New Attention Problems Perimenopause: When to Consider ADHD Testing
- Kiesa Kelly
- 3 days ago
- 8 min read
If you’re noticing attention problems perimenopause, you’re not alone. Many midlife women describe “brain fog,” losing words, misplacing essentials, or feeling like their executive function has vanished overnight. These symptoms can be common in the menopause transition, but they can also overlap with adult ADHD and other treatable conditions.
🧭 Key takeaway: Assessment isn’t about “picking a label.” It’s about getting clear on what’s driving the change so you can choose the right support.
If you’d like a structured starting point, you can review the Adult ADHD ASRS screener, learn what’s involved in psychological assessments, or request a free consult.
In this article, you’ll learn:
Why new attention changes can show up in perimenopause
The most common perimenopause brain fog patterns
Clues that point more toward ADHD vs menopause-related changes
What “screening” can and can’t tell you
A practical guide for deciding when to book ADHD testing
Start Here: New Attention Problems Can Have Multiple Causes
Perimenopause can impact sleep, mood, and cognition
During perimenopause, hormone shifts can ripple into sleep quality, mood regulation, and stress sensitivity. Cognitive symptoms are common, and many women report difficulty concentrating, distractibility, and forgetfulness as part of “brain fog.” In fact,
The Menopause Society notes that 40%–60% of midlife women report cognitive symptoms during the menopause transition, and that dementia at midlife is very rare. [1]
If disrupted sleep is part of the picture, explore practical next steps on our insomnia support options page.
If sleep is broken by hot flashes, night sweats, or early-morning waking, attention and working memory can take a hit fast. Cognitive function at midlife also appears to be influenced by menopause stage and symptoms like sleep difficulties and mood changes. [4]
🌙 Key takeaway: Before you assume ADHD, check the “big three” that often drive brain fog: sleep, mood, and stress load.
ADHD can be missed until midlife
ADHD is not “new” in midlife, but it can become more obvious when the systems that used to compensate stop working (for example: less sleep, more caregiving demands, more complex work roles). Research on adult women highlights delayed or missed diagnosis, often because symptoms can look more internal (inattention, overwhelm, emotional dysregulation) and may be masked by perfectionism or anxiety-driven coping. [5,6]
A common misconception is: “If it starts at 45, it can’t be ADHD.” ADHD criteria require that some symptoms were present earlier in life, even if they weren’t recognized at the time. [7]
You don’t have to decide alone—assessment is for clarity
You do not need to figure out “is it ADHD or menopause” by yourself. A quality evaluation is designed to sort through overlap, rule-outs, and patterns over time.
If you want skills support while you’re sorting out the “why,” executive function coaching and specialized therapy can help build routines, reduce overwhelm, and strengthen follow-through.
If you’re considering next steps, you can start with reputable screening options (like the Adult ADHD ASRS screener page), then move toward a fuller evaluation if needed.
Common Attention Problems Perimenopause: Brain Fog and Executive Function
Many perimenopause cognitive changes fall under executive function: the brain’s management system for planning, focus, working memory, and follow-through.
Forgetting, misplacing, losing words
This can look like:
Walking into a room and forgetting why
Losing common words mid-sentence
Misplacing keys, glasses, paperwork
These “everyday memory” slips are frequently described in perimenopause brain fog, and objective research suggests some women show changes in areas like verbal learning/memory and, in some studies, attention and processing speed. [2,3]
Trouble starting tasks and staying on track
You may notice:
Starting tasks feels unusually hard
You bounce between tabs, rooms, or projects
Your brain “shuts down” when tasks have many steps
Overwhelm and irritability when juggling demands
When cognitive bandwidth is lower, the same workload can feel impossible. Irritability can also spike when sleep is fragmented or mood symptoms rise. [2,4]
Clues It Might Be Primarily Perimenopause-Related
Here are patterns that often lean more toward menopause cognitive changes than ADHD.
Clear timing with cycle changes or new menopause symptoms
If attention problems began alongside new cycle irregularity, hot flashes, night sweats, or other menopause symptoms, perimenopause is a strong suspect. [1,2]
📅 Key takeaway: Timing matters. Symptom onset that tracks with cycle changes is clinically useful information.
Symptoms fluctuate strongly with sleep and hot flashes
If you have “good days” after better sleep and “bad days” after hot nights, that variability can point toward sleep disruption as a driver. [4]
Practical example: If your focus is 70% better after two nights of solid sleep, that’s not “proof” it isn’t ADHD, but it’s a strong clue that sleep is a key lever.
If sleep is a struggle, consider tracking it and discussing treatment options with your medical provider. You can also explore support for insomnia skills through therapy, including CBT-I approaches (see Insomnia support options for resources).
No meaningful history of similar patterns earlier in life
Many women with perimenopause brain fog say, “This is new.” If you didn’t have longstanding issues with time management, organization, or distractibility in school, early work life, or home life, ADHD is less likely (though not impossible). A thorough history still matters. [7]
Clues It Might Be ADHD Even If It’s Only Becoming Obvious Now
Lifelong “executive function friction” in school, work, or home
Adult ADHD often has a long trail: chronic difficulty sustaining attention, organizing, completing tasks, or regulating effort across settings. [7]
A misconception here is: “I did well in school, so I can’t have ADHD.” Many high-achieving women cope through intensity, last-minute adrenaline, or over-preparation. That can “work,” but at a cost. [6]
Chronic time blindness, procrastination, disorganization
Common ADHD patterns include:
Underestimating time and running late
Repeated procrastination despite consequences
Difficulty keeping systems (calendars, budgets, routines) stable
Coping systems relied on anxiety or perfectionism to function
Another misconception: “If anxiety is present, it can’t be ADHD.” Anxiety can be both a look-alike and a coping strategy that helps someone “push through” executive dysfunction. A good evaluation separates what’s primary, what’s secondary, and what’s interacting. [6,8]
🧩 Key takeaway: ADHD usually has a story that started earlier, even if perimenopause makes it louder.
The Most Common “Look-Alikes” to Rule Out
Anxiety, depression, burnout, trauma
Mood symptoms and chronic stress can reduce concentration, working memory, and motivation. Perimenopause is also a window of vulnerability for mood changes in some women. [1,4]
Sleep disorders, thyroid issues, anemia, medication effects
Sleep apnea, insomnia, thyroid dysfunction, iron deficiency, and medication side effects can all mimic ADHD-like symptoms. Your medical clinician may recommend lab work or sleep evaluation depending on your presentation.
ADHD + perimenopause overlap is common
It’s not always “either-or.” Hormonal transitions may influence ADHD symptom intensity in some females, and the research base is still developing. [6,9]
Screening vs Assessment: What’s the Difference?
Why online quizzes can’t confirm a diagnosis
Online checklists can be useful for noticing patterns, but they can’t confirm ADHD because diagnosis requires developmental history, impairment, and careful differential diagnosis. CDC notes that only trained healthcare providers can diagnose ADHD using DSM criteria, including evidence that symptoms were present before age 12 and occur in multiple settings with meaningful impairment. [7]
Some guidelines also emphasize that diagnosis should not be made on rating scales alone. [8]
✅ Key takeaway: A screening score is a conversation starter, not a diagnosis.
If you’re looking for an online ADHD assessment Tennessee option, focus on clinics that offer a true evaluation (not just a quiz). A clinician may start with screening tools such as the ASRS (see validation work by Kessler and colleagues). [10]
What a full evaluation includes
A thorough ADHD assessment typically includes:
A detailed clinical interview (current symptoms + lifetime history)
Review of functioning across settings (work, home, relationships)
Standardized rating scales, sometimes with collateral input
Screening for mood, sleep, trauma, substance use, and medical contributors
A clear explanation of findings and a tailored care plan
Quality standards for adult ADHD assessment highlight comprehensive, multi-source evaluation and careful attention to differential diagnosis. [11,12]
For more on what psychological testing can look like, see Psychological assessments.
What a thorough differential looks like
A good differential asks:
What changed, and when?
What improves symptoms (sleep, schedule, stress reduction)?
Were similar patterns present earlier in life?
Could another condition better explain the picture?
If you’d like a gentle first step, you can also explore broader mental health screening options.
A Practical Decision Guide: When to Book an ADHD Evaluation
If impairment is affecting work, relationships, safety, or health
Consider booking if attention problems are causing:
Job performance issues or repeated errors
Relationship conflict about follow-through or reliability
Safety concerns (driving focus, missed meds, risky mistakes)
If symptoms persist despite basic sleep and stress supports
If you’ve addressed the basics (sleep, realistic workload, stress supports) and symptoms are still persistent and impairing, it’s reasonable to pursue clarity through evaluation. [2,4]
If you need documentation, accommodations, or targeted care
If you’re seeking workplace accommodations, academic support, or a targeted treatment plan, a formal assessment can help.
📌 Key takeaway: Book an evaluation when symptoms are persistent, impairing, and you want a roadmap, not just reassurance.
What to Do Before Your First Appointment
Two-week log: sleep, symptoms, triggers, cycle stage
Bring data. A simple 2-week log can make an evaluation more accurate.
Try this daily template:
Sleep: bedtime, wake time, night waking, hot flashes/night sweats
Cycle stage: bleeding, spotting, no period, or unknown
Brain fog rating: 0–10
Attention examples: what was hardest today?
Stressors: work, caregiving, conflict, illness
Practical example: “Tuesday: slept 4.5 hours, two night sweats, brain fog 8/10, missed a
meeting, snapped at partner.”
Three to five real examples of impairment
Come with specifics, not just “I’m scattered.” For example:
“I missed two deadlines this month because I couldn’t start until the last minute.”
“I lose my phone daily and spend 20 minutes searching.”
“I forget agreements and it’s harming trust in my relationship.”
If skills support is part of your plan, you may benefit from Executive function coaching or therapy that targets organization, emotion regulation, and follow-through (see Specialized therapy).
Tennessee telehealth options and what to expect
Many clinics now offer telehealth ADHD evaluation services. A legitimate telehealth evaluation typically involves secure forms, a live video interview, validated measures, and a feedback session.
ScienceWorks provides assessment services, including telehealth options where appropriate. If you’re ready to explore next steps, you can reach out for a free consult to discuss fit and scheduling: Contact ScienceWorks.
About the Author
Kiesa Kelly, PhD, is a clinical psychologist and neuropsychologist at ScienceWorks Behavioral Healthcare. Her work focuses on comprehensive psychological assessment, including careful differential diagnosis when symptoms overlap across medical and mental health factors.
Dr. Kelly has advanced training in neuropsychology and assessment, and has worked with adults across the lifespan. Learn more about her background and assessment approach here: Kiesa Kelly, PhD.
References
The Menopause Society. Perimenopause. Accessed January 18, 2026.
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.
Greendale GA, Derby CA, Maki PM. Perimenopause and Cognition. Obstetrics and Gynecology Clinics of North America. 2011;38(3):519–535.
The Menopause Society. Mental Health. Accessed January 18, 2026.
Attoe DE, Climie EA. Miss. Diagnosis: A Systematic Review of ADHD in Adult Women. Journal of Attention Disorders. 2023;27(7):645–657.
Young S, Adamo N, Ásgeirsdóttir BB, et al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20:404.
Centers for Disease Control and Prevention. Diagnosing ADHD. Last reviewed October 3, 2024. Accessed January 18, 2026.
National Institute for Health and Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). Last reviewed May 7, 2025. Accessed January 18, 2026.
Osianlis E, Thomas EHX, Torales J, et al. ADHD and Sex Hormones in Females: A Systematic Review. Journal of Attention Disorders. 2025;29(9):706–723.
Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine. 2005;35(2):245–256.
Adamou M, Arif M, Asherson P, et al. The adult ADHD assessment quality assurance standard. Frontiers in Psychiatry. 2024;15:1380410.
Skirrow P. Practice Standards for the Assessment of ADHD: A Synthesis of Recommendations From Eight International Guidelines. Journal of the New Zealand College of Clinical Psychologists. 2025;35(1):96–116.
Disclaimer
This article is for informational purposes only and is not a substitute for professional medical, psychological, or psychiatric advice, diagnosis, or treatment. If you have urgent concerns about safety, severe mood symptoms, or rapid changes in functioning, seek immediate care.
