Perimenopause, ADHD, and the Mental Load: Why You're Not Just ‘Overwhelmed’

written by Michelle Oppermann, BSW, RSW (SK) 

I hit perimenopause at 40—and I have ADHD. Seven years in, I can tell you: this combination is not for the faint of heart. The brain fog, emotional whiplash, sleep disruptions, and feeling like my mind is wading through molasses... it’s a lot. Not to mention trying to stay focused on a task for more than five minutes without my brain offering up a dozen distractions. It’s not that I’m losing my keys—it’s that sometimes I sit at my computer and stare blankly, unable to figure out what I was just doing. Focus and concentration? Gone. Poof. 

If you’re reading this and nodding, wondering how everything suddenly got harder in midlife, you’re not alone—and you’re definitely not just "overwhelmed." You might be navigating the sneaky, under-acknowledged intersection of ADHD and perimenopause. 

The Mental Load Is Heavy—And ADHD Makes It Heavier 

Let’s talk about the mental load—the endless, invisible checklist so many of us carry: coordinating appointments, remembering birthdays, prepping meals, paying bills, managing emotions (ours and everyone else’s), and tracking All The Things at once. If life were a browser, our brains would have 50+ tabs open, with at least one playing mystery music we can’t locate. 

For neurodivergent folks, especially those with ADHD, this mental load doesn’t just feel heavy—it’s completely overwhelming. Executive dysfunction, a hallmark of ADHD, affects planning, prioritizing, starting tasks, staying on them, and—most frustratingly—finishing them. So, we end up spinning plates in the air while trying to work, care for aging parents, parent and maintain some semblance of personal health. 

Then Hormones Enter the Chat 

Perimenopause is a rollercoaster of shifting estrogen, progesterone, and testosterone levels. These hormonal changes affect everything from mood and energy to sleep and cognition. And here’s the kicker: estrogen helps regulate dopamine, which is the primary neurotransmitter involved in attention and focus—basically, the lifeline for anyone with ADHD. 

As estrogen drops, ADHD symptoms often intensify. This means that people who once managed their ADHD with structure, support, or even just grit and caffeine may suddenly feel like those strategies no longer work. I’ve seen clients—brilliant, capable, high-functioning individuals—wonder if they’re developing early dementia. I’ve felt that fear myself. 

And if you were never diagnosed with ADHD earlier in life, perimenopause might be the tipping point that makes symptoms unmanageable for the first time.

My Experience: Fanny Packs and Fog 

I’m a neurodivergent counsellor who lives with ADHD and perimenopause. There have been days where the fog is so thick, I can’t follow the plot of a TV show I’ve seen before. Or I reread the same sentence six times and still can’t retain it. At one point, I started wearing a fanny pack around the house with a notepad and pen—because I kept walking upstairs and forgetting what I went up for. I figured if my working memory wasn’t going to cooperate, I might as well outsmart it. 

Honestly, if I didn’t laugh, I might cry. 

Why Getting Help Can Feel So Frustrating 

Despite a growing awareness around ADHD and women’s health, there’s still a massive gap in how healthcare systems respond to this intersection. I’ve personally encountered medical professionals who minimized my symptoms, offered vague suggestions like “just try to relax more,” or handed me a generic hormone pamphlet and sent me on my way. 

I’m a trained mental health professional—I know what to ask, how to advocate, and how to research evidence-based care. And I still felt dismissed and invisible. So if you’ve experienced that same frustration, please know it’s not you—it’s the system. 

Many people assigned female at birth—women, non-binary folks, and gender-diverse individuals—are underdiagnosed or misdiagnosed, and then left trying to make sense of why everything feels like it’s falling apart. You're not imagining it. You're not weak. You're not broken. 

You're navigating a brain and body that’s being underestimated and underserved. 

Common Experiences I Hear in My Practice 

I work with folks every day who feel like they’re “failing” at life, when really, they’re living through the perfect storm of neurological and hormonal overload. Common things I hear include: 

• “I’m more reactive than I used to be. Little things send me into tears or rage.” 

• “I know what I should be doing, but I can’t seem to follow through.” 

• “Everything feels like too much, even small tasks.” 

• “I can’t focus at work, and it’s affecting my confidence.” 

• “I feel disconnected from who I used to be.” 

And underneath all that? A deep sense of guilt, shame, and fear of being a burden. 

But here’s the truth: these struggles aren’t character flaws. They’re signs that your current supports aren’t matching your brain’s current needs. 

So… What Can Actually Help? 

There’s no one-size-fits-all fix, but here are a few areas I often explore with clients: 

1. Understand What’s Happening Learning how hormones and ADHD interact can be a huge relief. Knowledge is power—and validation. 

2. Adapt Your Systems What worked before may not work now. We look at ADHD-friendly tools: visual reminders, body doubling, simplified routines, and external supports. 

3. Embrace Self-Compassion This is hard, and you’re doing your best. We practice quieting the inner critic and offering yourself the same grace you’d give a friend. 

4. Get the Right Professional Support Whether that’s counselling, medical guidance, ADHD coaching, or peer support, you don’t have to figure this out alone. 

5. Reimagine Productivity We let go of perfection and redefine success in ways that honour your capacity and values—not hustle culture expectations. 

You're Not Alone—And You Deserve Support That Works 

LEARN MORE ABOUT MICHELLE HERE

I wrote this not just as a counsellor, but as someone who lives with this every day. I get the frustration of knowing you’re capable, but feeling constantly defeated by your own brain. I know the fear of forgetting important things or reacting in ways you later regret. And I see the emotional toll of holding so much while feeling like you're falling short. 

If this resonates with you, please know: I work with people like you—women, non-binary folks, and others—who are done trying to push through and ready for a different way. 

There is space for you to feel understood, supported, and empowered again. 

Let’s figure it out—together.

-Michelle