How Perimenopause Turns Up The Volume On Your ADHD | Sara Kelly (ADHD coach, author, founder of ADHD Mindset Mastery)
Why your ADHD symptoms intensify in your 40s and 50s, and what actually helps
You finally worked up the nerve to talk to your doctor about ADHD. Maybe you got diagnosed in your 40s, or you’re still trying to explain why everything suddenly feels impossible. Either way, something shifted. The strategies you relied on for years stopped working. Brain fog got worse. You forgot words mid-sentence. Your emotions felt raw and unmanageable. You thought getting diagnosed would fix things, but now it feels like your ADHD is getting worse, not better.
Sara Kelly is an ADHD coach, founder of ADHD Mindset Mastery Academy, and author of the upcoming book The ADHD Awakening. With over 364,000 followers across Instagram and Facebook, she helps late-diagnosed ADHD women understand what’s actually happening in their brains and build systems that work. Diagnosed herself after years of anxiety and depression, Sara now specializes in helping women navigate the overlap between ADHD and hormonal changes.
In this guest post, Sara explains why perimenopause makes ADHD symptoms worse, what happens when estrogen drops, and what to do when your medication stops working and your coping strategies fall apart. If everything suddenly got harder in your 40s, here’s why.
If you are a woman with ADHD in your forties or fifties, there is a very particular kind of quiet panic that can sneak up on you.
Your brain used to be unreliable at times yet functional. You misplaced the odd receipt, accidentally booked two things at the same time, forgot a birthday here and there. Annoying, yes, but you could mostly keep the plates spinning.
Now you find yourself standing in the middle of a room with no idea why you walked in. You start to wonder: Is my ADHD getting worse? Is this perimenopause? Or am I just failing at being a grown adult?
Let’s cross that last one off the list.
What you are noticing is real. Hormonal changes in perimenopause can disrupt sleep, tug at your mood, and muddy your focus. If you already have ADHD, those shifts tend to make your existing symptoms feel louder, not imagined. I am going to walk you through what is happening in your brain, how it shows up in the day to day, and what kind of support actually helps.
Oestrogen, dopamine, and why things feel different
Here is the short version of the science.
Oestrogen helps support chemicals like dopamine and serotonin. Dopamine in particular is involved in things like focusing, getting started, following through, remembering what you are doing, and feeling a basic sense of motivation.
If you have ADHD, your dopamine system has always been wired a little differently. From early in life, you have probably needed more interest, more novelty, or more urgency just to get the same internal signal that other people seem to access with a simple to do list.
For years, oestrogen has quietly backed that system up. During perimenopause, oestrogen levels begin to swing and, over time, drift lower. That steady background support is no longer as steady.
An easy image is this: an ADHD brain is like a car that already needs more frequent refuelling. Oestrogen has been topping up the tank without a lot of fuss. In perimenopause, some days the tank feels fine. Other days the warning light is on by lunchtime and you are just willing yourself through the afternoon.
On the outside, that might look like concentration that used to be patchy becoming full on “what was I just doing,” emotional reactions feeling sharper and harder to recover from, or ADHD medication that feels consistent one month and almost invisible the next.
How it shows up in everyday life
Most women cannot feel their oestrogen levels. What you feel are the small, cumulative shifts in how you think, react, and cope.
