Running on Empty Isn't Normal: What ADHD and Perimenopause Taught Me About Rest
For years I ran on what felt like a three percent battery, and I tried my best to make sure nobody could tell.
Running on empty but pretending we’re fine
I assumed that everyone else felt utterly exhausted each day and that having a break was something you earned. So I brushed off what my body and nervous system were trying to tell me, pushed through, told myself to focus, told myself everyone was tired, told myself I was making excuses. This worked, until it didn't.
I felt lazy and ashamed when my energy started to flag during the day, even though I knew a short rest had such a positive impact on my energy and what I could get done. I didn't think anyone else felt like this, and was too embarrassed to tell anyone.
A world that wasn't built for our nervous systems
The world we're operating in wasn't built for neurodivergent nervous systems. It rewards constant output, always being productive and looking fine, even when you are feeling the very opposite. So we override our own warning signals early, and keep going long after there's nothing left in the tank.
That exhaustion was never a weakness. It was information.
Why our energy levels are depleted more frequently
Our executive functions, initiating tasks, planning and prioritising, organising, time management, memory, staying on task, all run on dopamine, which our brains are already struggling to utilise properly. A 2024 review of the evidence behind ADHD and dopamine confirms this isn't a minor player in the background. Dopamine signalling difficulties sit at the centre of the attention, motivation and executive function difficulties that come with ADHD (MacDonald et al., 2024).
Add in sleep deprivation, which disrupts that same dopamine system even further, and everything gets harder still. Research from Karolinska Institutet found that people with higher, even subclinical, ADHD traits show far greater variability in executive function after a night of poor sleep than those without those traits. In other words, the same bad night's sleep can cost an ADHD brain considerably more than it costs someone else's (Floros et al., 2021).
Where oestrogen fits in
Oestrogen regulates how dopamine gets produced and used in the brain, so as it fluctuates and drops through perimenopause, that dopamine becomes even harder to rely on, and every one of those executive functions costs more effort for the same task. A major 2025 review of female ADHD research described this same interplay, showing how falling oestrogen during hormonal transitions can affect dopamine pathways and worsen executive function and mood (Kooij et al., 2025). A separate 2025 study of women's menopausal experiences found that ADHD traits were linked to greater difficulties with memory, concentration and psychosocial functioning as women moved through the menopause transition (Chapman et al., 2025).
That's why exhaustion runs so much deeper than normal tiredness, and why a nervous system can end up stuck in survival mode with nowhere left to go.
What actually helps
Noticing when your energy is dropping, stopping before you hit the wall rather than after, treating your limits as information rather than proof you're failing and giving yourself permission to rest.
These are small changes. But they're the ones that actually make a difference.
We need to realise that often the answer to being more productive is resting when we need to.
References
Chapman, L., Gupta, K., Hunter, M.S. and Dommett, E.J. (2025) 'Examining the Link Between ADHD Symptoms and Menopausal Experiences', Journal of Attention Disorders, 29(14), pp. 1263-1277. Available at: https://journals.sagepub.com/doi/10.1177/10870547251355006
Floros, O., Axelsson, J., Almeida, R.G., Tigerström, L., Lekander, M., Sundelin, T. and Petrovic, P. (2021) 'Vulnerability in Executive Functions to Sleep Deprivation Is Predicted by Subclinical Attention-Deficit/Hyperactivity Disorder Symptoms', Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 6(3), pp. 290-298. Available at: https://www.sciencedirect.com/science/article/pii/S2451902220303086
Kooij, J.J.S., de Jong, M., Agnew-Blais, J., Amoretti, S., Madsen, K.B., Barclay, I., Bölte, S., Borg Skoglund, C., Broughton, T., Carucci, S., van Dijken, D.K.E., Ernst, J., French, B., Frick, M.A., Galera, C., Groenman, A.P., Kopp Kallner, H., Kerner auch Koerner, J., Kittel-Schneider, S., Manor, I., Martin, J., Matera, E., Parlatini, V., Philipsen, A., Ramos-Quiroga, J.A., Rapoport, I.L., Lundin Remnélius, K., Sénéquier, A., Thorell, L., Wittekoek, J.M.E. and Wynchank, D. (2025) 'Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease', Frontiers in Global Women's Health, 6, 1613628. Available at: https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1613628/full
MacDonald, H.J., Kleppe, R., Szigetvari, P.D. and Haavik, J. (2024) 'The dopamine hypothesis for ADHD: An evaluation of evidence accumulated from human studies and animal models', Frontiers in Psychiatry, 15, 1492126. Available at: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1492126/full
