Is it your hormones or is it ADHD?

You have started reading about ADHD. It sounds familiar.

You have started reading about perimenopause. It sounds familiar.

The people around you have opinions.

Has anyone said that you may be both?

Overlap

Put the two lists side by side and they are hard to tell apart.

Losing words mid-sentence. Starting things and not finishing them. Reading the same paragraph three times. Snapping. Crying. Lying awake. Forgetting the appointment you made this morning.

Or it might just be that you are working too hard.

A review of ADHD in women through the menopause transition puts the diagnostic problem plainly. The symptoms overlap so heavily that one is routinely read as the other. ¹

Why now?

Two things happen at once in your forties.

Oestrogen starts to fluctuate. It does not fall steadily. It moves, month to month, sometimes sharply. Sleep and mood are affected.

A study that followed over 2,000 women through the transition found a measurable dip in verbal memory and processing speed during perimenopause. Good news — it recovered afterwards. ²

If you have always had to work hard to stay organised, you will have systems in place to make sure you are organised. Maybe you have lists or a strict routine.

Your systems use your energy. When sleep is broken and your capacity drops, the systems fail. You don't notice a hormone level. The thing that you depended on for twenty years has stopped working.

Women with ADHD report more severe perimenopausal symptoms, and report them earlier. ³ The reasons are being researched. A systematic review of ADHD and sex hormones found only eleven studies, most of them small. ⁴

Why it was missed

ADHD in women was, for a long time, missed.

The pattern clinicians were taught to look for was a disruptive boy. Girls who were quiet, anxious, disorganised and exhausted did not fit it. They were called dreamy, or sensitive, or told they were not applying themselves.

Women are diagnosed on average around four years later than men, despite years of prior contact with services. ⁵ Many are treated for anxiety or low mood first.

So by your forties you may have decades of evidence and no diagnosis. When things get harder, there is no existing explanation to attach it to. Perimenopause arrives with a name and a lot of coverage, and it becomes the obvious answer.

Does the difference matter?

Yes. The treatments are different.

Hormone treatment can help hormonal change. Ask your GP whether it is right for you.

It will not help ADHD traits. Those need assessment, support and adjustments.

Neither will help if you are over-burdened. Something has to go.

Most women here are some combination of the three. The question is not which one you are. It is which treatment gives you the most.

What to ask for

Ask your GP for a blood test or two. Iron and thyroid function at least. Mention any medication you take.

Write down when things changed, and what you were already finding hard before that. ADHD traits are lifelong. If you were like this at nineteen, make sure you tell the GP.

Ask whether an ADHD assessment is appropriate. Waiting lists are long, so ask now and get the referral moving.

If your symptoms are new, severe or getting worse quickly, speak with your doctor.

Where to start

The Overload & Recovery Review™ is a structured assessment of the factors that may be affecting your recovery, energy and day-to-day functioning. It asks about sleep and recovery, work and daily demands, physical health, pain, activity, nutrition, medication, hormonal patterns where relevant, life events, and cognitive and emotional load, and considers your answers together rather than section by section.

You receive a prioritised report setting out what the review found, what may be happening, why one factor has been placed above another, and what to consider next.

The review does not diagnose. It will not tell you whether you have ADHD. It will not replace assessment by your doctor.

It gives you a considered account of what may be contributing, and in what order.

You also get a summary to take to your doctor, in language they will recognise.