Approximate reading time: 12–14 minutes
“You’re too young.”
If you’ve ever gone to your GP because something didn’t feel quite right, there’s a good chance you may have heard those words. Perhaps you left feeling confused, frustrated or even a little embarrassed for having raised the possibility of perimenopause in the first place. After all, you’re only in your early forties… or perhaps your late thirties. Surely you’re too young? Except what if you’re not?
For many women, the years leading up to menopause don’t begin with hot flushes. They begin with a quiet sense that something has changed. The strategies that have always helped you keep all the plates spinning suddenly don’t seem to work anymore. You’re forgetting things more often. You’re overwhelmed by decisions that once felt manageable. Your emotions seem closer to the surface, your sleep is disrupted, your confidence has taken a knock and you’re wondering why life suddenly feels so much harder than it used to.
For some women, this is also the point at which ADHD first comes into view. Perhaps you’ve spent your whole life unknowingly compensating, masking and pushing through. Or maybe you’ve always been the one who looked as though she was coping, despite the constant mental juggling act happening behind the scenes. Then, seemingly out of nowhere, everything becomes harder.
It’s not uncommon for women to receive their first ADHD diagnosis during perimenopause. Others begin to recognise autistic traits that they’ve spent decades masking. The hormonal changes of midlife don’t create ADHD or autism, but they can make it much harder to compensate for traits that have been there all along.
It’s one of the reasons Chantelle Knight and I wrote Meno-Wars: Battling the Menopause with ADHD (and its Comorbidities). We wanted to shine a light on the often-overlooked relationship between female hormones and neurodivergence because, time and time again, we were hearing the same story from women who knew something had changed but struggled to have those concerns taken seriously.
Yet instead of these possibilities being explored, many women are simply told they’re too young to be perimenopausal, too young to need HRT, or that their symptoms are “just stress”, anxiety or depression. I’ve lost count of the number of women I’ve spoken to who eventually discovered that they weren’t imagining any of it. Their instincts were right.
The reality is that being in your forties – or even your late thirties – and experiencing symptoms of perimenopause is entirely possible. For women with ADHD, there is also growing evidence that menopause may occur earlier than average, whilst the hormonal fluctuations of perimenopause can significantly affect attention, executive functioning, emotional regulation and overall wellbeing.
So, if you’ve found yourself wondering whether you’re losing your mind, whether your ADHD has suddenly become more difficult to manage, or whether your body is trying to tell you something despite being reassured that you’re “too young”, I hope this article helps you feel informed, reassured and, above all, listened to.
Why “You’re too young” doesn’t stand up to the evidence
One of the biggest misconceptions surrounding menopause is the belief that it somehow begins at the age of 51. It’s easy to understand why so many people think this, because we’re often told that the average age of menopause in the UK is 51. Unfortunately, somewhere along the way, average has become confused with expected, and the two are very different things.
Menopause itself isn’t actually something that lasts for years. In medical terms, menopause is simply the point at which you’ve gone twelve consecutive months without a menstrual period. It’s a milestone rather than a journey. The journey is perimenopause – the months, or more commonly the years, leading up to that point, during which our hormone levels begin to fluctuate.
Those hormonal fluctuations are responsible for many of the symptoms women experience. Sometimes they creep in so gradually that we barely notice them at first. At other times they seem to arrive almost overnight, leaving us wondering what on earth has happened to the capable, resilient woman we felt we were only a few months earlier.
What many people don’t realise is that perimenopause commonly lasts between four and eight years, and for some women it can last up to ten years or occasionally even longer. When you look at it that way, it becomes much easier to understand why a woman in her early forties – or even her late thirties – might quite legitimately be experiencing symptoms.
Imagine a woman who reaches menopause at the average age of 51. If her perimenopause lasts eight years, her symptoms could quite reasonably begin at the age of 43. If she reaches menopause at 49, they may begin at 41. And, of course, not every woman reaches menopause at 51 in the first place. Some will naturally experience it several years earlier, whilst others won’t do so until much later. Our reproductive hormones don’t all decline according to the same timetable, just as puberty doesn’t begin on exactly the same birthday for every girl.
This becomes even more relevant when we consider women with ADHD. Although research in this area is still developing, there is growing evidence to suggest that they may be more likely to experience menopause earlier than women without ADHD. We don’t yet fully understand why, but it reinforces something that should perhaps be obvious: age alone is never enough information on which to rule out perimenopause.
Good healthcare has never been about treating averages. It’s about listening to the person sitting in front of you. That means considering your symptoms, menstrual history, family history, overall health and, where relevant, your neurodivergence. Together, these pieces of information paint a far more meaningful picture than a date of birth ever could.
This is why I find it so concerning when women are told they’re “too young” without anyone taking the time to explore what has actually changed. Perimenopause is largely a clinical diagnosis. It’s based on listening, asking the right questions and recognising patterns, not simply glancing at someone’s age before deciding it can’t possibly be hormonal.
If there’s one thing I’d love every woman to take away from this, it’s that being in your early forties doesn’t make you too young for perimenopause. Neither does being 39. It may or may not be what’s causing your symptoms, but it deserves to be considered rather than dismissed.
When hormones meet ADHD
For many women, perimenopause doesn’t begin with hot flushes or night sweats. In fact, some women don’t experience those symptoms until much later, if at all. Instead, what they notice first is that their brain simply doesn’t seem to work in quite the same way it used to.
Tasks that once felt manageable suddenly feel overwhelming. Concentration becomes harder. Words disappear halfway through a sentence. Keeping on top of everyday life feels like wading through treacle. Emotionally, things can feel much closer to the surface too. Anxiety often increases, frustration becomes harder to manage, and resilience can seem to disappear overnight.
For women with ADHD, these changes can be particularly unsettling because they’re often accompanied by a noticeable worsening of traits that may have been relatively well managed for years.
I’ve spoken to countless women who tell me, “It’s as though my ADHD medication has stopped working,” or “I’ve spent my whole life just about coping, but now everything feels impossible.” Others don’t yet know they have ADHD at all. Instead, they find themselves searching online for answers, wondering why they no longer seem able to function in the way they once did.
It’s also worth remembering that hormonal changes can influence how well your ADHD symptoms are controlled. Some women find that the medication and strategies which once worked well no longer seem quite enough during perimenopause or at different stages of the menstrual cycle. For others, reviewing their ADHD medication, alongside lifestyle changes, HRT where appropriate, or adjustments to other aspects of their treatment plan, can make a significant difference. This is why regular medication reviews during midlife can be so important and why it’s worth discussing any changes with the clinician who prescribes your ADHD medication.
For many women, this is the point at which ADHD finally comes into view. The ADHD hasn’t suddenly appeared. Rather, the hormonal changes associated with perimenopause have made it much harder to compensate for traits that have been there all along.
To understand why, it helps to know a little about the relationship between hormones and the brain. Oestrogen doesn’t just influence our reproductive system. It also plays an important role in supporting several of the brain chemicals responsible for attention, motivation, memory and emotional regulation, including dopamine. ADHD is already associated with differences in the way dopamine functions within the brain, so when oestrogen levels begin to fluctuate and gradually decline during perimenopause, it’s perhaps not surprising that many women notice a significant increase in their ADHD traits.
This isn’t simply about feeling a little more forgetful. Hormonal changes can affect many of the cognitive functions we rely on every single day, including:
- planning and organising
- prioritising tasks
- getting started with jobs, even when we want to do them
- remembering appointments and conversations
- concentrating for sustained periods
- regulating emotions
- managing time
- making decisions
- filtering distractions
- switching attention between tasks
- holding information in mind whilst completing another task (working memory)
Many women also describe becoming far more sensitive to sensory input than they were previously. Busy environments become overwhelming, background noise is harder to filter out, clothing suddenly feels uncomfortable, and emotional overwhelm seems to arrive much more quickly than it once did.
Sleep often plays a significant role too. Hormonal fluctuations can make it more difficult to fall asleep or stay asleep, and poor sleep inevitably makes executive functioning even more challenging the following day. When you combine fluctuating hormones, disrupted sleep and a brain that is already working much harder than most, it’s little wonder that so many women describe feeling as though they’re “losing their mind”.
Perhaps the most important thing to understand is that the hormonal changes of perimenopause don’t create ADHD. They can, however, expose traits that have been quietly masked for decades.
Many women have unknowingly spent decades developing strategies to compensate for those traits. They’ve relied on structure, routines, adrenaline, perfectionism, people-pleasing or sheer determination to keep everything going. Those strategies may have been exhausting, but they were just about working.
Then hormones begin to change, and all of those carefully developed coping strategies begin to require far more effort than they once did. The mental juggling act becomes increasingly difficult to sustain, masking feels more exhausting than ever, and the countless ways you’ve unknowingly compensated for your ADHD over the years no longer seem to work quite as well as they once did.
It’s often at this point that women begin to wonder whether they’re somehow failing. In reality, many are simply reaching a stage of life where the strategies they’ve depended upon for decades are no longer enough to compensate for the neurological differences that have always been there.
And that’s why, for so many women, perimenopause becomes the catalyst for a late ADHD diagnosis. Not because ADHD suddenly develops in midlife, but because the hormonal changes of perimenopause can finally expose what has been quietly hidden beneath years of coping, compensating and masking.
This isn’t just anecdotal – what the research tells us
If you’ve been nodding along whilst reading this, you might be wondering whether all of this is simply anecdotal. After all, many of us have spent years being told that brain fog, anxiety, low mood and forgetfulness are just part of getting older or having a busy life.
The reassuring news is that researchers are increasingly recognising what so many women have been saying for years. We now know that oestrogen does far more than regulate our reproductive system. It also plays an important role in supporting brain function, influencing neurotransmitters such as dopamine, serotonin and acetylcholine, all of which contribute to attention, memory, motivation, mood and emotional regulation. As hormone levels fluctuate during perimenopause, it’s therefore entirely understandable that many women experience changes in their thinking, concentration and overall cognitive function.
Research has also shown that cognitive symptoms are a recognised part of the menopause transition. Difficulties with memory, attention, processing information and finding the right words are all commonly reported, and for many women these symptoms can be just as distressing as the physical ones.
For women with ADHD, the picture appears to be even more complex. A growing body of research suggests that fluctuating and declining oestrogen levels can exacerbate ADHD symptoms, making difficulties with executive functioning, emotional regulation and attention even more pronounced. Whilst researchers continue to explore this relationship, the evidence increasingly reflects what many women have been describing for years.
If you’ve noticed a significant change in your ability to think clearly, stay organised, regulate your emotions or cope with everyday life, you’re not imagining it and you’re certainly not alone. These experiences are increasingly recognised within the scientific literature, even if awareness hasn’t yet filtered through to every healthcare setting.
It’s not just hot flushes – the symptoms nobody warns you about
Ask someone to describe the symptoms of menopause and they’ll probably mention hot flushes, night sweats and perhaps irregular periods. Whilst those are certainly common symptoms, they’re only part of the story.
For many women, it’s the less obvious symptoms that have the greatest impact on everyday life. They’re also the symptoms that are most easily mistaken for stress, anxiety, depression or simply “getting older”, particularly when they’re experienced by women who are still having regular periods.
Perhaps that’s one of the reasons so many women begin to doubt themselves. They don’t necessarily recognise what they’re experiencing as hormonal because nobody ever told them that perimenopause could affect the brain quite as much as the body.
The reality is that fluctuating hormones can influence almost every aspect of our wellbeing. Although no two women will experience perimenopause in exactly the same way, symptoms can include:
Cognitive changes
- Brain fog or feeling as though your thinking has become slower
- Forgetting words or losing your train of thought mid-sentence
- Poor concentration
- Difficulty making decisions
- Increased distractibility
- Forgetfulness
- Reduced motivation
- Struggling to plan, prioritise or organise everyday tasks
- Feeling mentally overwhelmed by things that once felt manageable
Emotional changes
- Increased anxiety
- Low mood
- Irritability or a shorter fuse than usual
- Feeling tearful or emotionally sensitive
- Loss of confidence
- Feeling unlike yourself
- Greater emotional overwhelm
- For women with ADHD, an increase in rejection sensitivity or emotional dysregulation
Sleep and energy
- Difficulty falling asleep
- Waking during the night
- Waking very early and being unable to get back to sleep
- Persistent fatigue
- Feeling exhausted despite sleeping
Physical changes
- Hot flushes
- Night sweats
- Joint and muscle aches
- Headaches or migraines
- Heart palpitations
- Increased sensitivity to noise, light, smells or touch
- Changes in bladder function
- Vaginal dryness
- Reduced libido
- Changes in body composition or weight distribution
Of course, not every woman will experience every symptom, and having some of these symptoms doesn’t automatically mean you’re perimenopausal. Many of them can have other causes, which is why it’s always important to seek appropriate medical advice.
What matters is recognising the overall pattern. If you’ve noticed several of these symptoms developing around the same time, particularly during your late thirties or forties, it’s entirely reasonable to wonder whether hormones could be playing a part. And if you also have ADHD – or suspect you might – it becomes even more important to consider the whole picture, rather than viewing each symptom in isolation.
Far too many women have spent months, and sometimes years, believing they were simply becoming less capable, less resilient or somehow “losing themselves”, when in reality they were experiencing a perfectly understandable response to changing hormones.
You are still you. Your brain hasn’t suddenly become lazy, and you haven’t somehow become less capable or less resilient than you were before. Your body and your brain are simply navigating a significant biological transition that deserves understanding, support and, above all, to be taken seriously.
So why are women still being told they’re “too young”?
If you’re reading this and feeling frustrated, you’re certainly not alone. One of the questions I hear time and time again is,“If all of this is true, why was I told I was too young?” It’s a fair question, and unfortunately there isn’t one simple answer.
Most healthcare professionals genuinely want to help their patients. However, menopause education has historically been inconsistent, and our understanding of the relationship between female hormones, cognition and neurodivergence has evolved considerably over recent years. Whilst awareness is improving, it’s inevitable that knowledge and confidence will vary between clinicians, just as it does within any area of medicine.
There are also a number of persistent myths that continue to shape conversations around menopause. One of the most common is the belief that women must be experiencing hot flushes or irregular periods before perimenopause should even be considered. In reality, neither of those things is essential.
Many women continue to have regular periods throughout much of perimenopause, particularly in the earlier stages. Others experience predominantly cognitive or emotional symptoms long before they notice any obvious physical changes. That’s one of the reasons why perimenopause can be so difficult to recognise, both for women themselves and sometimes for the professionals supporting them.
Another common misconception is that a blood test can provide a simple yes or no answer. Unfortunately, it isn’t that straightforward. During perimenopause, hormone levels don’t decline in a smooth, predictable way. Instead, they fluctuate constantly – not only from month to month, but throughout the menstrual cycle itself. It’s entirely possible for a woman to have hormone levels that appear perfectly “normal” on the day her blood is taken, despite experiencing very real and very significant symptoms.
For this reason, NICE guidance recommends that women aged 45 and over with menopausal symptoms are usually diagnosed clinically, without the need for hormone blood tests. In other words, a healthcare professional should be listening carefully to your symptoms, considering your menstrual history and looking at the overall picture, rather than relying on hormone blood tests alone.
That doesn’t mean blood tests are never useful. They can play an important role in certain situations, particularly for younger women, where there is uncertainty about the diagnosis, where premature ovarian insufficiency (POI) is suspected, or where other medical conditions need to be ruled out. Like any medical investigation, they have their place. They just aren’t the reliable diagnostic tool for perimenopause that many people believe them to be.
Perhaps this also explains why some women are told that everything is “normal” when they know, deep down, that something has changed. A normal hormone blood test during perimenopause does not automatically mean that your symptoms aren’t hormonal. Nor should it bring the conversation to an end.
Sadly, many women describe leaving appointments feeling dismissed or doubting their own judgement. Some are prescribed antidepressants without anyone exploring whether hormonal changes might also be contributing to their symptoms. Others are told to come back once their periods become irregular, despite the fact that cognitive, emotional and physical symptoms may already be having a profound impact on their quality of life.
It’s hardly surprising that increasing numbers of women feel they have little choice but to seek help from private menopause clinics, often paying hundreds of pounds for assessments and prescriptions that they had hoped would be available through the NHS.
As a coach, I hear this story with heartbreaking regularity. Women often tell me that paying privately was never their first choice; it was simply the point they reached after months, and sometimes years, of feeling unheard. They weren’t looking for special treatment and they weren’t demanding HRT. More than anything, they simply wanted someone to listen, to take their symptoms seriously and to consider whether hormones might be part of the picture.
That isn’t a criticism of individual clinicians, many of whom are doing their very best within an incredibly stretched healthcare system. But it does highlight the need for greater awareness, better education and more consistent menopause care, so that women don’t feel they have to fight to have their symptoms taken seriously.
You know your own body better than anyone else. If something has changed, you deserve to have that change explored with curiosity rather than dismissed because of your age or a single blood test result. Good healthcare begins with listening.
How to advocate for yourself
If you’ve recognised yourself throughout this article, you may be wondering what to do next. My first piece of advice is simply this: trust yourself enough to ask the question. You know what feels normal for you, and if something has changed in a way that doesn’t feel quite right, it’s worth exploring rather than dismissing.
Before your appointment, it can be helpful to spend a little time thinking about what’s actually changed. When we’re living with brain fog, ADHD, poor sleep or simply the demands of everyday life, it’s surprisingly easy to forget important details once we’re sitting in the consultation room. Writing a few notes beforehand can make all the difference, not only because it helps you remember what you wanted to say, but because it can also help your healthcare professional build a clearer picture of what’s been happening.
You might find it helpful to think about questions such as:
- When did you first notice something had changed?
- Have your symptoms developed gradually or did they seem to appear quite suddenly?
- Which symptoms are having the biggest impact on your day-to-day life?
- Have they affected your work, relationships or ability to manage everyday tasks?
- Have you noticed any changes to your menstrual cycle, even if your periods remain fairly regular?
- Is there a family history of early menopause?
- If you have ADHD, have you noticed changes in your attention, emotional regulation, executive functioning or the effectiveness of your usual coping strategies or medication?
Keeping a simple symptom diary for a few weeks can also be incredibly helpful. You may begin to notice patterns that weren’t obvious before, such as symptoms worsening at particular points in your menstrual cycle or gradually becoming more frequent over time. These observations can provide valuable information during your consultation.
You don’t need to become an expert in menopause, but it can be reassuring to familiarise yourself with the NICE guidance before your appointment. It provides an evidence-based framework for the diagnosis and management of menopause and can help you feel more confident when discussing your symptoms.
When you do speak to your GP or another healthcare professional, remember that it’s perfectly reasonable to ask questions. If you’re told you’re “too young”, you might ask how perimenopause has been ruled out. If you’re told that your blood tests are normal, it’s entirely appropriate to ask how those results fit alongside your symptoms and whether your care is being guided by the current NICE recommendations.
The aim isn’t to challenge or confront your clinician. Most healthcare professionals genuinely want the best for their patients. Instead, think of it as working together to understand what’s happening. Bringing information, asking thoughtful questions and describing your symptoms clearly can help make those conversations more productive.
It’s also important to remember that perimenopause isn’t the only possible explanation for fatigue, anxiety, low mood or cognitive changes. There are many conditions that can cause similar symptoms, and a thorough assessment should always consider the bigger picture. Sometimes you’ll leave feeling reassured that something else has been identified, and that’s a positive outcome too.
However, if you leave your appointment feeling that your concerns haven’t really been explored, it’s okay to ask for a second opinion. Seeking another perspective isn’t about undermining the first clinician you saw. It’s about recognising that medicine is complex, knowledge evolves and different healthcare professionals bring different levels of experience and confidence to different areas of practice.
As someone who coaches women through this stage of life, I know just how difficult self-advocacy can feel. Many late-discovered neurodivergent women have spent years questioning their own judgement, minimising their struggles or assuming that everyone else knows better than they do. Learning to trust your own observations again can take time.
Please don’t ignore a persistent feeling that something has changed simply because you’ve been told you’re “too young”. Stay curious. Keep asking questions. Remain open to different possibilities, but don’t let a single conversation convince you that your lived experience doesn’t matter.
You deserve to have your concerns explored with curiosity, compassion and an understanding that every woman experiences perimenopause differently. Sometimes, the most important step you can take isn’t demanding a particular treatment. It’s making sure the conversation doesn’t end before the right questions have even been asked. You are not “too young” to be heard
Average doesn’t mean everyone. The average age of menopause in the UK may be around 51, but that doesn’t mean every woman’s journey begins at the same age or follows the same path. Some women experience physical symptoms first, whilst others notice changes in their thinking, emotions or ability to cope long before they experience a single hot flush. For women with ADHD, those hormonal changes can be even more significant, sometimes exposing challenges that have been quietly masked for decades.
None of this means that every woman in her forties who is struggling is perimenopausal, just as it doesn’t mean that every worsening of ADHD is caused by hormones. Our health is rarely that straightforward. But it does mean that perimenopause deserves to be part of the conversation, rather than being dismissed because of a date of birth.
Over the years, I’ve spoken to so many women who have left appointments feeling as though they no longer trusted themselves. They began questioning what they were experiencing because someone else had told them they were “too young”, “too stressed” or that their blood tests were normal. Yet, months or years later, many discovered that their instincts had been right all along.
I think that’s perhaps the saddest consequence of all. Not simply that women sometimes wait longer than necessary for treatment or support, but that they begin to lose confidence in their own lived experience. After spending years masking ADHD, questioning themselves or wondering why life felt harder than it seemed for everyone else, many women arrive at midlife already doubting their own judgement. They don’t need another reason to stop trusting themselves.
The good news is that awareness is growing. We understand far more about perimenopause than we did even a decade ago, and research into the relationship between female hormones and ADHD continues to develop. Conversations that simply weren’t happening a few years ago are now taking place in consulting rooms, workplaces and around kitchen tables across the country. There is still work to do, but things are moving in the right direction.
So, if this article has resonated with you, let it be the beginning of a conversation rather than the end of one. Talk to your GP. Keep a record of your symptoms. Ask questions. Seek a second opinion if you feel you need one. Most importantly, don’t dismiss what you’re experiencing simply because someone tells you you’re “too young”.
You know yourself better than anyone else, and whilst no one should ever diagnose themselves or assume that hormones are the answer to every symptom, you absolutely deserve to have your concerns explored with curiosity, compassion and an open mind.
Because being listened to isn’t a luxury. It should be the starting point of every woman’s menopause journey.
Please note: This article is intended for information and education only. It should not be used as a substitute for personalised medical advice. If you’re concerned about your symptoms, please speak to your GP or another appropriately qualified healthcare professional.
Further reading and resources
If you’d like to explore this topic in more depth, the following resources provide excellent, evidence-informed information:
- NICE Guideline NG23 – Menopause: Diagnosis and Management
- The British Menopause Society
- The Menopause Charity
- Women’s Health Concern
- ADHD UK – Resources and information about ADHD across the lifespan
- Meno-Wars: Battling the Menopause with ADHD (and its Comorbidities) – Sharon Worth & Chantelle Knight
- Menopause and ADHD: How to Navigate Hormone Flux and Neurodivergence – Dr Helen Wall
- The Menopause Brain – Dr Lisa Mosconi