Is it ADHD or perimenopause? How to tell the difference

If you’re experiencing symptoms like trouble sleeping, brain fog, and issues with mood, you might be thinking, “Am I in perimenopause, do I have ADHD… or is it both?”

The easiest way to tell the difference between ADHD (attention-deficit hyperactivity disorder) and perimenopause symptoms is to think about timing. Perimenopause symptoms show up during a specific time period — in the five to 10 years before menopause. But ADHD symptoms typically start in childhood or young adulthood. And even if you’re diagnosed with ADHD later in life, you can usually trace your symptoms back to when you were younger. 

That said, both conditions share symptoms — like issues with sleep, managing emotions, and memory. That can make it tricky to distinguish between the two. To further complicate things, perimenopause can make existing ADHD symptoms worse or reveal previously undiagnosed ADHD. In fact, according to ADHD expert Kathleen Nadeau, PhD, “perimenopause is often the ‘tipping point’ that makes a woman’s ADHD impossible to mask and compensate for.”

So how can you tell if what you’re dealing with is ADHD, perimenopause, or both? We’ll break down what research says about ADHD and perimenopause, and what you can ask your health care provider to get the right support. 

Perimenopauseopens in a new tab describes the years before menopause — when you stop having your period — during which your hormones begin to shift. It can start up to 10 years before menopause, which on average occurs around age 51. Perimenopause can last anywhere from five to 10 years.opens in a new tab It typically affects people in their 40s, but it can start as early as your 30s. 

During perimenopause, your hormones don’t drop steadily over time. They fluctuate, rising and falling unevenly.opens in a new tab These changes in estrogen and progesterone can cause symptoms like irregular periods, hot flashes, and difficulty sleeping.opens in a new tab 

Changes in your estrogen levels during perimenopause can also affect your cognitive function, like memory and concentration.opens in a new tab That’s because estrogen and progesterone affect how dopamine — a brain chemical also associated with ADHD — works in your brain. 

Perimenopause can also make ADHD symptoms worse or unmask previously undiagnosed ADHDopens in a new tab in some people. In those who don’t have ADHD, these symptoms are sometimes called “perimenopause brain fog.” 

It can be hard to tell ADHD and perimenopause apart, especially if your ADHD is not diagnosed. However, there are a few clues that can help. 

The first clue? Genetics. “One thing to pay attention to is that ADHD is highly genetic. So when there is a question — is it ADHD or something else — it’s important to look back at siblings, parents, first cousins, grandparents, and look for patterns suggestive of ADHD within the family,” says Nadeau. 

Other potential signs of ADHD include perfectionism, burnout, and “exhaustion in keeping up that you just can’t quite manage anymore,” Nadeau says. “These are all potential signs of ’hidden’ ADHD.” 

Perimenopause can make it harder for you to concentrate, just like ADHD. But there are some perimenopause-specific symptoms caused by changing hormone levels that are not typically associated with ADHD — for example, hot flashes, joint aches, and vaginal dryness.opens in a new tab 

Sleep problems are common with both ADHD and perimenopause. About 60 percent of adults with ADHD also have a sleep disorder, such as insomnia, restless leg syndrome, and sleep apnea.opens in a new tab And between 80 and 90 percent of women report sleep issues during perimenopause.opens in a new tab Poor sleep in both ADHD and perimenopause can affect cognitive function and make it difficult to focus.opens in a new tab  

Here’s a breakdown of symptoms unique to ADHD and perimenopause, and which symptoms overlap. 

The following symptoms are typically associated with ADHD, but not perimenopause. 

• Hyperfocus

• Impulsivity 

• Hyperactivity

• Feeling like you’ve always had to “work twice as hard” as your peers 

• Challenges with school or work 

• Symptoms that started in childhood or young adulthoodopens in a new tab

• Family historyopens in a new tab of these symptoms 

The following symptoms are typically associated with perimenopause, but not ADHD. 

• Hot flashes

• Irregular periods 

• Vaginal dryness 

• Night sweats 

• Changes in libido 

• Breast tenderness

• Headaches 

• Joint aches 

• Changes in weight

The following symptoms are seen in both ADHD and perimenopause. 

• Inattention

• Brain fog 

• Difficulty sleeping

• Memory lapses 

• Emotional dysregulation (trouble regulating your emotions) 

If your ADHD symptoms have spiked out of nowhere, perimenopause might be the culprit. 

Consulting your health care provider is a good first step for getting support since both perimenopause and ADHD can be difficult to diagnose. For instance, you can have normal hormone levels and still experience perimenopause symptoms — the fluctuation of hormones can also cause problems, points out Nadeau. 

An ob-gyn or a primary care provider can help you navigate symptoms. But be aware: There may be a knowledge gap when it comes to ADHD during perimenopause. While studies showopens in a new tab that ADHD symptoms can change with your menstrual cycle, there still isn’t much awareness about perimenopause, even in health care settings. And the research around perimenopause and ADHD is still relatively new. 

So in addition to consulting your ob-gyn or primary care doctor, talking to a licensed therapist, psychiatrist, or psychologist who specializes in ADHD might help fill in the gaps. 

To prepare for your appointment, it can be helpful to ask yourself these questions:opens in a new tab

• Are you experiencing any physical hormonal symptoms like hot flashes or breast tenderness?

• Have you seen a change in your periods? 

• Has your sex life changed? Is sex less comfortable? Has your libido changed? 

• What strategies do you use to stay organized and focused? Are they still working for you?

• Are you experiencing any changes in anxiety or depression symptoms? 

• If you take medications for ADHD, how are they working for you now?

If your symptoms fluctuate from day to day, you might want to track them. You can use your own tracker or a digital tracking tool. Try to track symptoms for two months. When you provide all this information, it’ll be easier for your health care provider to get a good sense of what’s going on. 

In your tracker, take note of the following:opens in a new tab

• Cognitive symptoms like brain fog, difficulty staying on task, and memory lapses 

• Physical symptoms like hot flashes, tender breasts, and night sweats 

• Mental health symptoms like feeling depressed or anxious

• Sleep quality 

• Menstrual cycle 

Bringing your questions and a symptom log to your health care providers can help them plan the best treatment options for you. For example, an ob-gyn may order some blood tests to measure your hormones and prescribe hormone replacement therapy (HRT).opens in a new tab A psychiatrist or psychologist who specializes in ADHD can evaluate you for an ADHD diagnosis. And a psychiatrist or primary care doctor can change your ADHD treatment to better fit your needs during perimenopause. 

Some other strategies and tips for managing ADHD and perimenopause symptoms include:

• Prioritizing sleep hygiene 

• Cooling your bedroom at night with an air conditioner or a fan 

• Working with a therapist to help manage emotional dysregulation 

• Trying new techniques to help with executive function, such as using a planner or setting calendar reminders. (Of course, it can take some adjusting and a few tries for a new strategy to work.) 

If you’re concerned about the symptoms you’re experiencing, it’s important to address them with a health care provider sooner rather than later. Worsening ADHD symptoms and perimenopausal brain fog can continue into menopause and beyond. Talking to your health care provider early can help you manage these symptoms throughout your perimenopausal and menopause journey. 

Thumbnail image credit: SDI Productions via Getty Images