ADHD, the most helpful next step is usually a careful timeline and a thorough differential diagnosis, not a quick label. Perimenopause can amplify attention problems, and ADHD can be missed for decades in high masking women, especially when anxiety has been doing the “coping” for years. [3-6]
A good evaluation should leave you with clarity, documentation, and a plan: what’s most likely driving your symptoms, what to address first, and where to get support next. If you’d like help deciding whether an assessment, therapy, or coaching makes sense, ScienceWorks offers a free consult to talk through options.
About the Author
Dr. Kiesa Kelly is a neuropsychologist by training and has 20+ years of experience with psychological assessments. Her NIH post-doctoral fellowship focused on ADHD in both research and clinical contexts.
She earned her PhD in Clinical Psychology with a concentration in Neuropsychology from Rosalind Franklin University of Medicine and Science and completed practica, internship, and an NIH-funded post-doc at the University of Chicago, the University of Wisconsin, the University of Florida, and Vanderbilt University.
References
1. Centers for Disease Control and Prevention (CDC). Diagnosing ADHD. Updated October 3, 2024. https://www.cdc.gov/adhd/diagnosis/index.html
2. National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87).Last reviewed May 7, 2025.https://www.nice.org.uk/guidance/ng87
3. Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard.Frontiers in Psychiatry. 2024;15:1380410. https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1380410/full DOI: https://doi.org/10.3389/fpsyt.2024.1380410
4. The Menopause Society. Perimenopause – Patient Education.Accessed January 17, 2026. https://menopause.org/patient-education/menopause-topics/perimenopause
5. The Menopause Society. Mental Health and Menopause – Patient Education.Accessed January 17, 2026. https://menopause.org/patient-education/menopause-topics/mental-health
6. Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive Problems in Perimenopause: A Review of Recent Evidence. Current Psychiatry Reports. 2023;25(10):501–511. https://link.springer.com/article/10.1007/s11920-023-01447-3 DOI: https://doi.org/10.1007/s11920-023-01447-3
7. Post RE, Kurlansik SL. Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults.A merican Family Physician. 2012;85(9):890–896. https://www.aafp.org/pubs/afp/issues/2012/0501/p890.html
8. U.S. Department of Veterans Affairs. Identification and Management of ADHD in Adults: Clinician Guide.October 19, 2023. https://www.healthquality.va.gov/guidelines/MH/adhd/
9. Hines JL, King TS, Curry WJ. The Adult ADHD Self-Report Scale for Screening for Adult ADHD. Journal of the American Board of Family Medicine. 2012;25(6):847–853.🔗 https://www.jabfm.org/content/25/6/847 DOI: https://doi.org/10.3122/jabfm.2012.06.120065
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment.