ADHD in Women Over 40: The Overlooked Diagnosis

For many women, turning 40 brings clarity. Careers are established, personal values are defined, and priorities shift from proving oneself to understanding oneself. For some, this is also a time when children are becoming more independent or leaving home, creating newfound space for self-reflection—and sometimes, emotional upheaval. Yet for a growing number, this stage of life also reveals something unexpected: long-standing struggles with focus, emotional regulation, and mental fatigue that can no longer be explained away as stress or personality.

These women are discovering that what they have lived with for decades is not a lack of discipline or resilience, but ADHD — a neurodevelopmental condition rooted in differences in brain structure, dopamine regulation, and executive functioning.

A Misunderstood Profile

ADHD in women does not typically align with the hyperactive childhood stereotypes. Instead, it often presents through internalised symptoms that are easily masked or misattributed to anxiety, mood disorders, or simply “being overwhelmed.”

Common neurological features include:

• Difficulty managing everyday tasks despite being highly competent professionally — a mismatch caused by variable dopamine release affecting motivation and task initiation.

• A constant feeling of mental “noise” — reflecting a brain with reduced activity in the default mode and executive control networks.

• Strong emotional responses or sensitivity to criticism — linked to impaired regulation in the limbic system.

• Reliance on last-minute pressure — because the ADHD brain often uses urgency as a chemical trigger to stimulate dopamine production.

• Coping strategies that begin to fail during hormonal shifts — as estrogen, a key modulator of dopamine, declines in perimenopause and menopause.

  
  

These are not character flaws. They are measurable neurological traits supported by neuroimaging and cognitive research.

Why Diagnosis Often Comes After 40

The Role of Hormones and Dopamine

Estrogen enhances dopamine activity in the prefrontal cortex — the area of the brain responsible for planning, organisation, working memory, and impulse control. As estrogen declines in perimenopause, dopamine levels drop, amplifying ADHD symptoms that were previously manageable or hidden.

Increased Cognitive Load

Around midlife, many women experience a peak in responsibilities: career advancement, teenage or adult children leaving home, caregiving for aging parents, and societal expectations of emotional labour. This exposes underlying deficits in executive function—revealing patterns that have been present for decades but masked by structure, adrenaline, or external support.

Research now shows that up to 75% of women with ADHD are not diagnosed until adulthood, and often not until their 40s or 50s.

The Scientific Case for Assessment

Pursuing an assessment is not about attaching a label — it is about understanding your brain’s unique wiring.

A diagnosis can provide:

• Neurological clarity: Understanding how dopamine dysregulation and executive function differences affect day-to-day life.

• Access to targeted treatment: Including medication that restores dopamine balance and psychological therapies that are evidence-based for ADHD.

• Hormone-aware interventions: Treatment plans that incorporate the role of estrogen, progesterone, and cortisol in symptom management.

• Improved cognitive resilience: Strategies to optimise brain function, reduce overwhelm, and improve long-term mental health outcomes.

  
  

Montrose Health Group: Specialists in Adult ADHD for Women

Montrose Health Group provides assessments tailored to the unique presentation of ADHD in women. Their clinicians understand:

• The interaction between neurotransmitters and hormones

• The overlap between ADHD, anxiety, and emotional dysregulation

• The impact of life-stage transitions such as menopause and children leaving home

Their approach goes beyond checklists. It uses evidence-based clinical tools, neuropsychological analysis, and a compassionate understanding of the female experience.

A Practical Next Step

If you have ever wondered why increased effort does not lead to increased clarity, or why your mind feels both overactive and exhausted at the same time, it is not a personal failure — it may be neurological.

A diagnosis does not change who you are. It finally explains who you have always been — with compassion, science, and a path forward.

To explore an assessment, contact us at 01144 990 500 or email clinic@montrosehealthgroup.com.