ADHD or Perimenopause/Menopause? Understanding Brain Fog, Forgetfulness and Executive Function in Midlife Women
By: Dr. Erinn Bailey-Sawatzky, Psy.D., R.C.C., C.T.
Country Counselling Services
“I used to be able to keep everything straight. Appointments, deadlines, work responsibilities, family schedules, household tasks—the dozens of little things that need to happen every day”
Then, somewhere in your 40s or 50s, things started to feel different.
Maybe you're forgetting why you walked into a room. You're losing your train of thought halfway through a conversation. Tasks that once felt manageable suddenly seem overwhelming. You're having trouble concentrating, procrastinating more, forgetting appointments, or struggling to organize things that you used to handle without much thought.
And perhaps you've started wondering:
Is this perimenopause? Could it be ADHD? Or could both be contributing?
It's an increasingly important question. New research is beginning to examine the considerable overlap between cognitive changes reported during the menopause transition and symptoms commonly associated with Attention-Deficit/Hyperactivity Disorder (ADHD).
And what researchers are finding suggests that the answer isn't always straightforward.
Why Can Perimenopause Feel Like ADHD?
“Brain fog” has become a common way of describing cognitive changes during perimenopause and menopause.
Women may describe forgetfulness, difficulty concentrating, losing words or thoughts, feeling mentally slower, or struggling to manage multiple demands at once.
Interestingly, research suggests that these experiences do not necessarily mean that memory itself has significantly deteriorated.
In one study of 75 perimenopausal women, 67% reported some degree of memory loss. Yet their subjective memory complaints weren't associated with how they performed on tests of verbal learning and memory.
Instead, their complaints were associated with areas such as working memory and complex attention, as well as sleep disturbance, depressive symptoms and other physical symptoms.
That distinction matters.
Sometimes what feels like “my memory isn't working anymore” may actually involve difficulty paying attention to information in the first place, holding information in mind while doing something else, or managing competing demands.
Those are also areas in which people with ADHD can experience significant difficulty.
Is Perimenopausal Brain Fog Measurable?
This is where the research becomes particularly interesting.
A 2025 systematic review and meta-analysis examined the relationship between how women felt their cognition was functioning during and after the menopause transition and how they actually performed on objective cognitive testing.
The relationship was remarkably small.
Across the studies included in the analysis, the overall correlation between subjective and objectively measured cognition was only r = .06 and was not statistically significant.
In other words, how impaired someone felt did not necessarily correspond closely with what appeared on traditional cognitive testing.
That does not mean that the cognitive difficulties women experience during perimenopause aren't real.
Instead, it raises an important question about whether traditional cognitive testing always captures the kinds of difficulties people encounter in everyday life.
Researchers don't even currently have a validated measure specifically designed to assess what women commonly describe as menopausal “brain fog.”
Large longitudinal research has also suggested that cognitive changes associated with the menopause transition may be relatively subtle and, for many women, temporary.
The Study of Women's Health Across the Nation (SWAN) followed more than 2,300 women and found that the improvement people would normally be expected to show when taking certain cognitive tests repeatedly appeared to stall during parts of the menopause transition. Those learning effects returned after menopause.
So there is evidence that the menopause transition can affect aspects of cognitive functioning—but the picture is considerably more nuanced than simply saying that menopause causes memory loss.
So Where Does ADHD Come In?
This is an area where research has expanded considerably in just the last few years.
A large 2025 Icelandic study examined 5,392 women between the ages of 35 and 55.
Women reporting an ADHD diagnosis had higher scores on a measure of perimenopausal symptoms than women without ADHD. Women with severe current ADHD symptoms were also approximately 2.5 times as likely to report severe perimenopausal symptoms.
That sounds compelling—but another 2025 study illustrates why we need to be cautious about drawing conclusions too quickly.
Researchers studying 656 women in the United Kingdom did not find a significant effect of ADHD diagnosis on menopausal complaints after correcting for multiple statistical comparisons.
They did, however, find something interesting:
The severity of ADHD-type symptoms was strongly associated with women's reports of memory and concentration difficulties, regardless of whether they had an ADHD diagnosis.
In other words, ADHD symptoms and menopausal cognitive complaints appear to share considerable territory.
Researchers are still trying to determine exactly what that relationship means.
Does ADHD Actually Get Worse During Menopause?
Many women with ADHD certainly feel that it does.
A 2026 study surveyed 600 women reporting an ADHD diagnosis about their experiences across different hormonal stages of life.
An extraordinary 97.5% of respondents reported that they perceived their ADHD symptoms as worsening during menopause.
But there was an important catch.
When researchers compared current ADHD symptom scores among women at different life stages, the scores were relatively similar.
This creates an intriguing discrepancy: women overwhelmingly described menopause as a period when their ADHD became worse, yet cross-sectional symptom measures didn't demonstrate the same change.
That doesn't tell us that either side is “wrong.”
It tells us that we still don't fully understand what is happening.
The study was retrospective and cross-sectional, meaning researchers weren't following the same women before, during and after the menopause transition. That type of longitudinal research is still needed.
Why Are Some Women First Diagnosed With ADHD in Midlife?
This may be one of the most interesting questions emerging from the newer research.
ADHD is a neurodevelopmental disorder. It doesn't suddenly begin for the first time when someone reaches perimenopause. An ADHD assessment therefore looks for evidence that symptoms or related difficulties were present much earlier in life.
But that doesn't mean ADHD was necessarily recognized earlier.
Some women may have developed ways of compensating for difficulties with attention, organization, time management or executive functioning for decades.
They may have relied on extensive planning, routines, lists, anxiety-driven preparation, working longer than other people, or simply putting enormous effort into keeping everything together.
Then something changes.
A small 2026 qualitative study involving women with ADHD described one of the themes emerging during perimenopause as a “collapse of coping strategies.”
Another 2026 qualitative study interviewed 19 women about ADHD and perimenopause. Among the 13 participants with a formal ADHD diagnosis, 10 had been diagnosed after their perimenopausal symptoms began.
These are small qualitative studies, so they cannot establish that perimenopause causes previously hidden ADHD to suddenly become apparent.
But they raise an interesting possibility:
Potentially, and I see this clinically with clients, is that ADHD obviously didn't suddenly appear—but that strategies that worked for years aren't working as well anymore now in life for them.
ADHD or Perimenopause: How Can You Tell What Is What?
Unfortunately, there isn't currently one test that can answer this question.
Instead, one of the most important pieces of information is the timeline and comprehensive assessment.
If problems with attention, organization, procrastination, time management or forgetfulness truly appeared for the first time during the menopause transition, that history looks different from someone who can trace similar patterns back through adulthood, university, high school or childhood.
For someone questioning ADHD in midlife, useful questions may include:
Were attention or organization difficulties present long before perimenopause?
Did school or university require considerably more effort than other people realized?
Have procrastination, lateness, losing things or forgetting obligations been longstanding patterns?
Have you always relied heavily on calendars, lists, reminders, routines or last-minute pressure to function?
Did you previously manage these difficulties successfully, but find that your usual strategies no longer seem sufficient?
Did the cognitive changes appear alongside menstrual changes, hot flashes, night sweats or other symptoms of perimenopause?
Are sleep difficulties contributing?
Have anxiety, depression, stress or other health changes occurred at the same time?
The answers don't necessarily point neatly toward one explanation.
Sometimes several things may be contributing simultaneously.
This is why assessment is important.
Could It Be Both ADHD and Perimenopause?
Potentially.
The emerging research suggests that women with ADHD may experience a greater burden of perimenopausal symptoms, while qualitative research suggests that some women experience previously manageable ADHD-related difficulties becoming much harder to compensate for during midlife.
At the same time, researchers have not yet demonstrated through prospective longitudinal research that menopause causes ADHD symptoms to worsen.
That distinction is important.
We currently have compelling reports from women, cross-sectional studies showing substantial overlap, and emerging research suggesting an association between ADHD symptoms and menopausal experiences.
What we don't yet have is research following women with and without ADHD over time—from before perimenopause, through the transition and into postmenopause—to determine exactly how ADHD symptoms change.
So, for now, the most scientifically accurate answer may sometimes be:
Both could be contributing, and figuring out how requires looking at more than a symptom checklist.
What If My Cognitive Testing Is Normal?
A normal cognitive test result does not necessarily mean that nothing has changed.
Research on menopausal brain fog repeatedly demonstrates a disconnect between subjective cognitive complaints (what you say you struggle with) and performance on objective cognitive tests.
Someone can perform within normal limits in a structured testing environment and still experience meaningful difficulties managing attention, working memory and executive demands in everyday life.
At the same time, feeling forgetful or mentally foggy doesn't automatically indicate ADHD or objective cognitive impairment.
This is one reason that understanding the broader clinical picture matters.
Assessment may consider current symptoms, developmental history, functioning across different areas of life, sleep, mood, medical factors and other possible explanations—not simply whether someone scores poorly on one cognitive task.
What About Hormones and ADHD Medication?
This is another area where the science is still developing.
Despite growing interest in ADHD and menopause, there have not yet been randomized controlled trials specifically evaluating ADHD medications in women with ADHD during or after the menopause transition.
There have been small studies examining lisdexamfetamine in menopausal women experiencing new executive-function difficulties who did not have ADHD. Some self-reported executive difficulties improved.
Those studies are interesting partly because they demonstrate just how similar menopause-related executive complaints can look to symptoms commonly associated with ADHD. They should not, however, be interpreted as evidence about how ADHD medication should be used during menopause.
Research examining menopausal hormone therapy has not demonstrated an overall benefit across cognitive domains, although some studies have identified possible effects that vary according to factors such as hormone formulation and timing of treatment.
Treatment decisions therefore need to be individualized and discussed with an appropriate medical professional rather than assuming that either ADHD medication or hormone therapy is the answer to midlife brain fog.
What Don't We Know Yet?
For all the attention this subject is receiving, there are some surprisingly large gaps in the research.
At the time of writing:
No prospective longitudinal study has tracked ADHD symptoms through the menopause transition.
No randomized controlled trials have specifically studied ADHD medication in peri- or postmenopausal women with ADHD.
There is no validated menopause-specific measure of “brain fog.”
Much of the existing ADHD-menopause research relies on self-report.
Many study samples have been predominantly White and highly educated.
So while the emerging research is fascinating, we should be careful not to turn early findings into conclusions that the science hasn't yet established.
When Might It Be Worth Looking Further?
If you've noticed significant changes in concentration, organization, memory, motivation or your ability to manage everyday responsibilities during midlife, it can be tempting to explain everything as “just menopause.”
For some women, the menopause transition may indeed account for new cognitive complaints.
For others, looking carefully at their history may reveal that difficulties with attention or executive functioning have existed for much longer than they realized—and that midlife has simply made those difficulties harder to compensate for.
And for some women, ADHD, perimenopause, sleep, mood and other factors may all be contributing at the same time.
The more useful question may therefore be less:
“Is this ADHD or perimenopause?”
and more:
“What has changed, what was already there, and what is contributing to the difficulties I'm experiencing now?”
A comprehensive assessment can help examine those pieces together rather than assuming that one explanation accounts for everything.
Country Counselling Services provides ADHD assessment and mental health services for adults. For individuals who aren't sure where to begin, a mental health consultation can also help clarify concerns and discuss possible next steps.
Dr. Erinn will work with you and your medical provider to help to assess what is happening.
Dr. Erinn, Psy.D
Research Referenced in This Article
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Chapman, L., Gupta, K., Hunter, M. S., & Dommett, E. J. (2025). Examining the link between ADHD symptoms and menopausal experiences. Journal of Attention Disorders, 29(14), 1263–1277. https://doi.org/10.1177/10870547251355006
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Disclaimer: This article is intended for educational purposes and does not provide a diagnosis or individualized medical advice.
