The Perfect Storm: ADHD and Perimenopause - No Such Thing as Normal

Experts say hormonal shifts can dismantle ADHD coping strategies. Photo / 123rf

For years, ADHD in women has been under-recognised and poorly understood. The same can be said for perimenopause - a significant life stage that remains woefully under-researched. But what happens when the two collide? The latest episode of No Such Thing as Normal explores why this intersection is leaving many women struggling to keep their lives on track.

On a sunny Sunday afternoon in Takapuna, 12 women are gathered for a one-day workshop. This group is intelligent and insightful. The women hold down jobs and raise families. For decades they’ve been the achievers, the nurturers, the “doers”.

Now, these women are exhausted and broken.

“I thought I had it nailed and then … collision”, one participant says. “I feel like I’ve gone backwards.”

Another adds: “I hit burnout, and everything just fell apart.”

The women are speaking to Sonia Gray in the latest episode of No Such Thing as Normal. Their struggles led them to sign up for a workshop run by ADHD coaches Dr Jacqui Johnson and Fiona Winfield, called When ADHD meets Menopause. Johnson and Winfield have ADHD themselves, and were blindsided by what happened when perimenopause hit.

ADHD coach, Dr Jacqui Johnson. Photo / supplied

ADHD coach, Fiona Winfield. Photo / supplied

The participants in the workshop are in their 40s and 50s, and all have ADHD or strongly suspect they do. For these women - and thousands like them - the experience of perimenopause is more than hot flushes and night sweats. It’s anxiety that comes out of nowhere, brain fog that makes simple tasks feel impossible, a sudden loss of confidence in skills they’ve relied on for years.

In a 2026 survey by Monash University, 97% of women reported a worsening of their ADHD symptoms in perimenopause. And a recent Cambridge University study revealed that perimenopausal symptoms may begin up to a decade earlier for ADHD women, often peaking between the ages of 35 and 39.

Yet despite growing recognition, the research base remains strikingly thin. Medical researcher Dr Rachael Sumner says this is not surprising.

“We have been excluding females from research since clinical research began,” she tells Gray. “I wouldn’t be surprised if much of what we understand about the neurobiology of ADHD is built on the male brain.”

A recent review of ADHD studies worldwide supports this. It found that just 0.23% of the research focused specifically on women. The result is a disconnect between lived experience and scientific understanding.

Sumner is committed to changing that. Her body of work largely focuses on how the female brain is affected by the complex interplay of hormones, like estrogen and progesterone.

Dr Rachael Sumner, clinical researcher at the University of Auckland. Photo / supplied

She says estrogen plays a key role in modulating the neurotransmitter systems, so it’s not surprising so many women with ADHD feel the cognitive impacts of perimenopause so intensely.

“Estrogen is a really dirty hormone, it interacts with so many systems in the brain,” Sumner says. “It’s embedded into the very health and function of the brain … and it’s in higher concentrations in females. Then, up to 14 years before menopause, it starts these wild fluctuations that are far greater, sometimes than what you would have even experienced over the menstrual cycle.”

Sumner says the brain struggles most of all to deal with the unpredictability - the hormonal “peaks and troughs”. For those with ADHD it can be a double hit. Their dopamine system is already dysregulated and many have built coping mechanisms to stay on track.

“And when menopause hits, the sudden fluctuations in these hormones basically kick down the scaffolding, pull out all of the supports that person had put up … they’re just left to deal with raw ADHD,” Sumner says.

The consequences can be significant. Women report leaving jobs, walking away from relationships and struggling to keep their lives afloat.

For some, perimenopause doesn’t just worsen ADHD, it reveals it. Women in their 40s are now being diagnosed with ADHD at unprecedented rates. What’s emerging is not a new condition, but one that’s previously been hidden behind hypervigilance, people-pleasing and extreme effort.

The life-changing effects of perimenopause are not limited to ADHD. Many autistic women describe this stage as a tipping point, where long-standing coping strategies begin to fall away, and challenges like sensory sensitivity can intensify.

For many, the hardest part isn’t just the symptoms, it’s the invisibility. The feeling that it’s some kind of personal weakness, that they’re not trying hard enough, and that their role in society has diminished.

Which raises a bigger question: do we need to rethink how we view this stage of life altogether?

Instead of seeing it purely as a decline, some argue it could be reframed as a transition, one that, in many cultures, is associated with experience, leadership and accumulated knowledge. In te ao Māori, for example, the role of the kuia carries deep respect. Older women are valued as knowledge holders, connectors and leaders within their whānau and communities.

In that light, this difficult chapter may not just be an ending, but a shift into something new and more authentic.

For more listen to the full episode of No Such Thing as Normal.

No Such Thing as Normal is an NZ Herald podcast, hosted by Sonia Gray, with new episodes available every Saturday.

Made with the support of NZ on Air.

You can listen to it on iHeartRadio, Apple Podcasts, Spotify or wherever you get your podcasts.