ADHD or Perimenopause? Why Women Over 40 Get Misdiagnosed

Have you ever felt like your brain was replaced overnight, focus gone, memory slipping, and a fog you just can’t clear? As someone who’s navigated both adult ADHD diagnosis and the rollercoaster of perimenopause, I’ve experienced firsthand how the intersection of hormones and brain chemistry can turn your world upside down.

In this episode of Create The Best Me, I break down the real science behind why so many women over 40 are suddenly being diagnosed with ADHD (or thinking they have it), why your medication may have stopped working, and the role estrogen plays in keeping our brains firing on all cylinders. I also share the three most common misdiagnoses women receive, plus, I give you a playbook to approach your doctor armed with the facts and confidence you need.

This episode is for every woman who feels like she’s “losing it.” You’re not alone, and there’s a reason for what you’re experiencing!

What You'll Learn

1. The real connection between estrogen and dopamine: Why perimenopause can upend years of mental clarity and what’s really happening beneath the surface.
2. Why your ADHD meds might feel useless now: How hormonal changes impact the effectiveness of stimulant medications as you move through midlife.
3. The three most common misdiagnoses to watch out for: How anxiety, depression, and even early-onset dementia can mask underlying hormone-related ADHD symptoms.
4. How to prepare for your doctor’s visit: The steps to build your case, track symptoms, and ensure you’re seen and heard in the medical system.
5. Why holistic strategies matter: From external systems, sleep, and routines to hormone therapy conversations, how to support every part of your life, not just your diagnosis.

Music by: 

Epidemic Sound

Call to Action: 

If this episode helped you, share it with a woman who may be sitting there with a diagnosis that does not quite fit and wondering what is wrong with her. This may be the piece that helps connect it all.

📕 Resources: 

https://createthebestme.com/ep169

Related Episodes:

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https://www.buzzsprout.com/1949561/episodes/19143428 

https://www.buzzsprout.com/1949561/episodes/19069119 

⚖️ Disclaimer:

This episode is for educational and informational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Please talk with your qualified healthcare provider about your symptoms and treatment options.

#ADHDAfter40 #Perimenopause #WomenWithADHD #MidlifeWomen #BrainFog #CreateTheBestMe 

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Transcript

0:00

I'd like to share a little bit about myself. I was diagnosed with adhd in about 2005. I've been on medication for almost 20 years because I stopped taking it six months before my pregnancy. During my pregnancy and While nursing my 13 year old daughter, I thought I understood my brain. I had built a system, I had found my rhythm, I had done the work. And then perimenopause hit. And I want to be honest with you, I did not recognize myself anymore. The medication that had worked for years suddenly felt like it had stopped. The focus was gone, the organization was gone. The version of me I had worked so hard to build felt like she was slipping. And not a single doctor connected. Two things, not one. Today I'm going to give you the connection they missed and it's going to change the way you understand what's happening in your brain. Here's what I know. There are two groups of women watching right now. The first group has been living with ADHD their entire lives. Maybe you were diagnosed, maybe you were not, and menopause has made everything dramatically worse. You feel like your medication has stopped working. You feel like you're doing things backwards. After years of progress. The second group is being told for the first time in their 40s or 50s, they have ADHD. And they're wondering, did I have this all along and missed it, or is this something brand new? Today I'm going to answer both of those questions and I'm going to explain what the science says about estrogen and your brain in the most simplest terms. No medical degree required. I'm going to walk you through the three most common ways women get misdiagnosed and sent home with the wrong treatment. And I'm going to share what this journey has looked like in my own life, because I have lived this from both sides for almost 20 years. If you are ready, let's get into it. Before I explain the connection, I want to make sure we are all working from the same understanding. Because ADHD is one of the most misunderstood conditions in women. And I want to clear something up right now. ADHD is not a focus problem. It's a dopamine problem. Dopamine is the chemical in your brain that regulates motivation, attention and reward. When dopamine is working the way it's supposed to, you can start tasks, stay on task, and feel a sense of satisfaction when you finish them. When it's not. When your brain is not producing, releasing or absorbing dopamine efficiently, everything feels like a mountain. Starting a simple task feels impossible. Finishing it Feels even harder for those of us with adhd. Our brains are not broken. They are just wired to need more stimulation to activate that dopamine system. We are not lazy. We are not careless. Our brain chemistry is different. And once I understood that, I truly understood it, and I stopped calling myself a failure. I was not diagnosed until I was an adult. And for years before my diagnosis, I thought something was fundamentally wrong with me. I could not understand why things that seem so effortlessly for other people, they required every ounce of energy that I had. When I started medication 20 years ago, it changed my life. I found systems that work. I built routines. I learned how to partner with my brain instead of fighting it. For years it worked. Until it did not. When perimenopause came, I noticed things shifting. The medication felt less effective. The brain fog I thought I had conquered years ago was back. And I kept thinking, what did I do wrong? What changed? It took me a long time to find the answer. And that answer is estrogen. Here's the connection to everything estrogen. What most women do not know, and what most doctors are not connecting in their conversations with patients, is that estrogen plays a direct role in how your brain regulates dopamine. In simple terms, estrogen helps your brain produce dopamine, release it, and absorb it more efficiently. When estrogen levels are high and stable, which they are for most of your reproductive years, estrogen is quietly boosting your dopamine system in the background. You may not even have noticed it there. Think of estrogen like a silent copilot. You were in the cockpit doing all the work, but estrogen was right there beside you and keeping things stable, helping you focus, supporting your mood, regulating your reward system. You did not need to ask for help. You did not know you were getting it. And then perimenopause begins and estrogen starts to decline. The silent co pilot starts stepping back, and suddenly the controller feels harder. The autopilot is off. Everything requires more conscious effort than you're used to. This is why so many women, whether they have a formal ADHD diagnosis or not, suddenly feel like their brain has been replaced during perimenopause. The brain fog, the word finding, struggles, the inability to start tasks that used to be automatic, the feeling of just not being able to keep up. That is not aging, that is not weakness. That is estrogen withdrawal affecting your dopamine regulation. Your brain chemistry is literally changing. And if you already had adhd, your dopamine system was already working harder than average to keep you functional. Losing that estrogen amplifier can feel absolutely catastrophic. Can you relate? Because when I finally understood this connection, I felt two things at the same time. Relief that I'm not going crazy and frustration that no one had told me sooner. Let me come back to the two groups I mentioned at the beginning because the experience is different and both deserve to be named. For those of you who have been living with ADHD and noticed perimenopause made everything worse, your medication may feel like it stopped working. I want you to hear this clearly. You are not building a tolerance. You are not imagining it. The estrogen that was quietly supporting your dopamine system is declining and that directly affects how your ADHD medication performs. Stimulants medications work by increasing dopamine availability in the brain. When estrogen was present and supporting dopamine naturally, your medication had a stronger foundation to build on. As estrogen declines, that foundation weakens. The same dose that worked beautifully at 38 may feel completely inefficient at 48. Not because the medication has changed, but because your hormonal environment has. If this sounds like you, please talk to both your psychiatrist and your gynecologist. They need to have a conversation together. You should not have to be the only bridge between those two worlds. For those of you who have been diagnosed with ADHD for the very first time in midlife, and here's what I believe was happening for most of your life, estrogen levels were high enough to compensate. You probably developed exceptional coping strategies. Color coded calendars, rigid routines, systems upon systems, without ever knowing why. You needed them more than other people. You were the organized one, the high achiever, the woman who held everything together. And then estrogen dropped, the coping strategies stopped being enough, and the ADHD that was always there, just masked, just managed, finally surfaced. You are not losing your mind. You are not developing dementia. Your silent co pilot just stepped out and what was always underneath is finally visible. I want to be honest with you about something. The medical system is failing women on this consistently and significantly. And I want you to walk into your next appointment prepared. Here are the three most common misdiagnoses that women with ADHD in perimenopause receive. Misdiagnose number one, anxiety. You are told you have generalized anxiety disorder. You are given an anti anxiety medication. It may help with the surface level symptoms. But the core issue, dopamine deregulation, is never identified. The underlying issue does not go away. It waits. Misdiagnosis number two, depression. You are prescribed an antidepressant again. It may take the edge off of what you are feeling, but you cannot finish tasks. You are still exhausted by 2 in the afternoon. You are still losing things and forgetting things and wondering why everyone else seems to be keeping up just fine. Misdiagnosed number three early onset dementia. I want to say this carefully because this is the fear that paralyzes women more than others. The word forgetting, the losing things, the brain fog that descends without warning. It can look like cognitive decline. It's terrifying. And because doctors are not asking, could this be hormonal? Could this be adhd? Could this be an intersection of both? Women are sitting there alone with that fear, I want you to know this is not dementia. For most of you watching or listening, what you are experiencing has a name and it has a treatment path. Can you relate? I know a lot of you know exactly what I'm talking about. Before I get into the practical steps, what you can actually do starting this week, I want to take a quick moment. If you are new here, this channel is built specifically for women in their 40s, 50s and 60s who are navigating the physical, emotional and mental shifts of midlife. New videos hit every week. Hit that subscribe button so that you don't miss out what is coming up. And if you want to go deeper on the today's topic, I will have additional information waiting for you at createthebestme.com/ep169. I will add the link below in the show notes. All right, I'm not going to leave you with a problem and no path forward. Here's the playbook. Step 1 Build your case before your appointment, do not go to your doctor's office and say, I think I have adhd. Come in with a timeline. When did the symptoms get worse? Was it gradual over the last two years or did it feel sudden? Write down specific examples, tasks you can no longer complete. Things you are forgetting. Ways your functioning has changed. Connect it to the hormonal timeline. When did your periods become irregular? This documentation is your evidence. Bring it. Step 2 Ask for the right kind of evaluation. Not every doctor is equipped to assess ADHD in midlife women. Ask for a referral to a psychiatrist or a neuropsychologist who specifically has experience with adult women. And tell them up front, I am in perimenopause and I know that estrogen affects dopamine regulation. I want to make sure we are looking at this as a connected picture, not two separate issues. Step 3 have the hormonal conversation directly. If you are already diagnosed with adhd, talk to your gynecologist about HRT hormone replacement therapy, specifically about whether estrogen stabilization might restore some of what has felt lost. Some women find that addressing the hormonal decline meaningfully improves their ADHD symptoms and medication effectiveness. You deserve that option on the table. Step 4 Stop adjusting your ADHD medication in isolation. If your stimulant medication feels like it stopped working, please do not simply ask for a higher dose as the only solution. More medication without addressing the hormonal foundation underneath is like turning the volume up on a broken speaker. It may help a little, but you need to fix the wiring. Step 5 Build external systems without shame. I am giving you permission right now to use every tool available to you. Write things down the moment you think of them. Use your phone calendars with alarms for everything. Create routines that are so automatic your brain does not have to decide. Lay your keys in the same place every single time. This is not admitting defeat. This is working intelligently with the brain you have right now. The women I know who are thriving in midlife with ADHD are not trying harder. They are building smarter. Here's what I wish someone had told me both when I was diagnosed first in 2005 and when perimenopause started changing the game. The old way was to push through it, mask it. Build enough discipline and enough structure to compensate for the way your brain was wired. White knuckle your way through the hard days. Tell yourself it was a willpower problem. Tell yourself that other people managed just fine. Tell yourself you should be able to figure this out. And for a while that worked. Not because you were broken, but because estrogen was quietly holding things together underneath all that effort. The new way, the way I'm choosing now, is to understand the whole system. My my ADHD is not separate from my hormones. My hormones are not separate from my sleep. My sleep is not separate from my cortisol levels. My cortisol levels are not separate from how I eat and how I move and how I manage the daily weight of being a woman in midlife. It's all one system, all connected. And the moment you stop treating these things separately, the anxiety over here, the brain fog over there, and the ADHD in another drawer and start seeing them as one interconnected picture. That is when things begin to shift. You stop feeling like you're losing the battle and you start feeling like you're learning a new strategy. I want you to hear me. You are not broken. You never were. Your brain has always had a different operating system. A powerful one, a creative one, a deeply perspective one. Perimenopause changed the hardware temporarily, but the operating system is still yours and you can work with this. I would love to hear from you. Are you someone who has been living with ADHD and noticed perimenopause made it dramatically worse? Or are you one of the women who received an ADHD diagnosis for the first time in midlife and felt like it finally explained everything? Share your stories in the comments when you're done listening or watching. I read every single one, and your words matter more than you know. If this episode helped you, please share it with the woman in your life who might need it. She may be sitting there with a diagnosis that does not quite fit, wondering what is wrong with her. This might be the piece that connects it all. If you'd like additional information not covered here, you can find that information at createthebestme.com/ep169. Until then, keep dreaming big. Take care of yourself and remember you are beautiful, strong, and capable of creating the best version of yourself one day at a time. You are worthy of being seen. Catch you next week. Bye for now.