How ADHD masking might be impacting your perimenopause care

I suspected from a young age that most adults thought I was a little too much. Too mouthy, too emotional and too eager to ask questions. Attending Catholic school in the 80’s and 90’s did an excellent job reinforcing these assumptions. I learned quickly that I needed to ignore my instinct to question rules and authority figures. My ability to mask might have protected me in my early years, but the costs continue to impact me today, four decades later.

Showing up as the compliant “good girl” didn’t stop at school, it infiltrated how I behaved at work, in relationships and perhaps most damaging, how I behave within the medical system.

Like many of us raised by in the 80’s and 90’s I was trained to see physicians as the ultimate authority figures. From a young age I experienced debilitating headaches and bouts of dizziness. In my teens I began having “episodes” which I described at the time as passing out. After my parents finally witnessed one of these events and the convulsions that accompanied them, they took me to the family doctor who ran an EKG in office. When no abnormalities were noticed he dismissed it as likely due to not getting enough calories, as I had recently started weight watchers with my mom. I continued to experience these episodes for a couple more years. Sometimes they were major and I would wake up on the floor disoriented and confused. Other times I would experience what I now know were seizure auras. I continued to bring these events up to my family physician, but when blood work showed no abnormalities, it began to be implied that this was a case of a teenage girl being a bit dramatic about symptoms. When I questioned the medical care I was receiving, my parents reinforced the message that physicians are the experts.

It took several grand-mal seizures in one evening that were witnessed by my parents, my boyfriend and emergency room nurses to finally be referred to a neurologist who diagnosed me with a seizure disorder.

Over the next several years as I navigated the medical system as a young adult, I made attempts at doing my own research but was often met with resistance and reminders “not to consult with doctor google”. Long explanations and too many questions were met with annoyance. It didn’t take long for my masking behaviors to infiltrate my medical appointments. I found myself placing more importance on being perceived as a “good patient” than having my concerns addressed.

I didn’t realize it at the time, but this wasn’t just a personal pattern, it was one widely adopted by the silent and baby boomer generations and those of us that were raised my them. Many of us were shaped by a medical system that operated under a paternalistic model, where doctors were positioned as the authority and patients were expected to comply, not question. Studies published in Frontiers in Public Health and broader health communication research show that older generations tend to report higher trust in physicians and are less likely to challenge medical advice, reflecting the norms they were socialized into.(1) When you layer that conditioning on top of undiagnosed neurodivergence it often fuses with masking and interferes with our ability to advocate for our medical needs.

Recent research has shown that perimenopause symptoms may begin impacting ADHD individuals earlier and more intensely than our neurotypical peers. With or without a diagnosis, many neurodivergent women are finding themselves in doctors’ offices reporting symptoms that are having a huge negative impact on their daily lives. Brain fog so extreme we struggle to function at work. Joint pain that is interfering with the movement that has historically been a reliable coping mechanism for our unsettled brains. Sleep disturbances that grow exponentially

Many of us are hesitant to express our concerns due to the fear we will be judged or ignored. If our symptoms are brushed off it may be harder for us to advocate for a deeper look. The masking habits we adopted earlier in life may now be making it even more difficult to navigate a system that has been ignoring women’s healthcare needs for decades. Ultimately, masking can delay or prevent proper treatment and reinforce the damaging beliefs that our struggles “aren’t that serious”.

While masking may present yet another barrier to perimenopause treatment for ADHDers, when we are aware of our tendencies, we can proactively take steps to better advocate for ourselves in medical setting. Awareness alone won’t undo decades of conditioning overnight, but it can help us stop interpreting our difficulty with medical self-advocacy as a personal failure. Many of us aren’t struggling because we’re incapable of speaking up. We’re struggling because we spent years being rewarded for staying agreeable, minimizing discomfort and making ourselves easy to manage. The problem is that those same survival skills can become liabilities when we’re trying to navigate complex health issues that require persistence, nuance and follow-up.

I’ve had to learn that self-advocacy is not something that magically appears once you become confident or informed enough. For many ADHDers, it requires external supports. I now write down symptoms ahead of appointments and bring these notes to help combat my tendency to downplay my experiences in real time. I practice direct language in advance because years of overexplaining, softening and apologizing for taking up space make it difficult to express what I am experiencing.

I’ve also had to stop equating compliance with being a “good patient.” Asking follow-up questions does not make me difficult. Requesting clarification is not disrespectful. Wanting a deeper investigation before accepting “everything looks normal” is not attention-seeking.

For neurodivergent people navigating perimenopause, this matters deeply. Many of us are entering a phase of life in which the systems and coping mechanisms that once kept us afloat are no longer sustainable. Hormonal shifts can intensify executive dysfunction, emotional dysregulation, sensory issues and burnout, and in a medical system that has historically minimized both women’s pain and neurodivergent experiences, the ability to self-advocate becomes critical.

There’s something deeply healing about being in a space where you don’t have to constantly explain, minimize or mask your experience. If this post resonated with you, you can join the interest list for The Neuropause Collective — a community for neurodivergent people navigating perimenopause, launching summer 2026.

References

(1)Cecconi, C., Adams, R., Cardone, A., et al. (2025). Generational differences in healthcare: the role of technology in the path forward. Frontiers in Public Health, 13, 1546317. https://doi.org/10.3389/fpubh.2025.1546317

(2)Jakobsdóttir Smári U, Valdimarsdottir UA, Wynchank D, de Jong M, Aspelund T, Hauksdottir A, Thordardottir EB, Tomasson G, Jakobsdottir J, Lu D, Nevriana A, Larsson H, Kooij S, Zoega H. Perimenopausal symptoms in women with and without ADHD: A population-based cohort study. Eur Psychiatry. 2025 Sep 4;68(1):e133. doi: 10.1192/j.eurpsy.2025.10101. PMID: 40903825; PMCID: PMC12538516.