Episode 38: Brain Fog, ADHD, or Both? How Perimenopause Changes Your Brain

Is that brain fog… or something more? Dr. Jillian and Dr. Ade break down how to actually tell the difference between perimenopausal brain fog, adult ADHD, and the surprisingly common overlap between the two — plus why so many women are only being diagnosed with ADHD for the first time in their 40s and 50s. They walk through the clues that separate the two, the estrogen-dopamine connection driving it all, how it shows up in relationships and parenting, and exactly what to say at your next appointment.SHOW NOTESIf the brain you’ve relied on for decades suddenly feels unreliable, you’re not lazy, careless, or incapable — and you may be one of three things: experiencing genuine perimenopausal brain fog, uncovering ADHD that’s been masked for decades, or dealing with both at once. In this episode, Dr. Jillian and Dr. Ade walk through the exact framework they use in clinic to help you tell the difference.In this episode:What ADHD actually is: current presentations (predominantly inattentive, predominantly hyperactive-impulsive, combined), and why “ADD” is now called ADHD, predominantly inattentive presentationThe three-bucket framework: perimenopausal cognitive change, undiagnosed ADHD surfacing, or both togetherFour clues that help separate them — timing and history, how broad the symptoms are, where they show up, and how much effort it’s taken to compensateThe estrogen-dopamine connection: why hormonal transition changes the environment attention and executive function operate inWhy so many women are only recognizing ADHD in midlife, and the historical gap in how girls were diagnosedHow this shows up at the kitchen table — in marriages, parenting, and intimacyWhat actually helps, and exactly what to say at your next appointmentBy the numbers:Nearly 60% of perimenopausal women report real memory complaints, per the Study of Women’s Health Across the Nation (SWAN)A 2025 population-based study of over 5,300 women (the Icelandic SAGA cohort) found 54.2% of women with a self-reported ADHD diagnosis experienced debilitating perimenopausal symptoms, compared to about a third of women without ADHDResources & sources referenced:Study of Women’s Health Across the Nation (SWAN) — longitudinal research on cognition and symptoms across the menopause transitionWeber, M. T., Maki, P. M., & McDermott, M. P. (2014). Cognition and mood in perimenopause: A systematic review and meta-analysis. The Journal of Steroid Biochemistry and Molecular Biology.Jakobsdóttir Smári, U., et al. (2025). Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. European Psychiatry.Kooij, J. J. S., et al. (2025). Research advances and future directions in female ADHD: The lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Frontiers in Global Women’s Health.Osianlis, E., et al. (2025). ADHD and sex hormones in females: A systematic review. Journal of Attention Disorders.DSM-5-TR. American Psychiatric Association. (2022). ADHD diagnostic criteria and presentation terminology.Have a question or want to learn more? Reach out at [email protected]. JILLIAN“If the brain you have relied on for forty years suddenly feels unreliable, you are not becoming lazy, careless, or incapable.”“The coping did not fail. The floor moved. Now the support system has to move with it.”DR. ADE“Success does not rule out ADHD. The more useful question is: what did that success cost?”“You do not need to be falling apart dramatically before asking for help. Quietly working twice as hard to maintain the same life is enough.”