ADHD, Hormones, and Midlife: Why So Many Women Are Asking, What’s Happening to My Brain?

By Shadi Gholizadeh, PhD, MPH

More and more women in midlife are asking versions of the same quiet question:

Why does my brain feel different—and why wasn’t I warned?

They describe lapses in focus, memory glitches, restlessness, overstimulation, difficulty initiating tasks—or finishing them. And they often ask if it could be ADHD, even if they’ve never considered that possibility before.

The truth is, they’re not imagining these shifts. Nor are they alone.

When Cognitive Load Meets Hormonal Change

Perimenopause and menopause aren’t just about reproductive change—they’re deeply neurological transitions. Fluctuations in estrogen, particularly estradiol, affect brain regions responsible for attention, memory, and executive function. This includes the prefrontal cortex and hippocampus—both of which are estrogen-sensitive and directly tied to how we think, decide, and regulate emotion.

As Dr. Lisa Mosconi, neuroscientist and author of The XX Brain, has shown, women’s brains are particularly vulnerable to cognitive shifts during perimenopause because estrogen is a key neuroprotective hormone. Brain scans of women in their 40s and 50s show measurable metabolic changes during this transition—sometimes long before other menopausal symptoms appear.

Brain fog isn’t vague or “in your head.” It’s biological. And for many women, it becomes the most disruptive symptom of midlife.

The Self-Blame Trap: Why Women Interpret These Symptoms Differently

In clinical settings, older adults who notice cognitive changes often fear dementia. We call this group the worried well—individuals who are typically aging within normal limits but are experiencing heightened anxiety, poor sleep, or mood symptoms that affect how they remember, learn, or process information.

But the pattern for women in midlife is often different. They rarely jump to dementia. Instead, they turn inward—with thoughts like:

Am I getting lazy? Why can’t I keep up? What’s wrong with me?

They blame themselves for what are, in fact, predictable cognitive effects of hormonal and life-stage transitions. The result is a profound dissonance: women feel their brains changing, but because the shifts are invisible and poorly understood, they often internalize them as personal failures rather than physiological events.

This isn’t just emotionally costly—it delays access to care, resources, and relief.

ADHD, Hormones, or Both?

For some, midlife surfaces ADHD-like symptoms for the first time. For others with a known diagnosis, it marks a turning point—when longstanding strategies begin to falter and overwhelm builds more quickly.

In an earlier research project—“Under Diagnosis of Adult ADHD: Cultural Influences and Societal Burden” (Asherson et al., 2012)—we examined the role of under-recognition, especially among adults who present as outwardly functional. Many had spent years compensating with structure, overachievement, or perfectionism—until midlife shifted the neurocognitive ground beneath them.

Whether the issue is ADHD, hormonal change, or both, the outcome is the same: cognitive shifts that deserve to be named, understood, and supported.

You Don’t Need a Perfect Label to Deserve Support

You don’t need to prove you’re struggling. You don’t need to map it back to childhood. If something feels different—and it’s affecting how you live, work, or relate—that’s enough to start the conversation.

At MID(ish), we don’t offer quick fixes or oversimplified advice. We offer something more durable: Validation. Clinical clarity. And tools to support the brain you have today.

And we’re not having these conversations in isolation. My colleague and MID(ish) co-founder, Dr. Autumn Backhaus, recently spoke on the Project Good Podcast about the deeper emotional and societal layers of menopause—from mental health to partner support to lifestyle alignment. Her compassionate, clear-eyed approach is a powerful complement to the clinical work we’re doing together to redefine what thriving looks like in midlife.

Explore MID(ish) Because midlife isn’t a breakdown—it’s a biologically meaningful reset. Let’s treat it that way.