Is It ADHD or Perimenopause? How Clinicians Tell the Difference
- Kiesa Kelly
- 4 days ago
- 8 min read
If you’ve been thinking “is it ADHD or perimenopause?” you’re not alone. Many midlife women notice changes in focus, memory, motivation, and emotional regulation—and it can feel impossible to tell whether this is a new hormone-driven shift, longstanding
ADHD, or both at once.
In this article, you’ll learn:
Why attention and “brain fog” questions spike in midlife
What ADHD often looks like in adult women
What perimenopause cognitive changes often look like
The specific differentiators clinicians use (timeline, context, impairment)
Common look-alikes to rule in/out
When an ADHD assessment makes sense and what “quality testing” includes
Next steps for Tennessee residents who want telehealth-friendly options
✅ Key takeaway: 🧭 The goal isn’t to “pick one label.” It’s to understand what’s driving your symptoms so you can get the right support.
Why This Question Is So Common in Midlife
Hormone shifts can change attention, mood, and energy
Perimenopause is the transition period leading up to menopause. Hormone levels don’t decline smoothly—they can fluctuate in ways that affect sleep, mood, stress sensitivity, and (for many) cognition. “Brain fog” in perimenopause is common, typically mild, and midlife dementia is rare, but the experience can still be disruptive and scary.[1]
Decades of masking can delay “ADHD realization” until burnout hits
Many women with ADHD spend years compensating: over-preparing, people-pleasing, perfectionism, and “white-knuckling” executive function. Research on ADHD in women highlights that internalizing symptoms and coping strategies can contribute to missed or delayed diagnosis.[2,3]
Life load (kids/caregiving/work) can expose executive function cracks
Midlife often stacks demands: parenting or launching kids, caregiving for parents, career responsibilities, and health changes. Even without ADHD, this can strain attention and memory—especially when sleep or stress are affected.[4,5]
✅ Key takeaway: 🧩 Midlife symptoms often come from a “perfect storm”: hormones + sleep + stress + lifelong patterns that finally feel unsustainable.
What ADHD Looks Like in Adult Women
Inattentive symptoms: mental clutter, time blindness, forgetfulness
Adult women with ADHD are more likely to present with inattentive features than the stereotypical “hyperactive little boy” image.[2] Common reports include:
“My brain feels like a browser with 37 tabs open.”
Losing track of time, underestimating task duration (time blindness)
Starting tasks but struggling to finish (especially boring or multi-step tasks)
Misplacing items, forgetting appointments, missing details
Emotional regulation + overwhelm (not just “can’t focus”)
For many adults, ADHD shows up as:
Overwhelm that escalates quickly
Irritability or “short fuse” when overloaded
Difficulty shifting gears between tasks
Shame spirals after forgetfulness or missed deadlines
Patterns that usually go back to childhood—even if subtle
Clinicians look for evidence of a lifelong pattern. ADHD is a neurodevelopmental condition, so symptoms typically begin in childhood (even if they weren’t recognized at the time).[6] In girls, signs may have been subtle:
Daydreaming, “spacey,” quiet underachievement
Strong grades but huge effort, procrastination, or tears at night
Messy backpack/desk, missed instructions, chronic lateness
Misconception #1: “If I did well in school, I can’t have ADHD.” High achievement can coexist with ADHD - especially when structure, anxiety, or perfectionism masked symptoms until adulthood.[2,3]
✅ Key takeaway: 🧠 In adult women, ADHD is often less about visible hyperactivity and more about chronic mental load, emotional overwhelm, and inconsistent follow-through.
What Perimenopause Cognitive Changes Often Look Like
Brain fog, word-finding, and memory lapses
Perimenopause cognitive complaints often sound like:
Word-finding issues (“It’s on the tip of my tongue”)
Forgetting why you walked into a room
Reduced mental sharpness or slower recall
More effort needed to multi-task
Reviews of the menopause transition describe changes that can include verbal memory, attention, and processing speed for some women.[4,7]
Sleep disruption and anxiety as “hidden drivers” of focus issues
Two common “behind-the-scenes” drivers of brain fog are sleep and stress/anxiety. Sleep disruption (including night sweats) and higher stress sensitivity can both interfere with attention and memory.[5,8]
Cyclical variability (better/worse weeks) and trigger patterns
A clue clinicians often listen for is variability:
Weeks where you feel much more clear, then suddenly foggy again
Symptom spikes tied to cycle changes, hot flashes, poor sleep stretches, or high-stress periods
Misconception #2: “Brain fog means dementia.” Brain fog is common in the menopause transition, changes are typically mild, and dementia at midlife is rare. Still, new or worsening cognitive symptoms deserve evaluation, especially if they’re rapidly progressing or affecting safety.[1,7]
✅ Key takeaway: 🌙 When sleep and stress get disrupted, attention and memory usually suffer—whether or not ADHD is present.
Key Differentiators Clinicians Use When You’re Asking, “Is It ADHD or Perimenopause?”
Timeline: lifelong pattern vs newer onset
A core differentiator is when the pattern started:
More consistent since childhood/adolescence: ADHD is more likely.
Noticeable shift in midlife with other perimenopause signs: hormone transition may be driving the change.
A high-quality assessment often includes a developmental history (school years, early organization patterns, long-term attention challenges) rather than focusing only on your last few months.[6]
Context: consistent across settings vs tied to sleep/hormone shifts
Clinicians explore whether symptoms are:
Pervasive across settings (work, home, relationships) and consistent over time (often ADHD)
More episodic and correlated with sleep disruption, anxiety spikes, or vasomotor symptoms (often perimenopause-related)
Impairment: what’s actually being impacted (work, home, relationships)
Two people can have the same symptom (forgetfulness) but very different levels of impairment. Clinicians look for:
Missed deadlines, performance issues, or job instability
Household management breakdowns (bills, meals, appointments)
Relationship stress from chronic forgetfulness, irritability, or overwhelm
Example #1 (pattern clue):
Perimenopause-leaning: “I’ve always been organized, but over the last year I’m losing words, sleeping poorly, and my focus tanks after night sweats.”
ADHD-leaning: “I’ve always lived by reminders and last-minute panic. I functioned, but it’s been exhausting since forever.”
✅ Key takeaway: 🧾 Clinicians rely on three anchors: timeline, context/variability, and real-world impairment—not just a symptom checklist.
Common “Look-Alikes” to Rule In/Out
Anxiety, depression, burnout, trauma
Anxiety and depression can both reduce concentration and increase forgetfulness. Burnout can mimic executive dysfunction. Trauma can affect attention, memory, and emotional regulation. These can also co-occur with ADHD—so clinicians screen broadly rather than assuming a single cause.[2,3]
Sleep disorders, thyroid issues, anemia, medication effects
Sleep apnea, insomnia, thyroid dysfunction, anemia/iron deficiency, and certain medications can all impact cognition and energy. A good clinician will ask about medical history and may recommend coordinating with your PCP or OB-GYN for lab work or sleep evaluation when appropriate.[4,5]
ADHD + perimenopause can both be true
This is more common than people expect. Hormonal transition can add cognitive strain to an already ADHD-vulnerable system. Emerging research suggests ADHD symptoms in females may shift with hormonal changes, though more menopause-specific research is still needed.[9]
Misconception #3: “An online quiz can diagnose ADHD.”Screeners can be useful starting points, but diagnosis requires clinical evaluation. The ASRS (Adult ADHD Self-Report Scale) is a validated screener, not a stand-alone diagnosis.[10,11]
When an ADHD Assessment Makes Sense
Red flags that point toward ADHD (even if you “function”)
Consider a formal assessment if several of these fit:
Longstanding time blindness, chronic lateness, or missed deadlines
“All-or-nothing” productivity (hyperfocus then crash)
Persistent disorganization that takes constant effort to manage
Emotional overwhelm out of proportion to the moment
A history of coping through perfectionism, overworking, or anxiety
If you’re curious, you can start with a screener like the Adult ADHD Self‑Report Scale (ASRS) and bring results to a clinician: Adult ADHD Self‑Report Scale (ASRS) Screener.
Signs it may be primarily menopause-related (and still deserves support)
Menopause-related cognitive shifts may be more likely if:
Symptoms began in the last 1–3 years with cycle changes and other perimenopause signs
Clear association with sleep disruption, hot flashes/night sweats, or new anxiety
Your history doesn’t show lifelong organizational/attention struggles
Even if ADHD isn’t the answer, support matters. Sleep-focused treatment (like CBT‑I) can be a game changer when insomnia is fueling brain fog: Learn about insomnia care.
What a quality assessment includes (vs online quizzes)
A strong adult ADHD evaluation typically includes:
A detailed clinical interview (symptoms + functional impact)
Developmental history (childhood patterns, school/work history)
Standardized rating scales (often including screeners like the ASRS)
Differential diagnosis (ruling in/out anxiety, depression, sleep disorders, trauma, and medical contributors)
Clear feedback and treatment recommendations
To explore options, see our overview of psychological assessments.
Next Steps (Tennessee + Telehealth-Friendly)
What to track for 2–4 weeks (symptoms, sleep, cycle, stressors)
Tracking turns “I feel foggy” into usable data. For 2–4 weeks, jot down:
Sleep: bedtime/wake time, awakenings, daytime fatigue
Cognitive symptoms: forgetfulness, attention, word-finding, overwhelm
Cycle or hormone clues: period changes, hot flashes/night sweats (if applicable)
Stressors: workload spikes, caregiving demands, major transitions
Caffeine/alcohol and medication changes
Example #2 (tracking insight):You notice your “can’t-start” executive dysfunction clusters after three nights of poor sleep, and your word-finding issues spike during weeks with night sweats. That pattern can point clinicians toward targeted sleep and perimenopause supports—while still evaluating ADHD if lifelong signs are present.
How to choose an evaluator experienced with adult women
Look for an evaluator who:
Routinely assesses ADHD in adults (not only children)
Understands inattentive presentations and masking in women
Screens for sleep, mood, trauma, and medical contributors
Gives clear, practical recommendations beyond “try harder”
If executive function is a key struggle, coaching can complement therapy and treatment: Executive function coaching.
How telehealth ADHD assessment works in Tennessee
Telehealth assessments typically use secure video, standardized measures adapted for online delivery, and structured interviews. You’ll usually complete questionnaires ahead of time, then meet with the clinician for a detailed interview and feedback session.
If you’re in Tennessee and want a telehealth-friendly evaluation path, you can start by exploring our mental health screening tools and then schedule a consult to talk through fit and next steps.
Conclusion
If you’re stuck in the “is it ADHD or perimenopause?” loop, you don’t need to solve it alone. Clinicians can help you map your timeline, identify trigger patterns, and rule in/out common look-alikes—so you can stop guessing and start targeting what actually helps.
If you’d like support, ScienceWorks Behavioral Healthcare offers telehealth services and individualized next-step planning. You can meet our team or schedule a free consultation.
About the Author
Kiesa Kelly, PhD, HSP is a licensed psychologist and the practice owner at ScienceWorks Behavioral Healthcare. She earned her PhD in Clinical Psychology (Neuropsychology concentration) and completed an NIH‑funded postdoctoral fellowship at Vanderbilt University.
Dr. Kelly provides affirming care and assessment services for ADHD and autistic neurotypes, as well as support for OCD, trauma, and insomnia.
References
The Menopause Society (North American Menopause Society). Perimenopause. Available from: https://menopause.org/patient-education/menopause-topics/perimenopause. Accessed 2026 Jan 16.
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
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Budson AE. Sleep, stress, or hormones? Brain fog during perimenopause. Harvard Health Publishing. 2021 Apr 9. Available from: https://www.health.harvard.edu/blog/sleep-stress-or-hormones-brain-fog-during-perimenopause-202104092429. Accessed 2026 Jan 16.
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American College of Obstetricians and Gynecologists. Mood Changes During Perimenopause Are Real. Here’s What to Know. Available from: https://www.acog.org/womens-health/experts-and-stories/the-latest/mood-changes-during-perimenopause-are-real-heres-what-to-know. Accessed 2026 Jan 16.
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
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-256. doi: https://doi.org/10.1017/S0033291704002892
Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res. 2007;16(2):52-65. doi: https://doi.org/10.1002/mpr.208
Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Menopause. 2012;19(4):387-395. doi: https://doi.org/10.1097/gme.0b013e31824d8f40
Disclaimer
This content is for educational purposes and is not medical advice. It does not replace individualized assessment, diagnosis, or treatment from a qualified healthcare professional. If you have urgent safety concerns, contact local emergency services.
