High masking ADHD women in menopause: Why you can look “fine” and still need an assessment
- Kiesa Kelly
- 4 days ago
- 8 min read
If you are juggling work, family, and everyone’s needs and still showing up on time, it can feel almost absurd to wonder about ADHD. You might even tell yourself, “I’m functioning. I’m fine.”
And yet inside, it may feel like you are running an invisible marathon: constant self-correction, overthinking, perfectionism, and a never-ending mental to-do list.
That mismatch is common in high masking ADHD women, especially around perimenopause and menopause, when the cognitive “buffer” that used to help you compensate can start to thin. Research and clinical consensus note that girls and women often develop compensatory strategies that can delay recognition and referral for ADHD. [1,4]
💡 Key takeaway: Looking capable is not the same as feeling okay. ADHD can be present even when you appear “high functioning.” [1]
What “Masking” Means
Masking is the set of strategies you use to hide ADHD-related struggles from others and sometimes from yourself. It is often brilliant, hard-won, and costly.
You learned strategies that hide symptoms from others
Masking can look like:
living by lists, alarms, and rigid routines
over-preparing so you do not get “caught” forgetting something
forcing yourself to be early because being on time feels precarious
rehearsing conversations, emails, or phone calls
choosing roles where your strengths cover your struggles
These strategies work well enough that teachers, coworkers, partners, and even clinicians may miss the underlying pattern. That is one reason many women are diagnosed later. [1,4]
The outside looks organized; the inside feels chaotic
A common internal experience is:
“I can do it… but only if I’m white-knuckling it.”
“If I stop tracking everything, everything falls apart.”
“I’m constantly behind, even when I’m technically ‘on time.’”
This is often the heart of high functioning ADHD women: the output looks polished, but the effort cost is enormous.
💡 Key takeaway: In ADHD, impairment is not only about outcomes. It is also about the effort required to maintain those outcomes. [9]
Masking is adaptive, not “fake”
Masking is not dishonesty. It is adaptation.
Many women learn early that being scattered, emotional, or forgetful gets punished. So they become the reliable one, the prepared one, the helper. Over time, that identity can become so strong that noticing ADHD traits feels confusing or even shameful.
Common High-Masking Patterns in Midlife Women
High masking often clusters around the same few patterns.
Over-preparing, over-apologizing, people-pleasing
Examples:
rewriting an email five times so you do not sound “wrong”
saying yes automatically, then scrambling to keep the promise
carrying the mental load for the household because delegating feels harder than doing it yourself
Practical example: You spend two hours prepping for a 30-minute meeting, not because you are overly conscientious, but because without intense preparation you fear you will blank, ramble, or miss details.
Anxiety as a productivity engine
Some high masking ADHD women run on anxiety. The pressure and adrenaline help you start tasks, meet deadlines, and keep it together. When anxiety drops, motivation drops too.
This can look like “I’m only productive when I’m stressed,” or “If I calm down, I’ll fall apart.” Clinical guidance emphasizes carefully assessing ADHD alongside anxiety and other conditions, rather than assuming anxiety explains everything. [8,9]
💡 Key takeaway: Anxiety and ADHD commonly overlap. Sometimes anxiety is a response to years of compensating for ADHD. [8]
“I do it, but it costs me” (exhaustion, resentment, shutdown)
Masking can be sustainable for years… until it is not.
Signs the cost is climbing:
burnout after basic life tasks
“shutdown” weekends where you cannot initiate anything
resentment that you are always the one holding it together
more conflict at home because your capacity is maxed out
This is often described as ADHD burnout midlife: the system works, but it is running too hot.
Why Menopause/Perimenopause Can Make Masking Harder
Perimenopause and menopause can affect sleep, mood, and cognition. Cognitive complaints are common in the menopause transition, and sleep disturbance is one of the most frequent symptoms reported. [5–7]
For women who have been masking for decades, this can be the moment the scaffolding starts to wobble.
Less cognitive “buffer” because of sleep disruption
Menopause-related sleep disturbance often involves frequent night-time awakenings and increased time awake after sleep onset. [5]
When sleep is lighter, shorter, or less restorative, skills like emotional regulation, working memory, and inhibition are harder to access. In real life, that can feel like:
losing track mid-sentence
forgetting why you walked into a room (again)
needing much more time to “get going”
If sleep is a major factor for you, our team’s resources on insomnia support can be a helpful starting point.
💡 Key takeaway: Sleep disruption can magnify both menopause brain fog and ADHD symptoms. Addressing sleep is often part of the assessment and the plan. [5–7]
Higher baseline stress + emotional reactivity
Hormonal transition periods can be linked with shifts in mood and stress sensitivity. [2,6,7]
If you have relied on calm self-control to compensate, increased irritability or emotional reactivity can make masking feel harder. This is also where perfectionism can spike: “If I can’t control my brain, I’ll control everything else.”
Existing coping systems stop working reliably
Many women describe a sudden change:
the same planner no longer prevents missed steps
routines feel brittle
focus feels “slippery” in a way that is new
Research exploring perimenopause in women with ADHD suggests symptom patterns and menopause-related experiences can differ between women with and without ADHD, reinforcing why individualized evaluation matters. [3]
How High-Masking ADHD Shows Up in an Assessment
A quality ADHD assessment is not a pop quiz and not a single questionnaire. There is no single test that diagnoses ADHD. [10]
Instead, good assessment looks for a pattern: symptoms over time, across contexts, with real-life impact.
If you want a structured screening step before scheduling, you can explore our ASRS self-screen. Screening tools can be informative, but they are not diagnoses.
History matters: patterns over decades, not just this month
For adults, ADHD requires a developmental history. Adults typically need evidence that symptoms were present earlier in life (commonly described as before age 12). [11]
High masking can distort the story if you only ask, “Are you messy?” or “Did you fail classes?” A better question is, “What did it take for you to keep up?”
Internal impairment: rumination, overwhelm, constant self-correction
High masking ADHD women may report:
mental noise: constant thoughts, tabs open in the brain
rumination and replaying mistakes
overwhelm that comes from too many steps, not laziness
chronic guilt: “Why can’t I just do it like everyone else?”
Assessment standards emphasize eliciting real-life examples and evaluating impairment, not just counting visible behaviors. [9]
Measuring impact: relationships, work sustainability, health
A common high masking pattern is that you can “perform” for a while, but it is not sustainable.
A good evaluator will ask about:
work output versus work energy cost
relationships (emotional availability, follow-through, conflict cycles)
health (sleep, stress, migraines, overeating, overtraining, etc.)
💡 Key takeaway: The question is not “Can you do it?” It is “Can you do it without burning out?” [9]
What a Good Evaluator Will Do Differently
Not all assessments are equally helpful for high masking ADHD women. Quality standards for adult ADHD assessment emphasize depth, probing, and attention to impairment and comorbidities. [9]
Ask for specific examples and the effort behind them
Instead of accepting “I’m organized,” they may ask:
How many hours do you spend maintaining that system?
What happens when you do not have the system?
What do you avoid because it feels too cognitively expensive?
Explore strengths without dismissing struggles
High masking ADHD women often have real strengths: creativity, empathy, pattern recognition, crisis competence.
A good evaluator can honor strengths while still taking impairment seriously. (Strengths do not cancel out needs.)
Consider ADHD + anxiety/burnout + menopause interactions
Misconceptions can block appropriate care. Here are three common ones to watch for:
Misconception 1: “If it got worse in menopause, it can’t be ADHD.”
Menopause-related cognitive changes and ADHD can both be true, and sleep disruption can worsen either. [5–7]
Misconception 2: “If you did well in school, you can’t have ADHD.”
Many women compensate through overwork, perfectionism, and anxiety-driven studying. Delayed diagnosis is well documented. [1,4]
Misconception 3: “If you can focus on what you love, you don’t have ADHD.”
ADHD often involves inconsistent attention regulation, including periods of intense focus. [12]
Gentle Next Steps (Without DIY Diagnosing)
You do not have to label yourself to start collecting useful information.
Track “effort cost” and recovery time, not just outcomes
For two weeks, jot down:
the task you completed
the effort cost (1–10)
the recovery time (minutes or hours)
what helped (deadline, body doubling, novelty, caffeine, fear)
This separates “I did it” from “what it took,” which is often the missing data in high masking ADHD.
Practical example: You finish the workday and immediately scroll, nap, or zone out for two hours before you can engage with your family. That recovery time is meaningful clinical information.
Bring 3–5 stories that show the pattern over time
Choose a few concrete stories from different eras:
childhood or teen years (school, chores, friendships)
early adulthood (college, first jobs, parenting)
now (midlife sustainability, burnout, menopause transition)
If you want help organizing the “so what do I do with this” part, executive function coaching can complement assessment and treatment planning.
If you’re in Tennessee: telehealth assessment as a lower-barrier option
If you are searching for an online ADHD assessment Tennessee residents can access, telehealth can reduce barriers like travel time, scheduling complexity, and childcare.
Many clinics (including ours) can start with an intake, structured interviews, and symptom measures via secure telehealth when clinically appropriate. Availability depends on where you are physically located and clinician licensure.
To explore next steps, you can learn about our psychological assessment services or contact ScienceWorks to ask what options fit your situation.
💡 Key takeaway: You do not need to prove you are “struggling enough” to deserve clarity. A good assessment is about understanding patterns and support needs. [9,10]
If you are also feeling stuck in anxiety or burnout patterns, specialized therapy can help you build capacity while you pursue answers.
About the Author
Dr. Kiesa Kelly, PhD, is a clinical psychologist with a concentration in neuropsychology. She completed NIH National Research Service Award postdoctoral training and has experience in neuropsychological assessment and evidence-based therapy approaches.
At ScienceWorks Behavioral Healthcare, Dr. Kelly provides neuroaffirming care and has pursued additional training and consultation in ADHD and autism assessments, as well as evidence-based treatments for insomnia and related concerns.
References
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Smári UJ, Valdimarsdottir UA, Wynchank D, et al. Perimenopausal symptoms in women with and without ADHD: a population-based cohort study. Eur Psychiatry. 2025 Sep 4;68(1):e133. doi: 10.1192/j.eurpsy.2025.10101.
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Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard. Front Psychiatry. 2024;15:1380410. doi: 10.3389/fpsyt.2024.1380410.
Centers for Disease Control and Prevention (CDC). Diagnosing ADHD. Updated 2024 Oct 3. Accessed 2026 Jan 17. Available from: https://www.cdc.gov/adhd/diagnosis/index.html.
National Institute of Mental Health (NIMH). ADHD in Adults: 4 Things to Know. Accessed 2026 Jan 17. Available from: https://www.nimh.nih.gov/health/publications/adhd-what-you-need-to-know.
American Psychiatric Association. ADHD in Adults. Accessed 2026 Jan 17. Available from: https://www.psychiatry.org/patients-families/adhd/adhd-in-adults.
Disclaimer: This article is for informational purposes and is not medical advice. If you have urgent safety concerns, seek immediate help.
