Is It ADHD or Perimenopause? Why Midlife Focus Feels So Much Harder
If you’ve found yourself walking into a room and forgetting why, rereading the same email three times, or wondering why everything suddenly feels so much harder, you’re not alone, and you’re not imagining it. This month, we’re thrilled to welcome Danielle Cogliano, Psychiatric Nurse Practitioner and founder of Northeast Women’s Psychiatry, to the blog. Danielle has spent 20 years helping women understand how hormones and mental health intersect, and she’s sharing what she sees every day in her practice.
Once you’ve started to gain an appreciation for what perimenopause is, and perhaps you’ve even become more educated on adult ADHD, you can see that there are some parallels. Indeed, perimenopause and ADHD share a number of symptoms like brain fog, mood swings, forgetfulness, and executive functioning issues. Parsing the two diagnoses out and identifying whether a woman is dealing with one or both is complex.
In very simple terms, hormonal changes during perimenopause result in worsening of inattention, poor memory, and emotional dysregulation. Women may complain more of focus/memory struggles, disorganization, procrastination, fatigue, sleep problems, irritability, and anxiety. Understanding the hormonal impact leads most women to come close to accepting that they are in perimenopause. However, there is a growing number of women who question whether their symptoms are truly “just perimenopause.” They wonder if they are experiencing those of ADHD. Their difficulties with focus and overwhelm (among other symptoms) seem more extreme than what they assume to be “normal.”
You may be thinking, “I never even considered having ADHD before this!” What clinicians have found, though, is that perimenopause often acts as a "tipping point" for women with undiagnosed ADHD. Declining estrogen levels worsen the executive dysfunction they may have been able to mask for years, leading to new diagnoses in midlife. Symptoms like brain fog, memory loss, and emotional instability significantly worsen, prompting many to first seek help in their 40s. Often, these women have functioned well their entire life. Those with high-functioning ADHD have utilized routines, high effort, and strict organization to mask their ADHD symptoms (without knowing it.) When perimenopausal burnout and cognitive decline occur, these systems fail, revealing the underlying ADHD.
As said earlier, there is considerable symptom overlap between perimenopause and ADHD. Symptoms of perimenopause (hot flashes, insomnia, anxiety) and ADHD (feeling scattered, inattention, forgetfulness, difficulty with word-finding, cognitive fatigue) often look similar, making it hard to distinguish between them without a thorough evaluation. It’s crucial to seek out a provider familiar with both ADHD and the hormonal health of women to differentiate between these complex diagnoses.
About Danielle Cogliano
Danielle is a Psychiatric Nurse Practitioner with 20 years of experience in psychiatry, focused on how reproductive hormones affect women’s mental health. At Northeast Women’s Psychiatry, she treats women through a whole-body lens, combining integrative methods with traditional psychiatry.
Want to dig deeper? Join us in person.
Danielle will be at Sapphire for a candid conversation on ADHD or Perimenopause? Why So Many Midlife Women Feel Overwhelmed, Anxious, and Unable to Focus.
📅 Thursday, November 19 | 6–8 PM
📍 Sapphire Women’s Healthcare, 3 Meeting House Road, Suite 12, Chelmsford, MA
💙 $30 per person to hold your spot (Venmo @sapphirewomens)
RSVP here