Perimenopause, neurodivergence, and the risk no one talks about
When we talk about perimenopause, the conversation often centres on hot flushes, night sweats, and disrupted sleep. These symptoms make headlines or get joked about among friends, yet beneath the physical changes lies a deeper story, and one that is rarely discussed. The emotional, cognitive, and psychological impact of perimenopause can be profound, and for neurodivergent women, it can be life altering.
For women with ADHD, perimenopause is not just a hormonal shift, it is a complete rewiring of how their brains function day to day. As oestrogen levels fluctuate and decline, the regulation of key neurotransmitters such as dopamine and serotonin becomes disrupted, which affects focus, motivation, and emotional stability. This means that existing challenges with attention, impulsivity, or emotional regulation can intensify dramatically. Tasks that once felt manageable may suddenly become overwhelming, and strategies that previously worked no longer seem to help.
Many women describe this stage as disorientating, frightening, and isolating. The sense of losing yourself is common and is captured powerfully by writer Bridgette Hampstead (2024), “Perimenopause feels like dementia in an AuDHD brain, and no one warns you.”
When ADHD and perimenopause overlap, women often experience increased forgetfulness, emotional volatility, and loss of motivation. Executive functions, including the ability to plan, prioritise, and regulate, can become particularly fragile. For those who have masked their neurodivergence for decades, this unravelling can feel like failure when in reality it is a biological response to hormonal change.
Many of the women I work with describe feeling as though their ADHD has suddenly worsened, or that their medication no longer works. This is often linked to oestrogen fluctuations, which affect how dopamine functions in the brain. Getting hormones balanced, in a way that is right for each individual, can make a remarkable difference to emotional wellbeing, focus, and confidence. I know this not only through the women I support, but because I have lived it first hand. The strategies and frameworks that once helped me each day stopped working, and the experience of no longer recognising myself was deeply unsettling. For many of us, this shift leads to a loss of confidence, disrupted thought processes, and a daily struggle to function.
Research increasingly shows that perimenopause is not only a physical transition but also a period of significant mental health vulnerability. Studies highlight that rates of depression and suicidality rise sharply during perimenopause, particularly when symptoms are misunderstood or dismissed by healthcare providers (Hendriks et al., 2025; Martin-Key et al., 2024).
For so many neurodivergent women, including myself, there is already a history of chronic stress, burnout, or years of feeling unseen, and the impact can be devastating. The collision of hormonal changes with executive dysfunction and emotional exhaustion can create a perfect storm for mental health decline.
When my own perimenopause collided with my ADHD, I felt as though everything I had worked so hard to manage suddenly unravelled. Concentration, confidence, and emotional stability all slipped through my fingers, it wasn’t weakness or lack of resilience, it was the effect of my hormones on my neurodivergent brain. Too often, women feel they should simply get on with it and accept these changes as part of ageing, yet recognising the link between perimenopause, neurodivergence, and mental health is essential.
Support can take many forms, medical, psychological, and practical. It might mean speaking to a GP about hormone replacement therapy, exploring neuroaffirming coaching or therapy to rebuild strategies and confidence, or finding a community of women who truly understand through online or face to face support groups.
It is time to change how we talk about perimenopause and neurodivergence. This is not just about hormones or hot flushes, it’s about identity, mental health, and the need for far greater understanding across healthcare and society.
References
Hendriks, O., McIntyre, J.C., Rose, A.K., Crockett, C., Newson, L. and Saini, P. (2025) The mental health challenges, especially suicidality, experienced by women during perimenopause and menopause: A qualitative study, Women’s Health (London), 21, p. 17455057251338941. Available at: https://pubmed.ncbi.nlm.nih.gov/40626330
Martin-Key, N.A., Funnell, E.L., Barker, E.J. and Bahn, S. (2024) Examining suicidality in relation to the menopause: A systematic review, PLOS Mental Health, 1(6), p. e0000161. Available at: https://journals.plos.org/mentalhealth/article?id=10.1371%2Fjournal.pmen.0000161
Hampstead, B. (2024) Perimenopause feels like dementia in an AuDHD brain, and no one warns you, LinkedIn, 15 September. Available at:https://www.linkedin.com/pulse/perimenopause-feels-like-dementia-audhd-brain-one-you-hamstead-ms-59hfc