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Category: Perimenopause/Hormones

  • Diagnosed With ADHD at 54: Why Late-Diagnosed ADHD in Women Shows Up in Midlife

    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

    Institute of Functional Medicine – Find a Practitioner Tool

    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

    <small>Disclosure: As an Amazon Associate I earn from qualifying purchases. Some links on this page are affiliate links, which means I may earn a commission if you buy through them, at no additional cost to you.</small>

    <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>

  • 3 Surprising Reasons Burnout Isn’t What You Think It Is

    The WHO calls it an occupational hazard. Your brain calls it a fuel shortage. Both are right, and neither one is your fault.

    I really, really hate the word “burnout.”

    It’s the catch phrase everyone reaches for to talk about bone-weary exhaustion in the most commonplace way.

    I’ve actually experienced it twice, and even then I REFUSED to call it burnout, out of sheer pride. Medicated, and threatened by my physician with a forced medical leave of absence, I still resisted the title, because to me “burnout” admitted defeat. Failure.

    But today everyone tosses the word around. Either they’re living it, or they’re selling a solution for how to avoid it, recover from it, outsmart it.

    Here’s my problem. Burnout is so much more than being “tired” or “fatigued” or even “exhausted.”

    Think about the word itself. It’s two words – burn and out. Extinguished. Complete. Nothing left.

    Meaning your brain literally does not have the fuel left to do what it needs to do.

    This is a neurochemical situation.

    And I come at this from a slightly different angle, for a few reasons.

    First, I teach undergraduate psychology, and I’ve spent over 20 years translating brain, behavior, and social psychology for organizational leaders going through disruption and transformation.

    Second, I was just recently diagnosed with ADHD, and I’m learning how differently neurodivergent brains are actually wired.

    Third, I went through menopause three times in my 30s. And now, as all my friends hit perimenopause and menopause, I’m revisiting my own experience through a new lens, because their questions keep surfacing ones I never thought to ask.

    I’m making connections I’ve never made before about the female brain, in large part thanks to Dr. Lisa Mosconi (lisamosconi.com), neuroscientist, women’s brain health specialist, author of The Menopause Brain, and director of the Weill Cornell Women’s Brain Initiative.

    Thanks to Dr. Mosconi, we now know the female brain is brilliantly different. Not “different” in the way it got weaponized for years through a neurosexism lens to keep women parked in intellectual inferiority. Different in a way that shows the real distinctions, and the plasticity. And that opens the door to real solutions.

    Because brilliant, senior, high-achieving women are hitting their late thirties, forties, and fifties and walking away from the peak of their careers. Or getting organizationally gaslit, stalled, and quietly exited from them.

    The narrative is that we’ve “lost our drive,” or we “need to slow down.” And the undercurrent culprit everyone names is “burnout.”

    So let’s actually take the word apart. Because the fight over what burnout is has two camps, and both are half wrong.

    Camp one says burnout is a personal problem. You’re not resilient enough. Do some self-care, build your grit, try yoga, take a bath, become a slightly better-optimized version of yourself who can absorb the exact same load without cracking.

    Camp two says burnout is purely structural. It’s the job, full stop, and your brain is an innocent bystander.

    Here’s what the data actually shows: it’s both, and they’re wired together. So here are three surprising reasons burnout isn’t what you think it is. You can’t fix what you refuse to see whole.

    Reason 1: It’s an occupational hazard, not a personal weakness

    In 2019, the World Health Organization put it in plain language. Burn-out is “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed” (World Health Organization, 2019).

    An occupational phenomenon. Tied to the conditions of work. Not a defect living in your personality.

    And the psychologist Christina Maslach, whose research built the standard measure of burnout, found it isn’t one thing. It’s three (Maslach & Leiter, 2016):

    + exhaustion – you have an empty tank

    + cynicism – you are going mentally distant from work

    + reduced efficacy – you have a creeping sense nothing you do lands

    Rest only touches the first one. That’s your first clue a bubble bath wasn’t going to fix this.

    She and Michael Leiter also found burnout isn’t random and shows up where there’s a chronic mismatch between a person and their job, in six nameable areas (Maslach & Leiter, 1997): workload, control, reward, community, fairness, values.

    For the record – in case you missed it – that’s a diagnostic you can use disguised as a list.

    If you are facing down burnout, the source is usually screaming at you from one or two of these areas, not all six.

    Reason 2: It’s a fuel shortage in your brain, not a feeling

    I’m sure the term “occupational hazard” sounds like a policy memo…right up until you see what the ongoing, day-to-day lived experience does inside your noggin.

    Chronic workplace stress isn’t just a bad mood. This stress floods your system with cortisol, the stress hormone that the body releases to help us survive in a fight or flight situation – you know like when we’re being chased by a sabre tooth tiger.

    This sustained high cortisol physically degrades the prefrontal cortex, the executive center that runs focus, judgment, working memory, and impulse control. Under that load, control shifts away from the thoughtful PFC and toward older, more reactive parts of the brain (Arnsten, 2009).

    So…when we need to be “thinking” what’s running the ship is the “reactive” part of the brain – most of the time on Autopilot.

    Burn. Out. The fuel and the machinery that runs on it, both depleted. That is why “just rest” and “just try harder” both fail. You’re asking a chemically downshifted system to power up on command, and it can’t, because the conditions drained the exact resource the command requires.

    Reason 3: Not every brain runs on the same size tank

    Now hold that next to the female brain, the ADHD brain, and the perimenopausal brain.

    ADHD is, at its core, a difference in how the brain regulates dopamine, the neurochemical you run on for focus and follow-through. Estrogen is a major player in regulating that same dopamine system. As estrogen swings and drops through perimenopause and menopause, the fuel supply gets really volatile (Mosconi, 2024).

    So take the same occupational load, the same six mismatches, and drop it on a brain that’s already running a smaller or more variable fuel reserve. The burn out doesn’t come because the woman is weaker on Tuesday than she was a year ago. It burns out faster because there is an oversized demand met an already-taxed supply.

    So here’s the actual equation

    I have math dyslexia, but to me this is actually a relatively simple formula.

    Burnout is occupational demand divided by neurochemical supply.

    What your work is demanding divided by the actual supply and reserves of the brain fuel you have to do.

    The job sets the demand.

    The demand is frequently rigged.

    The rooms you move through are often sending signals that you use extra energy to pay attention to without even realizing it. The tone of voice, who speaks first in meetings, who gets promoted, what project was assigned, who was released from employment, when and under what conditions.

    And your unique chemistry sets the supply, which is unique and variable.

    Blame yourself, and you get both variables wrong at once.

    The hidden “should” underneath all of it

    Running underneath burnout for many of us is a hidden “should”

    *I don’t “feel” stressed, so I “should” be able to handle this. If I were (fill in the blank – tougher, more resilient, more organized) I wouldn’t feel like I was burning out.**

    And that, should, my friend, is wrong twice over.

    The conditions are overloaded, AND your tank may be running lean through no fault of yours.

    What’s Your Move?

    So the question becomes – what do I do about? My recommendation, start by asking the question – Is this a me-problem, or is this a situation problem? Usually it’s both. And both have a move.

    Move 1 – Attack the demand.

    1. Use Maslach’s six areas and just ask yourself questions about each area and see if one is screaming. Workload? Fairness? Values?

    2. Name it candidly, don’t shy away from it.

    3. Determine the one move for the next 30 days that will give you the time, space, or energy you need to align with your priorities.

    Move 2 – Respect your supply.

    1. Stop comparing and grading your current brain and who you are today against some version of yourself in the past or someone around you.

    2. Get the real picture about your brain and where you are. There are actual clinical and support options for hormonal and neurodivergent side of this.

    FYI: Many OBGYN’s are ill equipped to talk about your brain health, but more and more functional doctors are becoming certified perimenopause and menopause trained to provide the support needed. Shoot me a DM if you want some resources and if you’re neurodivergent and experiencing perimenopause/menopause check out Dr. SarahNeurodivergent Women, Rewritten Hormones, Health, LongevityClear, science-based writing on hormones, health, and longevity for neurodivergent women, at every stage of life.By Dr. Sarah

    For the record, I believe you are quite possibly the most capable brain in the rooms you are running in … even if that brain does have little glitches here and there.

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    Frequently Asked Questions

    What is the real definition of burnout according to neuroscience and psychology?

    Burnout is a neurochemical fuel shortage resulting from chronic, unmanaged workplace stress, rather than a personal defect or lack of resilience. Formally recognized by the World Health Organization as an occupational phenomenon, burnout consists of three distinct components: physical exhaustion, cynicism (mental distance from work), and reduced efficacy. High cortisol levels from sustained workplace stress degrade the prefrontal cortex, shifting control to the brain’s reactive autopilot systems.

    How do perimenopause and ADHD accelerate burnout in women?

    Estrogen plays a major role in regulating dopamine, the neurotransmitter responsible for focus, working memory, and executive function. Because an ADHD brain already regulates dopamine differently, the hormonal fluctuations and estrogen drops of perimenopause create a compounding neurochemical deficit. High workplace demands paired with a volatile dopamine supply cause the brain to deplete its fuel reserves far faster.

    What are the six core workplace mismatches that drive burnout?

    Psychologist Christina Maslach’s research shows that burnout occurs when there is a chronic mismatch between a person and their work environment across six specific areas: workload, control, reward, community, fairness, and values. Rest and self-care only temporarily address physical exhaustion; resolving burnout requires identifying which of these six structural areas is creating the underlying strain.