Is My Medication Not Working? Perimenopause ADHD Treatment Questions to Ask in Perimenopause
- Kiesa Kelly
- 1 day ago
- 10 min read
Last reviewed: 02/12/2026
Reviewed by: Dr. Kiesa Kelly
If you’re in perimenopause ADHD treatment and it suddenly feels like your meds “stopped working,” you’re not imagining it. But it also doesn’t automatically mean your prescription is wrong or that you “need more.” Perimenopause can shift sleep, stress, and symptoms in ways that change what your day-to-day functioning looks like. [1,2]
In this article, you’ll learn:
Why sleep and stress can look like medication failure
What “not working” can actually mean (and how to describe it)
A clinician-friendly symptom review you can bring to appointments
Non-prescriptive questions to ask your prescriber
How to coordinate care, protect safety, and plan follow-up (including Tennessee telehealth notes)
💡 Key takeaway: A “meds aren’t working” feeling is often a signal to zoom out and reassess sleep, stress, timing, and overall health, not a reason to self-adjust. [3,4]
First: You’re Not Imagining It, But Many Factors Can Be Involved
Perimenopause is the transition leading up to menopause, marked by fluctuating hormones and often irregular cycles, and it lasts until menopause is confirmed (12 months after the final menstrual period). [2,3] Many people notice changes in attention, memory, mood, and sleep during this time, even without ADHD. [3,5]
If you already have ADHD, the overlap can feel brutal: the same executive functions you rely on to compensate (planning, emotional regulation, task initiation) may be under extra strain. [6–8]
Sleep disruption can mimic “meds stopped working”
Sleep is an executive-function amplifier. When it’s disrupted, working memory, attention, reaction time, and emotional regulation all tend to suffer, regardless of what medication you take. Menopause-transition sleep problems are common, and night sweats/hot flashes can fragment sleep even if you fall asleep easily. [4,5]
Practical example: You’re taking the same morning dose, but you’re waking up at 2:00 a.m. sweaty and restless three nights a week. By 10:30 a.m., your “med window” feels shorter and your patience is thinner. That pattern can look like tolerance, but the driver
may be sleep fragmentation and daytime fatigue. [4,5]
💡 Key takeaway: If sleep quality changes, medication can feel different, even if absorption and dose are unchanged. Track sleep first. [4]
Stress and burnout change cognitive performance
Stress loads the brain’s “control systems.” When your day is full of urgent demands (work, caregiving, emotional labor), it gets harder to do the quiet, self-directed tasks that ADHD medication helps with, like starting paperwork or sequencing a multi-step project.
Misconception #1: “If my meds work, I should be able to push through anything.” In reality, medication supports attention and follow-through, but it doesn’t erase overload or the need for recovery time.
A helpful data point is not just “I can’t focus,” but “I can focus on emergencies, but I can’t initiate the boring thing.” That distinction matters clinically.
Hormonal variability can affect symptom intensity
During perimenopause, hormone levels can rise and fall unpredictably. Many people report that ADHD symptoms fluctuate alongside those changes, and emerging research suggests the menopause transition can interact with attention and mood regulation in some women with ADHD. [6–8]
That said, the science on how perimenopause affects ADHD medication response is still developing. Across reproductive stages, research on sex hormones and ADHD is limited and sometimes mixed. [8,10] A shift in symptoms doesn’t automatically mean your medication stopped working, and it doesn’t point to one “right” medication change for everyone. [8,9]
💡 Key takeaway: Perimenopause can increase symptom variability. The goal is to map patterns and impairment, not to force a single explanation. [8]
What “Not Working” Can Look Like
When patients say “my meds aren’t working,” clinicians usually need a more specific picture. Here are a few common patterns.
Focus is worse, but motivation is the real problem
Sometimes attention is not the main issue. The bigger problem is task initiation, decision fatigue, or “I can’t make myself start.” That can show up as:
Procrastination that feels physically stuck
Scrolling or “research spirals” that replace action
Difficulty switching from one task to the next
Misconception #2: “If I can’t start, I must be lazy.” Task initiation is a core executive function, and it’s highly sensitive to sleep loss, mood, and stress load. [4,5]
Emotional regulation feels harder
Perimenopause can come with irritability, mood shifts, and heightened emotional reactivity for some people. [2,3] ADHD can also include emotional dysregulation (fast spikes, slower recovery). When both are present, you might notice:
Lower frustration tolerance
More crying, snapping, or feeling “flooded”
Rejection sensitivity feeling louder
Misconception #3: “If I’m more emotional, my ADHD must be ‘getting worse.’” Sometimes the driver is sleep disruption, anxiety, or perimenopause-related mood vulnerability, not a sudden change in ADHD itself. [3,4]
Side effects feel different than before
Some people notice that side effects they tolerated previously now feel more noticeable, especially if sleep is fragile. Examples include:
Feeling more “keyed up” with caffeine plus stimulant
More appetite suppression, or stronger rebound hunger
More noticeable heart racing or jitteriness when anxious
This is important to report without self-blame. It’s simply data your prescriber can use for safer decisions.
💡 Key takeaway: “Not working” can mean lower benefit, higher side effects, or a different symptom mix. Naming which one helps your clinician help you.
A Clinician-Friendly Symptom Review (What to Bring to Appointments)
A strong appointment is built on specifics, not self-criticism. If you can, bring 2–3 weeks of notes. You don’t need a perfect spreadsheet.
What changed, when, and in which settings
Try to capture:
What changed (focus, initiation, memory, mood, sleep, appetite)
When it started (a month, a week, “since my cycles became irregular”)
Where it shows up (work, home, driving, parenting, relationships)
What is now impaired (missed deadlines, more conflict, safety errors)
If you want structured self-report tools, our adult ADHD screening resources can help you organize symptoms, and psychological assessments can clarify a full diagnostic picture when needed.
Sleep, appetite, anxiety, irritability, cycle or transition symptoms
These domains often drive the “something changed” feeling in perimenopause:
Sleep timing and quality (including night sweats/hot flashes)
Appetite and meal regularity
Anxiety, worry, rumination
Irritability, tearfulness, mood shifts
Cycle changes and other perimenopause symptoms (brain fog, hot flashes)
If insomnia is part of the picture, consider reading our insomnia care overview. CBT-I is an evidence-based approach that can reduce impairment even when medication stays the same. [4]
Timing: dose schedule, caffeine, missed meals (just data, not blame)
Write down:
When you take your medication (and whether it varies)
Caffeine timing and amount
Missed meals (especially breakfast or lunch)
Any new supplements or medications
This isn’t about proving you’re “doing it right.” It’s about helping your prescriber see what your nervous system is being asked to run on.
💡 Key takeaway: The most helpful tracking is simple: sleep, timing, stress load, and what’s actually impaired.
Questions to Ask Your Prescriber (Non-Prescriptive)
The goal of these questions is collaboration and differential diagnosis, not pushing for a specific change.
“Could sleep or hot flashes be driving this change?”
Helpful follow-ups:
“If we treat the sleep disruption, what improvement would you expect in attention and mood?”
“Should we consider targeted treatment for hot flashes or night sweats, or coordinate with my OB-GYN?” [2,4]
“Should we reassess dose timing or formulation?”
You’re not asking to change anything on your own. You’re asking whether the plan still matches your day.
“Is my current timing aligned with my hardest hours?”
“Would a different formulation reduce rebound or late-day crash?”
“How should we think about appetite and sleep while we adjust the plan?”
“Do we need to screen for anxiety, depression, or thyroid or iron issues?”
Perimenopause is not the only possible driver of fatigue, brain fog, or irritability. It’s reasonable to ask about screening for common medical and mental health contributors.
If anxiety or depression screening would help organize symptoms, ask whether brief screeners such as the GAD-7 or PHQ-9 make sense for you.
💡 Key takeaway: The safest medication decisions happen after a quick “whole health” screen, not before it. [3]
Coordinating Care for Perimenopause ADHD
Many people do best when care is coordinated rather than siloed.
Primary care or OB-GYN plus ADHD clinician collaboration
If you have an OB-GYN or primary care clinician, consider signing a release so your clinicians can align on:
Sleep and vasomotor symptom treatment options
Medication interaction risks
Medical workup plans (thyroid, iron, etc.)
Perimenopause can affect multiple systems, so a team approach reduces guesswork. [2]
When therapy can reduce impairment even if meds are unchanged
Medication can support attention, but therapy targets the “how” of living with ADHD in a changing body. For many adults, this is where gains show up fastest:
Skills for task initiation and planning under fatigue
Stress regulation and values-based pacing
Communication strategies when irritability is higher
Our specialized therapy services and executive function coaching are designed to reduce impairment with practical, measurable goals.
Practical example: If mornings are now slower because sleep is fragmented, coaching can help you redesign routines (med timing, breakfast cues, “minimum viable morning”) so you’re not using willpower as your only tool.
Documentation and work accommodations if functioning dips
If your functioning drops in a measurable way, you can ask your clinician about documentation for accommodations (not excuses). Examples include:
Flexible start time for a limited period
Meeting-free blocks for deep work
Written instructions and deadlines
This is especially important if your role affects safety (driving, medication administration, high-stakes decisions).
Safety and When to Seek Prompt Help
Some situations call for faster follow-up than “wait until my next med check.”
Concerning side effects or severe mood changes
Contact your prescriber promptly if you have:
Chest pain, fainting, or severe palpitations
New or worsening panic symptoms that feel unmanageable
Severe agitation, insomnia, or mood changes after a med change
Any thoughts of harming yourself
If you feel in immediate danger, call 911. If you need urgent emotional support, you can call or text 988 (U.S.) or use chat through the 988 Lifeline. [11]
Substance interactions and self-adjusting risks
It’s common to try “fixes” when you feel desperate, like taking extra caffeine, skipping meals, or adjusting your dose. But self-adjusting can increase side effects, worsen sleep, and complicate prescribing.
Tell your prescriber honestly about:
Alcohol, cannabis, or other substances
Supplements marketed for menopause or energy
Any dose changes you’ve already tried
💡 Key takeaway: If you’re tempted to self-adjust, that’s a sign you need support sooner, not that you should experiment alone.
Crisis resources if you’re feeling unsafe
If you’re feeling unsafe or having thoughts of suicide, you deserve real-time support.
Call or text 988 in the U.S. (24/7).
If you are in Tennessee, the state’s crisis information page also directs you to 988 options. [11,12]
Access Notes for Tennessee and Telehealth
Rules change, and clinics must follow federal and state requirements. The notes below are general, patient-facing “what to expect,” not legal advice.
What to look for in a prescriber or clinic
Green flags for Tennessee telehealth ADHD care often include:
Clear evaluation process (history, symptoms across settings, impairment)
Transparent follow-up schedule and monitoring plan
Willingness to coordinate with primary care or OB-GYN
Thoughtful screening for sleep, mood, and medical contributors
If you’re looking for a next step, you can explore our team at Meet ScienceWorks or reach out through our contact page.
Common barriers and how to prepare
Common barriers include appointment availability, pharmacy supply issues, and the extra steps that sometimes come with controlled medications.
In Tennessee, prescribers are generally required to check the state’s Controlled Substance Monitoring Database (CSMD) at key points when prescribing Schedule II amphetamines and other monitored medications. That can affect timing for refills or med changes, especially if records need to be updated. [13]
What helps:
Bring your ID and updated medication list
Bring your 2–3 week symptom notes
Use one pharmacy when possible
Ask what the clinic’s follow-up cadence is before you run out
What a follow-up plan can include
A reasonable follow-up plan might include:
A shared definition of “working” (which outcomes matter most)
A short tracking plan (sleep, timing, side effects, impairment)
A timeline for reassessment and next steps
Coordination with other clinicians as needed
Telehealth prescribing rules for controlled medications have been extended at the federal level through December 31, 2026, which helps avoid sudden disruptions in care, but state rules still apply. [14]
Summary and next steps
If it feels like your ADHD medication isn’t working in perimenopause, you’re not alone, and you’re not “failing.” Perimenopause can change sleep, stress tolerance, and symptom intensity in ways that look like medication failure. The most effective next step is to bring clear, specific data to your prescriber so you can reassess the full picture: sleep, timing, mood, medical contributors, and safety.
If you’re in Tennessee and want support, we can help you organize symptoms, coordinate care, and build an evidence-based plan that fits real life. Contact us to discuss fit and next steps.
About the Author
Dr. Kiesa Kelly is a licensed psychologist and the owner of ScienceWorks Behavioral Healthcare. Her work focuses on neurodiversity-affirming assessment and evidence-based care for adults, including ADHD, autism, OCD, trauma, and overlapping presentations.
She has advanced clinical training in cognitive and behavioral therapies (including ERP, ACT, and CBT approaches) and values collaborative, measurement-informed care that helps clients translate insights into practical changes.
References
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Osianlis E, et al. ADHD and Sex Hormones in Females: A Systematic Review. J Atten Disord. 2025;29(9):706–723. Available from: doi:10.1177/10870547251332319 (accessed 12 Feb 2026).
de Jong M, et al. Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Front Psychiatry. 2023;14:1306194. Available from: doi:10.3389/fpsyt.2023.1306194 (accessed 12 Feb 2026).
Camara B, et al. Relationship between sex hormones, reproductive stages and ADHD: a systematic review. Arch Womens Ment Health. 2022;25(1):1–8. Available from: doi:10.1007/s00737-021-01181-w (accessed 12 Feb 2026).
988 Suicide & Crisis Lifeline [Internet]. Available from: 988 Lifeline (accessed 12 Feb 2026).
Tennessee Department of Mental Health and Substance Abuse Services. 988 Suicide & Crisis Lifeline [Internet]. Available from: TN 988 (accessed 12 Feb 2026).
Tennessee Department of Health. CSMD Board FAQ: Who is required to check the CSMD? Updated 2024 Sep 4 [Internet]. Available from: TN DOH CSMD FAQ (accessed 12 Feb 2026).
U.S. Department of Health and Human Services. HHS and DEA extend telemedicine flexibilities for prescribing controlled medications through 2026. 2026 Jan 2 [Internet]. Available from: HHS news release (accessed 12 Feb 2026).
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding a medical condition or medication. Never change or stop medication without medical supervision.