Why Perimenopause Feels Like ADHD: The Neurological Link and How to Thrive During this Phase of Life
- Melissa Strickland
- Nov 3
- 8 min read
The "Keys in the Fridge" Moment
Have you ever found your keys in the fridge or forgotten a word mid-sentence, struggling to recall a thought that was just there? Perhaps you’ve been hit by an overwhelming wave of tiredness, feeling that the mental load of juggling work, family, and life has become inexplicably heavier.
If you’re a woman in your late 30s or 40s, you might be asking if this is just aging, stress, or something more. The answer is that it is something more. These experiences are the real, brain-based signs of perimenopause. This article will explain the science behind these changes, decode the symptoms by linking them to the framework of executive functions often associated with ADHD, and provide actionable strategies to support your long-term brain health. This transition is not a pathology to be cured, but a neurological passage to be navigated. This guide provides the map.
What is Perimenopause? A Neurological Transition
Perimenopause is the transitional period leading up to menopause, which is clinically defined as the final menstrual period. This transition is not a brief event; it can begin up to a decade before your periods stop, often starting for women in their late 30s or early 40s.
While perimenopause is often defined by its reproductive changes, it's crucial to understand that it is also a neurological event. For too long, the brain-based symptoms have been overlooked. Dr. Mary Haver, an OB-GYN, recalls being taught a shorthand diagnosis for middle-aged women with vague complaints. Her male superior called it a "WW" or "whiny woman," advising her to "pat her on the knee, tell her to have some wine." This dismissal of legitimate suffering highlights a critical truth: the vast majority of perimenopausal symptoms—from hot flashes to brain fog—are rooted in the brain's response to a changing hormonal environment. This phase isn't characterized by a steady decline in hormones but by a "hormonal roller-coaster," where estradiol fluctuates erratically and creates a volatile internal environment for the brain.
The Science of "Perimenopause Brain": An Energy Crisis
For decades, estradiol (the primary form of estrogen) acts as a "master regulator" for the brain. Receptors for this hormone are located throughout key regions like the hippocampus (memory) and the prefrontal cortex (executive function), ensuring the brain can effectively generate energy.
During perimenopause, hormonal volatility disrupts this system, compromising the brain's ability to use its main fuel, glucose. This leads to a "brain energy crisis," where the brain struggles to get enough energy. In response, the brain adaptively shifts to using ketone bodies as an alternative fuel source. This hormonal chaos also disrupts key neurotransmitters, including:
- Serotonin (mood, sleep)
- Dopamine (motivation, reward)
- GABA (the primary calming neurotransmitter)
These are not just subjective feelings. Brain imaging studies like fMRI and PET scans confirm measurable shifts in brain activity. Crucially, studies reveal that perimenopausal women can show reduced gray matter volume (GMV) in specific areas like the left superior temporal gyrus, demonstrating tangible structural changes.
The ADHD Connection: Why Symptoms Feel So Familiar
The mental challenges of perimenopause, like trouble focusing and staying organized, can feel a lot like ADHD. A powerful way to understand these challenges is through Dr. Thomas E. Brown's model, which defines ADHD as a complex syndrome involving developmental impairments of executive functions, which constitute the self-management system of the brain.
For many women, this feels intensely personal—a sudden decline in capability. However, Brown's model provides a clinical, impersonal framework that separates a woman's intelligence and competence from the temporary impairment of her brain's management system.
Brown uses the metaphor of a symphony orchestra to illustrate this concept. The brain's individual skills are like the musicians; they may be excellent, but without a conductor (the executive functions) to organize and direct them, the resulting music is poor. This emphasizes that these impairments are distinct from a person's intelligence or knowledge.
Mapping Perimenopause Symptoms to the Six Executive Functions
Activation: The Struggle to Get Started
Dr. Brown defines this cluster as the impairment in organizing, prioritizing, and activating to work. This is the neurological architecture behind the "mental load" so many women describe. It manifests as a paralyzing difficulty with planning and organization, leading to chronic procrastination where tasks are delayed until an immediate deadline forces action.
Focus: The Pervasive Brain Fog
This cluster involves difficulty in focusing, sustaining, and shifting attention to tasks. This is the clinical framework for the widely reported symptom of "brain fog." It illuminates why you might read the same paragraph three times, find yourself unable to minimize distractions at work, or lose your train of thought mid-sentence—a direct consequence of hormonal effects on the brain's prefrontal cortex.
Effort: The Mysterious Loss of "Steam"
This cluster describes the challenge in regulating alertness, sustaining effort, and processing speed. Brown's research specifies that individuals with this impairment "tend to run out of 'steam' quickly on jobs requiring sustained effort with minimal immediate reward." This brilliantly explains why a woman in perimenopause might have boundless energy for a passion project but feel utterly depleted by routine administrative tasks, a phenomenon tied directly to the brain's energy crisis and dopamine dysregulation.
Emotion: The Overwhelming Mood Swings
This cluster is defined as the difficulty in managing frustration and modulating emotions. Perimenopause is a period of heightened vulnerability for mood disorders, with the risk for depression doubling and anxiety often increasing. This emotional volatility, tied to the disruption of neurotransmitters like serotonin and GABA, is a core executive function challenge. The alarming statistic that suicide rates peak for women aged 45-55 underscores the severity of this impairment.
Memory: The "Tip-of-the-Tongue" Problem
Dr. Brown defines this as the impairment in utilizing working memory and accessing recall. This directly links to difficulties learning new information, recalling appointments, and finding the right word. Working memory involves holding multiple facets of information in mind simultaneously—like following a multi-step recipe while listening to your child's story. When this function is impaired, it creates the cognitive fog many women report.
Action: The Challenge with Self-Regulation
This final cluster involves the impairment in monitoring and self-regulating action. While often associated with physical impulsivity, this function is also critical for emotional regulation. In the context of perimenopause, this impairment manifests as difficulty regulating an emotional response—the snap of frustration that feels out of character or the sudden welling of tears. This is a direct consequence of the emotional volatility and stress of the transition.
A Critical Window of Opportunity for Your Brain
For most women, these cognitive and mood challenges are temporary and tend to stabilize after the transition is complete. More importantly, scientists now view perimenopause as a critical window for long-term brain health.
If the brain's adaptive shift to alternative fuel sources is not adequately supported, the consequences can be serious. In a state of prolonged energy deficit, the brain can begin to catabolize its own lipids for energy, a process that can disrupt cell membranes and damage lipid-rich structures like myelin. This adaptive but potentially damaging state may increase the risk of neurodegenerative diseases, such as Alzheimer's, later in life. The lifestyle choices made during this period have a significant impact on your future cognitive wellness.
Taking Control: 5 Actionable Strategies to Protect Your Brain
Exercise Smarter, Not Harder
Exercise smartly with a mix of high-intensity workouts and gentle activities. High-Intensity Interval Training (HIIT) can boost your brain's energy, while activities like walking or yoga help manage stress. Strength Training is crucial for building metabolically active muscle that helps manage glucose and reduce inflammation.
Fuel Your Brain with an Anti-Inflammatory Diet
A plant-forward, whole-foods diet is one of the most powerful tools for managing symptoms.
- Prioritize fiber for a healthy gut microbiome, which helps metabolize estrogen and buffer hormonal fluctuations.
- Include healthy fats from sources like avocados, nuts, and olive oil to support hormone production.
- Ensure adequate protein at every meal to support muscle.
- Limit or avoid ultra-processed foods that are pro-inflammatory and contribute to metabolic dysfunction.
Prioritize High-Quality Sleep
Protecting sleep is fundamental for cognitive function and mood. Poor sleep exacerbates the brain's energy crisis, further destabilizes neurotransmitters like serotonin and dopamine, and impairs the overnight clearing of metabolic waste, which is critical for long-term brain health. Maintain a consistent sleep schedule, create a cool and dark bedroom environment, and avoid screens for at least an hour before bed.
Limit Smoking and Alcohol
Making changes in these areas can have a direct impact. Smoking is linked to an earlier onset of menopause, while limiting alcohol can significantly reduce symptoms like hot flashes and sleep disruption.
Master Your Stress with the Help of a Competent Therapist
Chronic stress exacerbates hormonal chaos. Several evidence-based mental health therapy modalities can help manage stress effectively.
Cognitive Behavioral Therapy (CBT) - centers on identifying and changing negative thought patterns and behaviors.
Acceptance and Commitment Therapy (ACT) - designed to help individuals accept difficult thoughts and feelings without being controlled by them, allowing them to commit to actions that align with their personal values.
Focuses on accepting difficult thoughts and feelings rather than fighting them.
Aims to help individuals commit to actions that align with their personal values.
Mindfulness-Based Stress Reduction (MBSR) - uses meditation to help people become more aware of their mental state and thoughts.
Involves formal meditation practice.
Encourages bringing awareness into daily life.
Dialectical Behavior Therapy (DBT) - teaches specific skills to help individuals effectively manage intense emotions and curb impulsive behaviors.
Teaches skills to manage intense emotions.
Aids in reducing impulsive behaviors.
Can be helpful for individuals with high-conflict relationships or frequent emotional ups and downs.
Interpersonal Psychotherapy (IPT) - concentrates on improving a person's relationships and social functioning as a direct way to enhance their overall mood.
Identifies how interpersonal issues impact mood.
Helps build skills for navigating social and relational challenges.
Uses improved relationships as the primary vehicle for stress reduction.
Emerge Stronger from the Transition
Navigating perimenopause can be challenging, but understanding the neurological changes at its core is the first step toward reclaiming control.
- Perimenopause is a significant neurological transition, not just a reproductive one.
- Symptoms like brain fog and mood swings are rooted in the brain's shift in energy systems.
- This period is a critical window to proactively protect long-term brain health.
- Targeted lifestyle strategies are powerful tools for navigating this phase with resilience.
Despite its challenges, this phase can lead to positive brain changes. With the right knowledge and tools, you can navigate perimenopause and emerge stronger, enjoying more stable moods and improved emotional well-being, ready for a new and powerful phase of life.
Further Reading:
Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature Reviews Endocrinology, 11(7), 393–405. https://doi.org/10.1038/nrendo.2015.82
Essential psychological therapies and modalities. (n.d.).
Fidecicchi, T., Giannini, A., Chedraui, P., Luisi, S., Battipaglia, C., Genazzani, A. R., Genazzani, A. D., & Simoncini, T. (2024). Neuroendocrine mechanisms of mood disorders during menopause transition: A narrative review and future perspectives. Maturitas, 188(108087). https://doi.org/10.1016/j.maturitas.2024.108087
Geddes, L. (2025, March 20). We’re finally learning how perimenopause profoundly changes the brain. New Scientist.
Liu, N., Zhang, Y., Liu, S., Zhang, X., & Liu, H. (2021). Brain functional changes in perimenopausal women: an amplitude of low-frequency fluctuation study. Menopause, 28(4), 384–390. https://doi.org/10.1097/GME.0000000000001720
Mazur, S. (2024, October 8). How menopause impacts your brain health – And what you can do about it. Henry Ford Health.
Printz, C. (2024, October 8). How does menopause affect the brain? CU Anschutz therapist explains how large fluctuations in estrogen can cause thinking and memory problems, depression and anxiety. CU Anschutz Medical Campus.
The Diary Of A CEO. (n.d.). Hormone & fertility experts: We've been lied to about women's health! If this happens, call a doctor [Video transcript]. YouTube.
The Diary Of A CEO. (n.d.). Longevity debate: SHOCKING weight loss truth! They've been hiding this for years! [Video transcript]. YouTube.
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