By: Carole Gionet, Nurse Practitioner NP-PHC

If you’ve been wondering why your focus, memory, or mood seem to have taken a nosedive in midlife, you’re not imagining it.

For many women, the hormonal roller coaster of perimenopause can turn daily life upside down.

And if you also happen to have ADHD (diagnosed or not), the combination can feel downright overwhelming.

Let me share what I’ve learned the hard way, and what I wish someone had told me years ago.

When Everything Started to Change

If I could go back to my late 40s or early 50s, I’d tell myself one thing: “you’re not losing your mind, your hormones are just throwing a wild party you didn’t sign up for”.

As a woman in my early 60s now, I can look back and see the pattern clearly. The brain fog, the forgetfulness, the irritability, the mood swings, the sleepless nights… they all hit me like a freight train.

I remember thinking, what is wrong with me?

Looking back, I suspect I may have also been dealing with undiagnosed ADHD. The combination of fluctuating hormones and ADHD brain chemistry created the perfect storm that left me struggling with focus, memory, and emotional ups and downs.

Why Hormones Affect the Brain

Here’s the part most of us never learned in school: our hormones, especially estrogen and progesterone, don’t just affect our periods, but they directly influence how our brains work.

When these hormones start fluctuating during perimenopause, they can throw our neurotransmitters out of balance. That’s why even the most capable, organized women can suddenly feel foggy, forgetful, anxious, or emotionally fragile.

Estrogen: The Brain’s Energizer

It helps boost neurotransmitters such as dopamine, serotonin, and acetylcholine, essential for focus, motivation, memory, and mood.

When estrogen is high (usually in the first half of your cycle), you may feel sharper, happier, and more productive.

For women with ADHD, it can even make stimulant medications work better.

But when estrogen levels drop or fluctuate (as they do during perimenopause), you might start to notice:

• Trouble concentrating or remembering things,

• Feeling unmotivated or mentally “foggy,”

• More mood swings or irritability,

• Sleep problems and lower energy.

 Sound familiar?

Progesterone: The Calming Counterpart

Progesterone, on the other hand, has a soothing effect.

Progesterone interacts with GABA, a neurotransmitter that promotes calm and helps us sleep.

But as always, too much of a good thing can backfire.

High progesterone levels (which rise in the second half of the cycle) can make you feel drowsy, foggy, or low-energy, and for women with ADHD, it can also blunt the effects of their medication.

That’s why so many women say their focus and mood seem to “change with the month,” or feel like their ADHD medication has stopped working.

What Is Perimenopause, exactly?

Perimenopause is the time leading up to menopause when your hormones start to fluctuate before eventually settling down. It often begins in your late 30s or 40s and can last anywhere from four to ten years.

During this transition, your estrogen and progesterone levels rise and fall unpredictably, which is what causes the roller coaster of perimenopausal symptoms like:

• Brain fog and forgetfulness,

• Anxiety and mood swings,

• Fatigue and poor sleep,

• Problems focusing or staying organized,

• Feeling like your ADHD medication isn’t working anymore.

If you’re nodding along, know that you’re not alone and there’s nothing “wrong” with you. 

Your body and brain are just adjusting to a new hormonal rhythm.

So, What Can We Do About It?

Here’s the good news: you’re not powerless. 

There are ways to support both your hormones and your brain during this stage of life. Here’s what we recommend.

1. Consider Menopausal Hormone Therapy (MHT)

Menopausal Hormone Therapy (MHT) (formerly referred to as “HRT”) is a treatment that replaces declining estrogen and progesterone to relieve common symptoms. MHT is also used to address long-term changes such as bone loss, and is most effective for symptom relief in early menopause. When carefully managed, MRT can help smooth out hormone fluctuations and improve cognitive and emotional symptoms.

Estrogen (usually through patches, gels, or sprays) can:

• Boost dopamine and improve focus,

• Stabilize mood and reduce anxiety,

• Help ADHD medication work more effectively.

Progesterone is needed for women with a uterus, but it should be balanced carefully. Micronized progesterone (a bioidentical form) is often better tolerated and it can support sleep without causing brain fog.

Finding the right balance between estrogen and progesterone is key. 

Too much progesterone can dull your energy, while too little can disrupt sleep and mood.

Regular follow-ups with your healthcare provider make all the difference.

(If you’ve got ADHD, do future-you a solid and pre-book your appointments!)

2. Revisit Your ADHD Treatment

If you already take medication for ADHD and it suddenly feels less effective, it might not be the medication, it could be the influence of your hormones.

Talk to your doctor, nurse practitioner, or psychiatrist about possible dose adjustments, or combining ADHD treatment with hormone therapy.

And if you’ve never been formally diagnosed but suspect ADHD, now might be the perfect time to explore it.

Consider booking an appointment with one of our Nurse Practitioners at Dig A Little Deeper for a psychiatric evaluation or see another health care provider.

3. Ask About Other Options

• Veozah – a newer, non-hormonal medication for hot flashes.
• SSRIs – antidepressants that can also help with low mood, anxiety, and hot flashes.

4. What else helps?

Medication and hormones can help, but lifestyle changes can make a huge difference too:

• Therapy – Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy, Interpersonal Therapy (IPT) or other relationally focused therapies can help you strengthen not only focus, but also emotional regulation, helping you get more out of your relationships. Ready to give this a try? Check out our team of experienced therapists.

• Mindfulness – Even a few minutes a day of meditation or deep breathing can help calm your mind by increasing self-awareness of your own bodily sensations and signals. If you’ve got ADHD, you might consider a specifically neurodivergent mindfulness program.

• Healthy habits – Regular exercise, good sleep, and stress management support both your hormones and your brain.

Some women may want to explore natural options like phytoestrogens or herbal supplements, though research is still limited. If you go that route, consult a naturopathic or functional medicine doctor for guidance.

The Bottom Line

Perimenopause is a natural part of life, but that doesn’t mean you have to suffer through it or lose your sense of self in the process.

If you’re noticing brain fog, mood changes, or ADHD symptoms that seem worse than they have been before, listen to your body, it’s telling you something important. 

With the right support, treatment, and knowledge, this can be a time of renewal. You can move through perimenopause feeling informed, empowered, and fully in charge of your mind and your health