Why is Everything Suddenly So Much Harder Now?

You had it all figured out. You were the “capable” one. You were organized, smart, dependable. Then your mid-thirties hit and you couldn’t even remember to look at that planner you bought to keep your life on track. You started forgetting basic words like “fridge,” pointing vaguely at the kitchen and saying, “thing food cold,” when trying to find it. Suddenly, noises you’d figured out how to ignore were unbearable, and overwhelm? Let’s not even talk about that. Plus now, your sleep is shit, you’re sweating through your sheets at night, and you’re PMS-irritable, but like, all the time.

You’re not imagining it. You’re just a neurodivergent woman who hit perimenopause, living in a patriarchal system where doctors aren’t taught how to deal with something that happens to 51% of the global population. That's right, it's (peri)menopause.

Did you know that women with ADHD can hit perimenopause up to 10 years earlier? Not only that, but perimenopausal symptoms are more severe for us than for “neurotypical” women. These symptoms that are worse for us include somatic symptoms: sweating/hot flashes, heart blips, joint and muscle problems, night sweats, histamine reactions and sleep problems; urogenital: dry vagina, bladder issues, and sexual problems; and psychological symptoms: irritability, increased tiredness, brain fog, anxiety, and depressive feelings. So this means that I — poor, undiagnosed at this time, me — hit 35 and had no clue what was happening. My doctor ran all sorts of tests, I went to an allergist, had every allergy needle poke puff up and was eventually told that my kidneys and liver were fine and I’d simply have to take an antihistamine every day for the rest of my life.

Fast forward to 2026 — a few years post AuDHD diagnosis — when the insomnia started creeping in: I desperately require my sleep. I started reading up on perimenopause, realizing that I had been taught nothing about it my entire life, and… Lo and behold, these books were telling me exactly what I was going through. Specifically, if you haven’t read The New Menopause, I highly recommend it. It didn’t answer every question I had, because most menopause books don’t have a neurodivergent angle, but it sure got me going in the right direction.

To understand what’s going on here, we need to back up and talk about estrogen

First off, estrogen isn’t just one hormone, it’s a group of hormones, each having a different role in a woman’s lifecycle; for brevity and understanding though, we’ll just use the word “estrogen” here. Also, men have estrogen too (for example, it’s used to make sperm), though it doesn’t vacillate in the same way that it does in women’s bodies with our cycles and age. That said, estrogen isn’t just a group of reproductive hormones, it’s a neurochemical regulator. Estrogen modulates noradrenaline, dopamine and serotonin, which means this will have a huge impact on women with ADHD & ASD, who already have issues with dopamine. This bears out: ADDitude magazine conducted a survey of 1,500 women with ADHD, and 94% responded saying that their ADHD symptoms grew more severe during peri/menopause. Estrogen also impacts the prefrontal cortex, which is responsible for emotional regulation and executive function (planning, task completion, working memory, masking, etc…) — also common problem spots for neurodivergent women. Additionally, changes in estrogen will affect a woman’s cognition: so much so, that a lot of perimenopausal women have feared having early-onset Alzheimer’s or dementia, due to the constant brain fog and losing of words.

Another way in which perimenopause affects one's brain functions is by reducing the amygdala's regulatory capacity, because estrogen strengthens the pathway from the prefrontal cortex to the amygdala, allowing the cortex's "brakes" to work properly. The amygdala, if you didn't know, is responsible for your fight or flight response, and ore importantly, how your brain calibrates what counts as a threat. Studies show that estradiol deficiency in early menopause is associated with reduced amygdala volume, which can result in greater reactivity and higher threat activation, meaning a reduced ability to see nuance between threats and neutral stimuli. So if this hasn’t been made clear, perimenopausal estrogen fluctuations for a “neurotypical” woman would already be devastating; now put this onto a woman who already is super sensitive to neurochemical changes… Woof.
The woman who’s been so good at masking her whole life has suddenly lost the ability to maintain that mask.

So what can be done?

From that earlier survey, 26% women with ADHD who went on hormone replacement therapy (HRT) found it helped with their ADHD symptoms. Now, if you’re thinking, isn’t HRT dangerous? Let’s just say that HRT went through a really bad press phase when a 2002 study was fully botched, leaving symptomatic women without recourse as their uninformed doctors screamed, “breast cancer!” In the intervening years, countless studies have proven HRT to be helpful rather than harmful, and yet, the damage is done, and women need to advocate for themselves (yet again) when speaking with their doctors about menopausal health.

ADHD meds may work differently when you hit perimenopause, because estrogen modulates the effect of dopamine; this means a dose that used to work perfectly fine will not have the same effect when your estrogen dips. This is something to bring up to your doctor if you’re feeling that your old dose is no longer working.

And finally, it might be time to rebuild new systems. The ones you built so long ago no longer seem to be working, not because you’ve failed as a person, but your baseline shifted. This is where a good therapist comes in — someone to help normalize this experience for you (because well, at least I’m going through it too). Working with a therapist who knows what’s happening can help decipher that new baseline of yours and build new scaffolding to help keep you going, accounting for this new reality rather than pathologizing you.