I was diagnosed with ADHD at 54.
Fifty. Four.
By then I’d built two multi-million-dollar consulting practices at two different firms. Earned a PhD. Sold multi-million dollar deals. Worked in the intelligence community. Wrote speeches for Admirals, Generals, and rocket scientists. Was a behavioral-health counselor and taught cognitive psychology.
Yes. I taught other people how the brain works while mine ran an entirely different operating system in the background.
(Please – nobody tell those students.)
So when people ask how it got missed for that long, here’s the candid answer:
I was very good at masking it. And didn’t know to look for it.
That’s the pattern for a lot of women with late-diagnosed ADHD. Especially high-performing, successful, Type A+ overachieving women. Symptoms so well covered nobody went looking, including us. Then we hit our 40s and 50s, hormones shift, and the mask stops working.
It’s ADHD Awareness Month. Here’s what I wish someone had told me in my 30s instead of 54:
- Why ADHD in women gets missed for decades
- What masking actually looks like in a high performer
- Why it so often falls apart in perimenopause
- What to do when the coping strategies quit at work
Why is ADHD diagnosed so late in women?
Short answer: ADHD in women is often missed because it looks different than the hyperactive-boy picture the diagnosis was built on, and because capable women compensate. Good grades, big careers, and elaborate workarounds hide the struggle until something, often midlife hormone changes, pulls the workarounds out from under them.
The research has been saying this for a while. Girls and women are underdiagnosed, more often show inattentive symptoms than disruptive ones, and are more likely to get treated for the anxiety or depression sitting on top of the ADHD instead of the ADHD itself (Hinshaw et al., 2022; Quinn & Madhoo, 2014).
Translation: if you weren’t bouncing off the classroom walls, nobody checked.
And if you were succeeding? Forget it.
High performance is the best camouflage there is. Nobody refers the woman running the department for an evaluation. They give her more work!
The takeaway: a late diagnosis doesn’t mean you didn’t have it. It means you were compensating so well that nobody, you included, thought to call “chronic stress” or “burnout” or “success” something else..
What does ADHD masking look like in high-performing women?
Short answer: ADHD masking is the set of workarounds you build to look like everything’s fine: over-preparing, perfectionism, panic-powered deadlines, backup systems for your backup systems. It works. That’s the trap. From the outside it looks like competence. From the inside it costs a fortune in energy.
I call mine the duct tape.
Here’s what it looked like:
- Deadlines met at 2 a.m. on pure adrenaline…and kinda loving it (it was the dopamine chase)
- Three backup systems for the one system that kept failing.
- A Post-it stuck right in front of my face. Staring straight at it. Still forgot the meeting I scheduled.
- Keys locked in the Jeep. (Once. Okay. More than once. Okay, stop counting.)
Here’s the thing.
It worked.
For decades, it worked.
Success held together by duct tape still looks like success from the outside. Nobody checks the duct tape. Including the woman holding the roll.
In fact – you get called “quirky” or “eccentric” and people start to compensate for you.
My doctoral research was on women leaders navigating chronic pain in gendered environments and found deliberate masking is a key tactic to survival and success. I found the exact thing I was doing. And still didn’t see it in my own mirror.
Seriously people – that’s not a lack of intelligence. I’m smart. That’s a “yeah, but that’s not me.” Masking is designed to be invisible. If you could see it easily, it wouldn’t be a “mask”
The takeaway: masking is armor. The problem isn’t that you have the armor…but that you wear it every day and it costs you.
Why do ADHD symptoms get worse in perimenopause?
Short answer: Estrogen helps regulate dopamine, the brain chemical ADHD already runs short on. In perimenopause, estrogen swings and drops even more than normal, and dopamine signaling swings with it. Sometimes radically. Focus, working memory, and follow-through get harder, and coping strategies that worked for decades can stop working fairly suddenly.
But you don’t know why.
Your OBGYN makes offhanded comments like “yeah that’s normal” – but that doesn’t really help. Guess what? OBGYN’s want to birth babies. They are (and yes this is a rant) regulated by insurance to 15 minutes per patient regardless of your issue, so having an educational conversation about your menopause brain and how the neurochemicals work 1) isn’t what they went to school for, 2) isn’t the conversation they want to have, 3) isn’t what insurance reimburses them for. So who makes the connection for you?
Well Dr. Lisa Mosconi in her book The Menopause Brain – trust me. This neuroscientist is shaking things up and she’s showing what the female brain is all about!
Heads up: that’s an Amazon affiliate link from my other platform 10PM Somewhere. If you buy through it, I earn a small commission. It costs you nothing extra.
Bottom line – Estrogen is freaking important for dopamine! Dopamine is freaking important for our executive function. Working memory, focus, attention, emotion regulation, finding words, prioritizing, holding a thought long enough to finish it. Without enough we feel foggy…
I can’t tell you in perimenopause it isn’t dementia, but I can tell you if your in your 30s to 50s and you all of a sudden your brain feels “foggy” it could be hormone’s – not matter what your gaslighting medical professional may say. They may call you a WW (Whining Woman) off-the-record because that’s what they were trained to do (watch this video only if you want to be really pissed
ADHD already involves dopamine trouble. Then perimenopause shows up, and estrogen doesn’t glide gently downhill. It swings. Hard. For years.
Every drop takes a little dopamine with it.
So all that masking machinery you spent a lifetime building – the perfectionism, the hyper-vigilance, the panic-powered deadlines – doesn’t fade out politely.
It quits. All at once. Usually mid-quarter.
Researchers have found that women with ADHD report more hormone-related mood symptoms, including heavier symptoms during the menopause transition (Dorani et al., 2021). Which tracks with every woman I’ve talked to who said some version of “my meds just stopped working.”
They may not have stopped working. The ground under them moved.
The takeaway: if your brain suddenly got harder to run in your late 30s, 40s or 50s, there’s likely a biological reason worth bringing to your doctor…and not just any doctor. Find a functional doctor that will work with you.
Is it ADHD, perimenopause, or both?
Short answer: It can be both, and the symptoms overlap heavily: brain fog, forgetfulness, trouble focusing, irritability, sleep problems. Only a clinician can sort out which is which. You don’t need to have the answer before asking for help. You need data to bring to the appointment.
I’m doctor but not that kinda doctor. I’m an integrative psychological scientist, not a physician. I can’t tell you which one you’ve got.
What I can tell you is this: you don’t have to pick one before you’re allowed to ask. Don’t diagnose yourself with dementia before you’ve talked with a trained professional who knows what they are doing.
A lot of women get bounced between offices. Too smart for ADHD. Too young for perimenopause. Too stressed, have you tried yoga?
Each specialist treats their slice. Nobody looks at the intersection, which is where you actually live.
Find a functional practitioner – here’s a link to the
That’s why the next section matters.
The takeaway: walk in with evidence, not just a feeling. Feelings are easy to dismiss. Patterns are not.
What to do when your ADHD coping strategies stop working at work
Short answer: Stop treating it as a willpower problem. Start tracking what’s actually happening: when focus shows up, when it doesn’t, how you slept, where you are in your cycle. A written pattern removes the guesswork, gives your doctor real data, and shows you where to put your limited energy at work.
For most of my life, I had a name for my brain.
“Chasing shiny things.”
Said the way great-aunt Hilda says it at Thanksgiving.
Turns out it was wiring. The same wiring that makes me see patterns other people miss.
Not a superpower. And not a defect.
Simply different wiring. And wiring I can work with, now that I see it.
You may not feel it. But I know you can see it.
What finally helped me wasn’t a new planner. (FYI: I own enough planners to wallpaper a Target.)
It was writing it down where I couldn’t argue with it.
- When focus showed up.
- When it didn’t.
- What happened the night before.
Not to fix anything.
Just to stop lying to myself.
When you’ve lived in overdrive long enough, your internal gauge breaks. You honestly don’t feel how bad it is. But two weeks of notes on paper? That you can see. And then you can’t ignore the pattern of data.
A feeling is easy to talk yourself out of. A pattern on paper is data..
Here’s what the data gets you:
- At the doctor: a log instead of “I just feel off” is much harder to wave away and ignore. (Remember – I’m a researcher!)
- At work: you learn when your good hours actually are, and you stop scheduling the hardest thinking into the worst ones.
- In your own head: the evidence that this is chemistry, not “character” which shuts up the voice saying you’re losing your edge, are lazy, or my personal favorite a “moron.” (such a nice word Shannan, such. a. nice word (sarcasm)
The takeaway: energy is the finite resource, not time. Track your energy and capacity.
And a book worth your bandwidth this ADHD Awareness Month
If you want something to read in short bursts (and let’s be honest, short bursts is the name of the game (not this mammoth blog I wrote to appeal to SEO/AEO!)
ADHD Field Guide by Cate Osborn, Erik Gude, and Rennie Dyball, with a foreword by KC Davis, LPC.
Seriously! As someone who loves format, simple, soundbytes, real-talk, getting to the point. These folks do an amazing job.
Heads up: that’s an Amazon affiliate link from my other platform 10PM Somewhere. If you buy through it, I earn a small commission. It costs you nothing extra.
The bottom line
Late-diagnosed ADHD in women isn’t a mystery. It’s been working. Then hormones changed, the duct tape let go, and it looked like we were falling apart.
Not really, the workarounds ran out. But the wiring has been in tact the whole time, it’s just different type of wiring.
So this month, don’t buy another planner. Don’t white-knuckle it.
Write down what’s actually happening for two weeks. Take it to someone who’ll read it.
Happy ADHD Awareness Month.
Now…go find your keys.
(Tip: check the freezer or the Jeep ignition.)
Frequently asked questions
Can you be diagnosed with ADHD in your 50s?
Yes. ADHD is present from childhood, but many women aren’t diagnosed until their late 30s, 40s, 50s or even 60s, often when hormone changes make long-standing strategies stop working. I was diagnosed at 54.
Why does ADHD get worse during perimenopause?
Estrogen helps regulate dopamine, which affects focus, working memory, and follow-through. As estrogen fluctuates and declines in perimenopause, many women with ADHD notice symptoms getting harder to manage, sometimes suddenly.
What is ADHD masking?
ADHD masking is the set of strategies people use to hide ADHD symptoms and appear organized: over-preparing, perfectionism, adrenaline-fueled deadlines, and backup systems. It often works for years, which is one reason ADHD in women is diagnosed late.
How do I know if it’s ADHD or perimenopause?
The symptoms overlap, and it can be both. Only a clinician can tell them apart. Tracking focus, sleep, mood, and your cycle for a few weeks gives your doctor concrete data instead of a vague description.
About the author
Dr. Shannan Simms is an Integrative Psychological Scientist, a Professor of Business, Psychology of Gender and Cognitive Psychology and a Certified Stress Coach through the American Institute of Stress. She holds a PhD, built and ran two multi-million-dollar consulting practices without ever taking a business class, is a neurodivergent thinker and lives what she teaches, coaches, consults and speaks on.
References
Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience, 9, Article 37. https://doi.org/10.3389/fnins.2015.00037
Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., & Kooij, J. J. S. (2021). Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133, 10–15. https://doi.org/10.1016/j.jpsychires.2020.12.005
Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual research review: Attention-deficit/hyperactivity disorder in girls and women: Underrepresentation, longitudinal processes, and key directions. Journal of Child Psychology and Psychiatry, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480
Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3). https://doi.org/10.4088/PCC.13r01596
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<small>Not medical advice. This article is for education and is based on my own experience and published research. It isn’t a substitute for diagnosis or treatment. Talk with a qualified clinician about your symptoms.</small>
