ADHD in Adult Women: Finally Getting the Diagnosis You Deserve

If you are a woman who’s always felt a little “off” compared to everyone else, you are not alone.

Let’s be real - ADHD doesn’t care about gender. But somehow, the diagnosis often does. While males are more likely to get diagnosed and treated early on as boys, many girls grow up flying under the radar. And that can mean years- sometimes decades- of struggling without support.

Let’s break down why ADHD in women is often overlooked, what a late diagnosis can feel like, and what to do if you think it applies to you.

Why Women Often Get Missed

ADHD usually shows up in childhood. Boys tend to get diagnosed early because of their hyperactivity behaviors - like bouncing off of walls or interrupting class- are hard to ignore. Girls on the other hand, often show more inattentive symptoms; daydreaming, forgetting things, trouble focusing. Teachers and parents might just chalk it up to being “spacey” or “flighty.”

Add social expectations into the mix- like being organized, nurturing, and calm-and many women spend years masking their ADHD without even realizing it.

Signs ADHD Might Look Different in Women

Some common symptoms in girls and women include:

• Constantly losing things or forgetting appointments

• Struggling to stay organized

• Feeling distracted or “all over the place”

• Fidgeting or restless energy

• Anxiety, depression, or low self-esteem

As girls grow into wpomen, these symptoms can make everyday life harder-challenging course work, handling finances, juggling work and home, or keeping relationships on track. Over time, frustration can build, and many women end up blaming themselves for things outside of their control.

The Emotional Rollercoaster of a Late Diagnosis

Many women only see a diagnosis as adults-sometimes after their own child is diagnosed, or when they start recognizing the same struggles in themselves. Social media and online communities have also made it easier to realize, “Hey, this sounds like me!”

Getting the diagnosis can be life changing

• Suddenly years of confusion starts to make sense.

• Self-esteem can improve because it’s not your “fault” that you’ve struggled.

• You can start learning strategies to manage symptoms effectively.

But it can also be emotional: grief for lost time, frustration at past stigma, or anger at not having been understood. It is completely normal to have these mixed feelings.

Why ADHD Looks Different in Women

Here’s the thing: ADHD was historically studied in boys, so diagnostic criteria often focus on hyperactivity and externalizing behaviors. Women may have more internalizing symptoms, like anxiety, or chronic mental overload. Combine that with social pressure to be perfect, and many women hide their ADHD without even realizing it.

Hormones can also play a role-fluctuations during the menstrual cycle can affect adhd symptom and medication effectiveness. Doctors and researchers are just starting to understand how big of a factor this is.

Perimenopause and ADHD: When Hormones Make Things More Difficult

For many women, perimenopause can significantly worsen ADHD symptoms-or even reveal ADHD that went undiagnosed earlier. Why? It’s all about estrogen.

Hormonal Influence on the Brain

Estrogen helps regualte neurotransmitters like dopamine and serotonin, which are crucial for focus, mood, and executive functioning. When estrogen levels drop or fluctuate during perimenopause these neurotransmitters can be affected- makingADHD symptoms more noticeable or intense.

Symptom Overlap

Perimenopause and ADHD share many symptoms, which can make it tricky to tell what is causing what. Common overlappiing or worsened symptoms include:

• Brain fog and memory issues

• Difficulty concentrating and mental fatigue

• Emotional dysregulation, mood swings, and irritablity

• Increased anxiety and overwhelm

• Disorganization and time management challenges

• Sleep disruptions - which can most definitely make ADHD symptoms worse

In surveys, over 90% of women with ADHD report that their symptoms became more severe during perimenopause or menopause, with many going so far as to describing this as the most challenging phase of their lives.

Managing ADHD During Perimenopause

Managing ADHD at this stage often requires a multifaceted approach with healthcare providers needing to be familiar with both ADHD and hormonal changes:

• Diagnosis/Reassessment: If symptoms are new or worsening, it is important to get evaluated. Clinicians will distinguish between lifelong ADHD and symptoms primarily triggered by hormonal shifts.

• Medication Adjustments: ADHD medications many need to be adjusted during perimenopause for optimal effeect.

• Hormone Replacement Therapy (HRT): Stabilizing wstrogen levels can improve focus, memory, and emotional regulation, reducing overlapping perimenopausal and ADHD symptoms.

• Therapy and Lifestyle: Cognitive Behavioral Therapy (CBT) can help develop strategies for managing symptoms and stress. Lifestyle changes-like exercise, healthy eating, sleep hygiene, and mindfulness- can support both ADHD and perimenopause symptom management.

How Diagnosis Can Help

ADHD in women is real- and it often flies under the radar. Hormonal changes like perimenopause can make symptoms more pronounced or reveal previously undiagnosed ADHD. A diagnosis can finally give you clarity, tools, and strategies to live your best life. If you are diagnosed as an adult, it can feel like a light being turned on: “Oh! That’s why things have always been so hard.” But diagnosis is just the beginning.

Here are some things that can help:

• Behavioral strategies: Time management, organization, and daily routines

• Coaching: Career or life coaches can help you set goals and create structure

• Therapy: To manage anxiety depression, or sense of being overwhemed

• Medication: Can improve focus and help control symptoms- but it’s monitored carefully by your doctor

Remember, it is never too late to seek help, learn about ADHD, and get support. You’ve been managing for years without understanding why - now you don’t need to do it alone.

Sources and Resources:

• Pharmacy Times: The Lost Girls: ‘Chaotic and Curious, Women with ADHD All Have Missed Red Flags That Haunt Us’

• Nature: Adverse Experiences of Women With Undiagnosed ADHD and Late Diagnosis

• APA PsycNet: Exploring Women’s Experiences of Diagnosis of ADHD in Adulthood

• ADDitude: Offers videos, articles and resources for ADHD in women

• UCLA Health: Guides on recognizing and treating ADHD in Women

• Sage Journals: Miss. Diagnosis: A Systemic review of ADHD in Adult Women

A note from the author: Hi, I’m Dr. Joanna Gratton and this topic hits very close to home for me. I’m a board-certified psychiatrist based in the Asheville / Hendersonville area of Western North Carolina. I help adults (ages 18-64) navigate a wide range of emotional and mental health challenges. I have a special interest in supporting women throughout all stages of their reproductive lives. I work with women throughout pregnancy, post natal, peri and post menopause and beyond. Together we will work to help you develop a deeper sense of self, increased confidence, improvement of family relationships and communication, a healthier sex drive and a greater ability to navigate through life’s difficult chapters.

I see people locally in my office in Hendersonville, or via telehealth. I am licensed in North Carolina, Virginia, and Maine

Learn more about Stillpoint Psychiatry and Dr. Joanna Gratton