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023 | The Unmasking: When Perimenopause Strips Away What Was Holding You Together · Spacious Success

• 0:05
  Hi, it's Dr. Christy Goodwin. Welcome back to the Spacious Success Podcast. If you have spent any part of your 30s, 40s, 50s wondering whether you're losing your mind, losing your marbles, this episode is for you. If you've sat in a meeting that would have once been effortless
• 0:23
  and found yourself struggling to track the conversation, or if you've walked into a room at home and completely forgotten why you're there, or if your GP has told you that everything is fine while you sit there knowing that fine is doing a lot of the heavy lifting, this episode is for you.
• 0:42
  Today I want to talk about the ADHD perimenopause collision, what's actually happening in your brain, why so many brilliant women are being missed, misdiagnosed, or simply not believed, and what you need to know to advocate for yourself.
• 0:58
  Let's dive in. Hi, I'm Dr. Christy Goodwin, a neuroperformance scientist, speaker and executive coach who learned the hard way that chasing success can come at a cost. After burnout landed me in hospital, I made it my mission to help ambitious women who are done trading their health and happiness for high performance. On Spacious Success, I share science-backed strategies that help them to help them.
• 1:26
  and real stories to help you flourish as a female at work and beyond so you can stop paying the success tax. I want to start with a story that's not mine.
• 1:46
  but I have permission to share it. One of my performance coaching clients, let's call her Mel, she came to me about two years ago. She was the director at a large financial services firm. She was in her mid-40s, the kind of woman who'd built her career by being exceptionally capable and also very composed. She had two teenagers at the time, a demanding travel schedule and a reputation for never, ever dropping a ball.
• 2:14
  And then over the course of about 18 months prior to when we worked together, things started to shift.
• 2:21
  Not dramatically at first, not in ways that she could easily name or identify, but she started losing her thread in a conversation that she was having dozens of times before. She started waking up at 2am with her mind racing, not about anything specific, just a kind of electrical low-grade hum that she just couldn't switch off. She started snapping at her team in ways that were completely out of character.
• 2:46
  She started to wonder very privately at first whether she was becoming someone that she just didn't recognize. She went to see her GP three times. She was told that her blood work were all within normal ranges. She was told it could be stress. She was given a referral to a psychologist. Okay.
• 3:03
  What she was not told and what I think changed everything was when she finally learned that it was estrogen. It's not just a reproductive hormone. It is one of the most powerful neuromodulators in our human brain. And when it starts to fluctuate for women who are already running a neurological system that was always just barely compensating, the consequences can be profound.
• 3:30
  Mel, as it turned out, had inattentive type ADHD, but she'd managed it for 42 years with structure, intelligence, and the sheer force of will. She'd built elaborate compensation systems, meticulous calendars, rigid routines, the kind of preparedness that colleagues admired and she privately knew were non-negotiable.
• 3:52
  Remove one pillar of that system she had once told me and the whole thing wobbles. It collapses. And you see perimenopause removed multiple pillars simultaneously. This is not unusual. Mel is based on the research and I'm about to share with you exactly what you should expect and what we are completely failing to prepare many women for.
• 4:16
  Let me walk you through what the research actually shows because this is an area where science is genuinely moving quite fast. In 2025, a population-based cohort study published in the European Psychiatry Journal examined perimenopausal symptoms in women with and without ADHD, and their findings were significant.
• 4:39
  Women with ADHD had substantially higher perimenopausal symptom scores, 18 on the menopause rating scale compared to 13 for women without ADHD. 54% of women with ADHD reported severe perimenopausal symptoms compared to 30% of women without ADHD. That is close to double the rate.
• 5:03
  But here is where the finding that most surprised me and that I think matters the most for women listening to this podcast. The largest symptom gap was not in women in their late 40s. It was women aged 35 to 39, which the author suggested was that perimenopausal symptoms may begin much earlier in women with ADHD than in the general population. Now, I want to be careful here because the science is not yet definitive. Okay.
• 5:33
  This particular study found an association, a plausible age pattern. It did not directly measure biological menopause onset. So the most accurate thing to say is, well, current evidence suggests that women with ADHD may experience perimenopausal symptoms earlier and more severely. Wow.
• 5:55
  We cannot yet say definitively that menopause itself begins earlier, although some genomic research is beginning to look and hint in that direction. A separate analysis from the King's College London found that menopausal difficulties increased in line with ADHD symptom severity, not just diagnosis.
• 6:16
  This means that even women who have never been formally diagnosed but who carry a significant ADHD symptom burden may be experiencing a more challenging, difficult hormonal transition than their peers. Okay.
• 6:31
  So why is this happening? What's the actual biological mechanism? Estrogen is a neuromodulator, and it directly influences dopamine synthesis, receptor sensitivity, and dopamine transport, particularly in the prefrontal cortex, the hippocampus, and brain regions responsible for attention, working memory, emotional regulation, and our executive function. And these are precisely the circuits that ADHD affects. Okay.
• 7:01
  During perimenopause, estrogen does not simply decline. It fluctuates unpredictably, high one week, low the next, cycling in ways that are not predictable from the outside. That volatility destables dopamine signaling. And for a brain that was already relying on compensatory systems to manage their dopamine dysregulation, that instability is not a minor inconvenience or a hiccup. It's a structural disruption. Okay.
• 7:29
  We have research from the menstrual cycle that shows this in real time. Lower estradiol levels predict worsening ADHD symptoms the very next day, including inattention and emotional dysregulation. If that is the pattern across a monthly cycle...
• 7:46
  Imagine the cumulative effect across years of perimenopausal hormone volatility. In a large study with 2,600 women with ADHD, 61% reported that their ADHD had the greatest impact on their lives between the ages of 40 and 59. 43% received their first ADHD diagnosis between the ages of 41 and 50.
• 8:11
  Think about that for a moment. Nearly half of the women with ADHD are not diagnosed until midlife. Not because they did not have ADHD symptoms earlier, but because they were managing it, masking it, because they built structures, routines and compensatory systems that worked well enough until their hormonal transition removed all the scaffolding.
• 8:35
  Perimenopause can do these things to ADHD. It can unmask it in women who have been compensating for decades.
• 8:44
  It can worsen it, amplifying symptoms that were just previously manageable. And it can mimic it, creating cognitive and emotional symptoms in women without ADHD that look nearly identical to an ADHD presentation. Brain fog, poor memory, difficulty tracking conversations, emotional reactivity. And this is why the diagnostic picture is complicated.
• 9:09
  A woman presenting to her GP at 42 with concentration difficulties and emotional volatility could be experiencing perimenopausal cognitive symptoms. It could be unmasked ADHD, worsening ADHD, or a combination of all three. And if her GP has not connected the dots, and many have not, let's be honest, because the intersection is not well covered in training, she is most likely to be told that she's just stressed. She's anxious. She's simply getting older.
• 9:39
  I also want to name something that really matters in this conversation, and that is the masking story. High-achieving women with ADHD are extraordinarily good at masking. They have overprepared. They have used their intelligence and their capability to compensate for the arenas where their brain is, well, less reliable. Correct.
• 10:00
  Colleagues admire them for their organization, but nobody sees the effort behind it. When that masking collapses, the people around them do not understand why, and neither do they, because what felt like capability was always partly compensation.
• 10:19
  And when your compensation stops working, the identity built around it also starts to crack. So I want to be really clear before I offer you some strategies. If you are recognizing yourself in this episode, the most important thing you can do is to speak to a trusted medical professional who understands both ADHD diagnosis and perimenopause.
• 10:45
  These are areas still that require specialist knowledge. This episode is certainly not a medical substitute because the field is still evolving. That said, there are things I think that you can do right now that are evidence informed and will hopefully help you. The first is to get a fuller picture before your next medical appointment.
• 11:05
  The symptoms of perimenopause and ADHD overlap significantly. Brain fog, poor working memory, emotional dysregulation, sleep disruption, fatigue, overwhelm. When you arrive at your GP's appointment with these symptoms described individually, you're likely to be treated for each one in isolation. But when you arrive with a coherent picture, I like to think these symptoms might be interconnected. Here is what I have read. Here is what I'm experiencing. Here is what I'm experiencing.
• 11:34
  you're far more likely to receive a useful referral. This is where I'm a huge fan of Ovum, an app. It is a health journal for women to track their symptoms. It's a smart conversational AI tool that understands women's health. And as you chat, Ovum integrates your symptoms, your wearable data if you use it, test results, lifestyle logs, and hormonal history to build a clear picture of your health. Because when you know what your body's saying...
• 12:04
  You can act on it with confidence and be heard. The second is to track the pattern, not just the symptoms. ADHD symptoms that correlate with hormonal fluctuations that are reliably worse in the days before your period or that have progressively worsened over the last year or two. Well, they are a specific data point. So is any family history of early menopause.
• 12:28
  Now, your wearable data, if you use it, can also be useful here. HRV patterns, sleep quality, resting heart rate can all shift measurably during perimenopausal transitions. And they provide really useful information for a medical specialist.
• 12:44
  The third is to reduce the cognitive load on your compensation systems. If you are someone who has built elaborate systems to manage your executive function, this is not the time to strip those back, dial them up. This is the time to protect them, simplify them, and to ask for more support around you
• 13:05
  Delegate more aggressively. Reduce decision volume where you can. Use external structures, written lists, calendar blocks, process documentation. Use AI more deliberately. This isn't giving in. This is an intelligent biological decision. A surgeon who knows the next 12 months will be cognitively challenging does not stop operating.
• 13:28
  They reduce the unnecessary cognitive loads elsewhere so that they can bring their full capacity to what matters most.
• 13:37
  The fourth is to take the masking story seriously. If you have spent your career building compensatory structures around an ADHD presentation that was never identified, midlife may be the moment when those structures need to be made visible to you, to your team, to the people who support you, your partner. Not as a confession, as a redesign tool.
• 14:01
  The best leaders I work with are not the ones who need no accommodation. They are the ones instead who understand their own architecture well enough to build it in the moment and to know what they need. If your brain has felt unfamiliar in recent years...
• 14:21
  I want you to hold this reframe. It's not a failing. It's not necessarily aging. It may not be burnout, although burnout can be present. It is predictable. And I want to stress that word predictable. Collision between your hormones and your neurobiology and the fact that it has been predictable for years.
• 14:43
  and that women are still arriving at their GPs in confusion and distress, is a system failure, not a personal failure. You deserve a health practitioner who can hold the full picture. You deserve a diagnosis that is accurate, not a reassurance or just a script that everything is fine. You deserve an understanding of your own biology, and that puts you back in the driver's seat.
• 15:08
  This week's power-up is that if any part of this episode resonated, write down three things you've noticed changing in the past one to three years. Cognitive changes, emotional changes, changes in how you manage your work. Bring those notes to your GP or specialist appointment. Specificity is your greatest asset in these conversations.
• 15:30
  In a future episode, we are going to look at what is happening to women's attention and memory across all age groups. Because the data here is frankly alarming. And the youngest women are the ones showing the steepest decline because of how we are living and working. And so I look forward to sharing that episode with you. Until then, if your brain and your biology feel different, trust that signal.
• 16:00
  It's trying to tell you something. I'm Dr. Christy Goodwin. Thank you for tuning in to Spacious Success.