Why So Many Women Are Diagnosed with ADHD or Autism in Perimenopause

If you're a woman in your 40s or 50s who has recently started wondering whether you might be autistic or have ADHD, you're part of a genuine pattern, not a coincidence. A striking number of late diagnoses happen right around perimenopause. Here's why.

Hormones and masking

Oestrogen plays a real role in cognitive function, particularly in attention, working memory, and emotional regulation. Many women unknowingly rely on stable oestrogen levels to hold together the coping strategies and masking they've used their whole lives.

When oestrogen starts fluctuating in perimenopause, those coping strategies can suddenly stop working as well as they used to. Executive function difficulties, emotional dysregulation, and sensory sensitivities that were always present but successfully hidden can become impossible to manage the same way.

"Why now?" is the wrong question

A lot of women arrive at assessment asking, confused, "why is this happening now, out of nowhere?" But it isn't new. What's changed is the hormonal buffer that made masking sustainable. The traits were there all along, often since childhood. Perimenopause doesn't create them; it removes the cover.

Compounded by a lifetime of being overlooked

This intersects with something bigger: the diagnostic criteria for ADHD and autism were developed based on how young boys present, particularly boys who visibly struggle to function in school or social settings. Girls and women who masked well, who caused no trouble, were far less likely to be referred, noticed, or assessed as children. So by the time perimenopause strips away the coping mechanisms, many women are meeting a threshold of visible distress for the first time in their lives, decades after the traits themselves first appeared.

What this means for assessment

A useful assessment at this life stage needs to hold two things at once: your current presentation, and your full developmental history, including how you coped and masked for decades before things became harder. It also needs to weigh perimenopause itself as a relevant factor, rather than treating it as the whole explanation.

If this sounds familiar, you're not imagining it, and you're not alone.

Masking and Burnout covers what the coping was costing before it stopped working. If you are considering assessment, my assessment page sets out what is involved.

If this resonates, you're welcome to get in touch, or read more about how I work.