ADHD vs anxiety women in perimenopause: How a good assessment sorts out what’s driving what
- Kiesa Kelly
- 4 days ago
- 8 min read
If you’ve been Googling "ADHD vs anxiety in women" while also dealing with perimenopause changes, you’re not overthinking it. The menopause transition can bring “brain fog,” sleep disruption, irritability, and spikes in worry that make attention feel unreliable. Many midlife women report trouble concentrating and distractibility during this stage. [1]
In this article, you’ll learn:
Why ADHD and anxiety look so similar in perimenopause
How anxiety-driven attention problems typically show up
How ADHD-driven executive dysfunction tends to look across the lifespan
What a quality adult ADHD evaluation does to separate patterns (or confirm both)
What else a careful clinician screens for, including sleep and medical contributors
What to expect from telehealth ADHD testing in Tennessee
🧭 Key takeaway: The goal isn’t a label for its own sake. A good evaluation clarifies patterns so treatment targets the right “engine,” not just the loudest symptom. [7]
Why ADHD and Anxiety Get Mixed Up for ADHD vs anxiety women (Especially in Perimenopause)
Both can cause distractibility and restlessness
When your nervous system is revved up, sustained focus gets harder. Anxiety can pull attention toward threat-scanning (“What did I miss?” “What if something goes wrong?”), while ADHD can make attention drift because the brain is constantly seeking novelty, urgency, or interest.
Both can look like:
racing thoughts menopause-style (fast, repetitive, hard to “turn off”)
feeling mentally scattered
restlessness or trouble sitting still
overwhelm and forgetfulness
Perimenopause adds another layer: many people experience mild, temporary changes in attention and memory during the transition, often described as brain fog. [1,3]
Anxiety can be a coping strategy for ADHD
A common (and exhausting) pattern is “anxiety as a scaffold.” If you’ve had ADHD-related time blindness or forgetfulness for years, worry can become the system that keeps you on track: fear of consequences, perfectionism, and over-preparing.
That can mask high-masking ADHD, especially in women who learned early to compensate by working harder, being extra prepared, or people-pleasing. Research on
ADHD in women highlights how symptoms can be overlooked and how coping strategies can camouflage impairment. [5,6]
🔍 Key takeaway: Sometimes anxiety is primary. Sometimes it’s a learned tool to compensate for ADHD. Sometimes it’s both—and the “order of operations” matters for treatment. [5,7]
Hormone shifts can intensify both
During perimenopause, fluctuating hormones can affect sleep, mood, and stress reactivity, which in turn can worsen attention. [1,2]
Emerging research also suggests that hormonal life phases may influence ADHD symptom expression in some women, though the evidence base is still developing. [8,9]
How Anxiety-Driven Attention Problems Often Present
Focus drops when worry spikes
With anxiety-driven attention problems, focus often tracks with perceived threat. On calmer days, you can concentrate. When stress rises, attention narrows to the worry itself—or the attempt to prevent something bad from happening.
Practical example: You sit down to write an email. You can write, but you keep rereading the same paragraph because you’re worried it will sound wrong. Thirty minutes later you’ve rewritten three sentences and feel behind, which increases panic.
“What if” loops and threat scanning
Anxiety pulls attention toward uncertainty. You might notice:
“What if” loops (catastrophic or perfectionistic)
reassurance-seeking (asking others, searching online, double-checking)
body scanning (“Is this a panic attack?”)
a sense of urgency that never resolves
Perimenopause can amplify the physical side of anxiety too: hot flashes, palpitations, and sleep disruption can make your body feel “on edge,” even when your life circumstances haven’t changed. [2]
🌡️ Key takeaway: If attention improves when worry calms (or when your body feels safer), anxiety may be the primary driver—even if the distractibility feels severe. [2]
Avoidance and reassurance-seeking patterns
A hallmark of anxiety is avoidance: procrastinating because the task feels risky, uncomfortable, or uncertain. That avoidance can look like ADHD task initiation issues.
The difference is often the why:
Anxiety: “If I do this wrong, something bad happens.”
ADHD: “I can’t get traction unless it’s interesting, urgent, or clearly structured.”
How ADHD-Driven Attention Problems Often Present
Chronic disorganization/time blindness (even on calm days)
With ADHD, executive dysfunction tends to be present across contexts and across time - even when mood is stable and worry is low. The pattern is often lifelong (though it may have been missed).
Signs can include:
chronic misestimating time (time blindness)
losing track of steps, details, or deadlines
overwhelm with planning, sequencing, and follow-through
inconsistent working memory (“I just had that thought… where did it go?”)
Diagnostic frameworks for ADHD emphasize persistent symptoms, impairment, and patterns that are not better explained by other conditions. [10]
Interest-based attention and task initiation issues
ADHD attention is often interest-based:
You can hyperfocus on what’s compelling.
You struggle to start tasks that feel boring, ambiguous, or multi-step.
You do better with external structure, body-doubling, and clear next actions.
Misconception #1: “If I can focus sometimes, it can’t be ADHD.”You can absolutely focus - especially with interest, urgency, or high stakes. That variability is part of the profile for many adults. [5]
Emotional overwhelm from load + transitions
Many adult women describe emotional overwhelm that isn’t “overly sensitive,” but rather a capacity issue: too many demands, too many transitions, not enough recovery.
Common triggers:
rapid context switching (home, work, family logistics)
decision fatigue
sensory overload
sudden plan changes
Misconception #2: “ADHD always looks like hyperactivity.” In women, inattentive symptoms and internalized coping can be more prominent, which is one reason ADHD is often missed. [5,6]
🧩 Key takeaway: When disorganization, time blindness, and task initiation problems show up even on calm days, ADHD becomes more likely—especially if the pattern has been there for years. [5,10]
The Assessment Approach That Clarifies the Relationship
A quality adult ADHD evaluation isn’t a single questionnaire. There is no biomarker or one definitive cognitive test that “proves” ADHD. Instead, best-practice assessment relies on a detailed clinical interview, symptom history, impairment across settings, and triangulation of data. [7,11]
If you’re considering an adult ADHD evaluation (including online ADHD assessment Tennessee options), here’s what typically clarifies “what’s driving what.”
Timeline: which came first, and when did it worsen?
A clinician will map:
childhood and adolescent functioning (school, organization, attention, self-management)
adult functioning before perimenopause
what changed during the menopause transition (sleep, mood, cycles, medical changes)
Misconception #3: “If it started in perimenopause, it must be hormones, not ADHD.” Perimenopause can absolutely unmask an underlying ADHD pattern by reducing the effectiveness of compensation strategies and by worsening sleep and stress. [8,9]
Context: what improves with rest, structure, or reduced stress?
Good assessment asks: what helps?
If rest and reduced stress reliably restore focus, anxiety and sleep may be key drivers.
If structure, external reminders, and clear next steps help more than “calming down,” ADHD may be central.
This is also where coaching and skills support can be useful, whether or not ADHD is diagnosed. (If you want to explore skill-building options, see our Executive Function Coaching.)
Impairment: what’s consistently hard across settings?
Diagnostic criteria require meaningful impairment, not just traits. [10]
A careful evaluator looks for consistency across major life areas:
work or school performance
home management
relationships
health routines (sleep, appointments, medication adherence)
They may also use validated rating scales and, when possible, collateral input (partner, family member, past records) because self-report alone can miss blind spots. [11]
🧠 Key takeaway: The best assessments don’t just name symptoms. They explain patterns, rule-outs, and why the conclusion fits the evidence. [7]
Other Factors a Careful Evaluator Screens For
Sleep disruption and panic-like physiology
Perimenopause can disrupt sleep, and poor sleep can mimic both anxiety and ADHD: slower processing, irritability, and reduced working memory. [1,3]
If insomnia is part of your story, addressing it can change everything. (Learn more about insomnia treatment options.)
Depression, trauma, burnout, medical contributors
A good differential diagnosis ADHD vs anxiety evaluation also screens for:
depression and burnout (low energy, reduced motivation, cognitive “slowness”)
trauma and chronic stress responses (hypervigilance, shutdown, dissociation)
medical contributors (thyroid issues, anemia/iron deficiency, vitamin deficiencies, medication effects)
If trauma is in the mix, that deserves respectful, specialized care. (Explore our trauma therapy services.)
ADHD + anxiety can both be valid—and treated together
Comorbidity is common. Many adults with ADHD also meet criteria for an anxiety disorder, and anxiety can increase impairment. [5]
The point of sorting out “what’s driving what” is not to pick a single winner, but to build an effective plan:
ADHD supports (medication discussion with a prescriber when appropriate, coaching, systems)
anxiety treatment (CBT/ACT skills, exposure-based approaches when indicated, nervous system regulation)
sleep and medical coordination
If you’re exploring whether an evaluation is a fit, start with our overview of psychological assessments and what to expect from the process. You can also see our ADHD & autism assessments options.
What You’ll Get From a Good Outcome (Regardless of Label)
A clear explanation of what best fits and why
A strong report should answer:
What patterns were most consistent with ADHD, anxiety, or both?
What evidence supported that conclusion (history, impairment, measures)?
What alternative explanations were considered and ruled out? [7]
Practical next steps (therapy/skills, medical coordination as needed)
Your next steps should be specific and doable, not generic. For example:
“Start with sleep stabilization and anxiety skills for 4–6 weeks, then reevaluate attention.”
“Implement an externalized planning system and coaching supports while coordinating with a prescriber.”
“Treat both: ADHD supports for load and initiation, plus anxiety treatment for worry loops.”
If you’re looking for therapy that’s tailored to how your brain works, explore our specialized therapy options.
Tennessee/telehealth logistics and documentation expectations
If you’re considering telehealth ADHD testing Tennessee or an online ADHD assessment Tennessee, here’s what to expect from most reputable services:
You must be physically located in Tennessee for Tennessee-based telehealth assessment.
Expect a structured interview, standardized measures, and careful rule-outs. [7,11]
Ask what documentation you’ll receive (diagnostic letter vs full report) and what it’s designed for (medical coordination, workplace/school accommodations, personal clarity).
If you’d like to talk through options, you can reach out through our Contact page.
About the Author
Dr. Kiesa Kelly, PhD, is a psychologist and neuropsychologist by training at ScienceWorks Behavioral Healthcare. Her work focuses on evidence-based assessment and care for neurodivergent and high-masking presentations, with attention to the real-life impact of burnout, sleep, and stress.
Dr. Kelly earned her PhD in Clinical Psychology with a concentration in Neuropsychology and completed advanced clinical training including an NIH-funded postdoctoral fellowship with a focus on ADHD. She emphasizes respectful, self-affirming evaluation and practical recommendations that clients can use right away.
References
The Menopause Society. Perimenopause. Available from: https://menopause.org/patient-education/menopause-topics/perimenopause
The Menopause Society. Mental Health. Available from: https://menopause.org/patient-education/menopause-topics/mental-health
Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: a narrative review of current knowledge. World J Psychiatry. 2021;11(8):412–428. doi: https://doi.org/10.5498/wjp.v11.i8.412
Reuben R, Karkaby L, McNamee C, Phillips NA, Einstein G. Menopause and cognitive complaints: are ovarian hormones linked with subjective cognitive decline? Climacteric. 2021;24(4):321–332. doi: https://doi.org/10.1080/13697137.2021.1892627
Quinn PO, Madhoo M. A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596. doi: https://doi.org/10.4088/PCC.13r01596
Attoe DE, Climie EA. Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. J Atten Disord. 2023;27(7):645–657. doi: https://doi.org/10.1177/10870547231161533
Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard. Front Psychiatry. 2024;15:1380410. doi: https://doi.org/10.3389/fpsyt.2024.1380410
Osianlis E, Thomas EHX, Jenkins LM, Gurvich C. ADHD and Sex Hormones in Females: A Systematic Review. J Atten Disord. 2025;29(9):706–723. doi: https://doi.org/10.1177/10870547251332319
Smári UJ, Valdimarsdottir UA, Wynchank D, et al. Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. 2025;68(1):e133. doi: https://doi.org/10.1192/j.eurpsy.2025.10101
Centers for Disease Control and Prevention (CDC). Diagnosing ADHD. Updated Oct 3, 2024. Available from: https://www.cdc.gov/adhd/diagnosis/index.html
American Academy of Family Physicians (AAFP). Adult ADHD: Assessment and Diagnosis. Available from: https://www.aafp.org/family-physician/patient-care/prevention-wellness/emotional-wellbeing/adhd-toolkit/assessment-and-diagnosis.html
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical or mental health advice, diagnosis, or treatment.
