One of the biggest patterns I see in clinic is women reaching their late 30s and 40s feeling like their ADHD has suddenly become worse overnight. Many women who previously managed reasonably well start experiencing: increased brain fog forgetfulness overwhelm emotional sensitivity anxiety reduced stress tolerance sleep disruption low motivation difficulty focusing or completing tasks increased sensory overload For some women, this is actually the stage where they first realise they may have ADHD. The reason this happens largely comes down to hormones — particularly the decline and fluctuation of oestrogen during perimenopause. Oestrogen plays a major role in supporting dopamine production and signalling in the brain. Dopamine is one of the key neurotransmitters involved in focus, motivation, executive function, emotional regulation and attention. When oestrogen begins fluctuating and declining during perimenopause, dopamine activity can become less stable too. This is why many women notice: ADHD medications may suddenly feel less effective their ability to cope with stress reduces masking becomes harder burnout symptoms intensify emotional regulation becomes more difficult sleep and anxiety worsen At the same time, perimenopause is often occurring during an already demanding life stage — careers, parenting, caring for ageing parents, relationship stress and years of accumulated nervous system depletion can all compound symptoms further. What Can Help? A neuroaffirming, holistic approach during perimenopause focuses on supporting both hormones and the nervous system, rather than blaming the person for “not coping.” Support may include: stabilising blood sugar and increasing protein intake supporting sleep quality and nervous system regulation correcting nutrient deficiencies such as iron, magnesium and B vitamins reducing inflammation supporting gut health and detoxification pathways using evidence-based herbal and nutritional medicine to support hormone balance reviewing stress load, recovery time and burnout patterns working collaboratively alongside ADHD medication support where appropriate Perimenopause can absolutely amplify ADHD symptoms — but understanding why this is happening can often bring enormous relief and validation for women who have spent years feeling like they are suddenly “failing.” Your brain hasn’t suddenly broken. Your hormonal environment has changed, and your nervous system now needs a different level of support.