If you have ADHD and are in your late 30s or 40s, you may feel like something shifted before you were ready. Your focus feels worse. Your emotions feel harder to manage. Sleep is unpredictable.  Anxiety, irritability, or overwhelm show up in ways they never did before. Sometimes hot flashes or night sweats appear earlier than expected.

Many women are told this is stress, burnout, or just their ADHD getting worse.

Emerging research suggests something else may be happening.

Recent studies indicate that women with ADHD often experience perimenopausal symptoms earlier and with greater severity than women without ADHD. These differences show up most clearly in mood symptoms, physical complaints, sleep disruption, and urogenital changes. In some women, symptoms begin in the late 30s, well before menopause is usually discussed.

This matters, because when perimenopause is missed, women are left questioning themselves instead of getting support.

ADHD affects brain systems involved in attention, motivation, emotional regulation, and stress response. Estrogen supports many of these same pathways. During perimenopause, estrogen levels fluctuate unpredictably. For women with ADHD, whose brains are already more sensitive to changes in neurotransmitters, these hormonal shifts can amplify symptoms that were previously manageable.

That is why many women say their ADHD medication no longer feels as effective. In many cases, the issue is not medication failure. Sleep disruption, hormonal instability, anxiety, and nervous system overload can all make focus and executive function feel dramatically worse.

Perimenopause is often overlooked in women with ADHD because symptoms overlap. Difficulty concentrating, emotional reactivity, low energy, and sleep problems are frequently attributed to anxiety, depression, or ADHD itself. When hormonal context is not considered, women are told to push through or adjust medications without addressing the root cause.

What actually helps is a more complete view of what is happening.

Care that supports women with ADHD during perimenopause often includes recognizing the transition earlier, addressing sleep and vasomotor symptoms like night sweats, supporting mood and emotional regulation, and adjusting ADHD strategies during periods of hormonal change. When hormone therapy is not appropriate, non hormonal options and cognitive behavioral therapy can be highly effective.

There is no single solution. What matters most is individualized care and being taken seriously.

If you have ADHD and feel like everything became harder all at once, you are not imagining it. You are not failing. You may be moving through a hormonal transition that deserves attention.

If you are in your late 30s or 40s and noticing changes in focus, mood, sleep, or physical comfort, it may be worth asking a different question.

Could this be perimenopause, not just ADHD?