Adult ADHD in Women: Late Diagnosis, Trauma Overlap, PMDD & Perimenopause — Support with Laura Nolan, Clinical Psychologist in Charlestown

Two adults sitting on a couch with a dog, relaxed home setting

Many women are diagnosed with ADHD later in life. Symptoms often present subtly and may be masked until adult responsibilities intensify. ADHD is a lifelong neurodevelopmental condition that typically begins in childhood and persists into adulthood.^1,2 National and international guidelines emphasise accurate identification, comprehensive assessment, and person‑centred treatment across the lifespan.^1,2 Professional bodies also note that ADHD is under‑diagnosed and under‑treated in adults, with gender differences influencing recognition and timing of diagnosis.³

At Mind‑Care Charlestown, Laura Nolan (Clinical Psychologist) supports adult women exploring ADHD, including those with trauma histories, cycle‑related symptom changes, Premenstrual Dysphoric Disorder (PMDD), and perimenopause. Care is tailored, evidence‑based, and aligned with your goals and context.

How ADHD commonly shows up in women

Women often present with inattentive symptoms (e.g., time blindness, forgetfulness, difficulty planning and organising), internal restlessness, and emotion regulation challenges, rather than overt hyperactivity.^4,5 Reviews highlight the impact of masking and compensatory strategies, the emotional costs of delayed diagnosis, and improvements in self‑understanding once ADHD is recognised.^4,5 Position statements confirm diagnostic ratios shift from childhood (more boys identified) toward near parity in adulthood, reflecting under‑recognition of girls/women earlier on.³

Day‑to‑day impacts frequently cluster around executive functioning (EF)—working memory, planning, cognitive flexibility, and inhibitory control—domains consistently associated with adult ADHD.^6,7

Executive functioning challenges (and why tasks can feel relentless)

ADHD is consistently linked with EF differences: initiating tasks, prioritising steps, sustaining attention, managing time, and also switching focus.^6,7 Neurophysiological evidence in adults (e.g., EEG/ERP changes affecting error detection, cognitive control, and attention allocation) helps explain why seemingly simple tasks can demand disproportionate effort.⁶ Practical EF frameworks (e.g., working memory, inhibitory control, cognitive flexibility) translate directly into strategies that can be coached in therapy and reinforced via external supports (planners, prompts, structured routines).⁷

What this looks like day‑to‑day:

Re‑reading emails repeatedly before replying.
Avoiding complex, multi‑step tasks until deadlines loom.
Losing track of time or appointments (“time blindness”).
Feeling “revved up” internally despite appearing calm externally.

ADHD and trauma: why the overlap matters

ADHD and post‑traumatic stress often co‑occur and can amplify clinical burden.⁸ A 2025 systematic review reported increased PTSD risk among adults with ADHD and greater impairment when both are present.⁸ Earlier controlled work found higher lifetime PTSD prevalence in adults with ADHD compared with controls, along with more comorbidity and lower quality of life.⁹ Because hyperarousal, concentration problems, emotion dysregulation, and sleep issues may appear in both conditions, trauma‑informed assessment is essential to ensure that care plans address the full picture.^8,9

PMDD and ADHD: an emerging link for women

Recent research suggests women with ADHD are around three to four times more likely to meet criteria for PMDD than those without ADHD, in addition, the risk is highest when anxiety or depression co‑occur.^11,12 PMDD involves severe mood, cognitive, and physical symptoms in the late luteal phase (the days before menstruation). For women with ADHD, this can intensify inattention, overwhelm, rejection sensitivity, and emotional reactivity premenstrually.¹¹ Independent coverage underscores the potential value of PMDD screening in women with ADHD, particularly when mood symptoms are present.¹²

Perimenopause: another hormonal shift to consider

Hormonal changes during perimenopause and menopause can exacerbate ADHD symptoms.¹³ A King’s College London study reported that women with ADHD experienced worse menopausal symptoms (sleep issues, concentration problems, emotional distress), and that higher ADHD trait scores correlated with greater menopausal complaints.¹³ Consumer and clinical summaries echo women’s lived reports: ADHD symptoms often peak for many during perimenopause/menopause, and reduced estrogen affects dopamine and serotonin—critical for focus and mood.^14,15 Consequently, practical implications include anticipating brain fog, increased emotional variability, and potential changes in medication response that warrant review by qualified prescribers.^14,15

Why ADHD in women matters for mental health & relationships

Late recognition can carry emotional costs—years of self‑criticism (“lazy,” “disorganised”) despite high effort; as a result, strained relationships often occur due to misinterpreted behaviours.^4,5 Adult women frequently juggle multiple roles (work, caregiving, community), so EF challenges may spill over into family dynamics (missed appointments, difficulty starting tasks), while emotion regulation differences can affect communication and conflict resolution.^6,7 Co‑occurring anxiety or depression further compounds functioning, underscoring the need for integrated care plans.¹⁰

Practical strategies for women with ADHD

Cycle‑aware planning:

Track symptoms across your cycle (e.g., over 3–4 months) and note luteal‑phase changes (focus, energy, mood).
Where patterns are clear, front‑load cognitively demanding work into follicular/ovulatory phases and simplify tasks premenstrually.^11,12

Executive‑function supports:

Use external scaffolds (calendar blocking, step‑lists, visual timers) to reduce cognitive load and decision fatigue.
Break tasks into micro‑steps with realistic time estimates; set context cues (e.g., “reply to three emails during morning coffee”) to trigger starts.⁷

Trauma‑informed routines:

Pair EF tools with grounding, sleep hygiene, and arousal regulation (e.g., structured wind‑down).
Explore skills‑based therapy for emotion regulation and attentional control alongside any trauma‑focused work.^8,9

Work & home anchors:

Agree on communication norms (e.g., “bullet‑point emails”) and shared calendars.
Use environment cues (task‑specific zones, frictionless storage) to reduce switching costs and forgotten items.⁷

How to prepare for an ADHD assessment

Collect a timeline: note childhood school reports, uni/work performance, and key life stages (incl. pregnancy, postpartum, perimenopause).^1,2
Track symptoms: bring brief logs covering focus, organisation, emotion regulation, sleep, and pre‑menstrual/perimenopausal changes.^11,13
List supports and stressors: identify what helps (routines, apps, coaching) and what hinders (shift work, caregiving load).^6,7
Screen comorbidities: flag trauma history, anxiety/depression, and PMDD symptoms to inform a comprehensive plan.^8,10,11

FAQs for Women with ADHD

Q: Does perimenopause affect ADHD symptoms?

A: Yes. Hormonal changes during perimenopause often worsen ADHD symptoms—especially focus, executive control, and mood—due to estrogen declines impacting dopamine and serotonin.^13,14,15 Many women report increased brain fog, irritability, and reduced medication effectiveness during this stage. Strategies include cycle tracking, adjusting routines, and discussing medication reviews with qualified prescribers.^14,15

Q: Why was my ADHD missed earlier in life?

A: Girls often present with inattentive/internalised symptoms and may mask difficulties through high effort or perfectionism, leading to under‑recognition in childhood.^4,5 Diagnosis in adulthood can bring clarity and reduce self‑blame, enabling targeted support for work, relationships, and wellbeing.^4,5

Q: Can ADHD symptoms fluctuate across the menstrual cycle?

A: Yes. Many women experience symptom spikes premenstrually, linked to hormonal changes. Women with ADHD are significantly more likely to have PMDD, which can amplify emotional reactivity and executive dysfunction.^11,12 Cycle‑aware planning can help; for example, scheduling demanding tasks during higher‑focus phases.^11,12

Q: What treatment options are available for women with ADHD?

A: Evidence‑based care often combines psychoeducation, skills‑based therapy (e.g., CBT for ADHD), and medication where appropriate.^2,10 For women, care may also include strategies for hormonal transitions (PMDD, perimenopause) and trauma‑informed approaches when relevant.^8,13

Q: How does trauma impact ADHD symptoms?

A: Trauma can intensify ADHD‑related challenges like emotion regulation and concentration.^8,9 Overlapping symptoms may complicate diagnosis, so trauma‑informed assessment is essential. Therapy can address both conditions through grounding techniques, coping skills, and emotion regulation strategies.^8,9

Q: Is ADHD linked to anxiety or depression?

A: Yes. Adults with ADHD frequently experience co‑occurring anxiety and depression.¹⁰ Integrated care—addressing both ADHD and mood symptoms—can improve functioning and quality of life.^10,2

Assessment & care in Australia

The AADPA NHMRC‑approved guideline outlines best‑practice identification and diagnosis for adults—drawing on clinical interviews, multi‑source history (including childhood), functional impairment, and screening for comorbidities such as trauma‑related symptoms and mood/anxiety disorders.¹ NICE NG87 (UK) similarly emphasises person‑centred, multimodal care for adults, clarifies how symptoms can change across the lifespan, and recommends structured support options.² Reviews also highlight adult ADHD trends and underdiagnosis among women, supporting the need for accessible services and clear pathways.³

How Laura Nolan supports women with ADHD in Charlestown

Laura’s work with adult women focuses on practical, evidence‑based strategies aligned with your goals and context:

Clarify your profile: mapping inattentive symptoms, EF profile, and any trauma or mood/anxiety factors.^8,10
Build EF routines: planning, task initiation, time‑management, and attention supports grounded in EF science.^6,7
Cycle‑ and perimenopause‑aware care: exploring PMDD red flags and luteal‑phase symptom patterns, then timing strategies for periods when focus and emotion regulation are most affected.^11,13,14,15
Person‑centred goals: sustainable routines for work, study, caregiving, and relationships, consistent with national guidance.^1,2

When to reach out

Consider an appointment if you identify with:

Persistent organisation/planning difficulties, even with strong effort.
Time blindness or frequent overwhelm with multi‑step tasks.
Focus variability, especially worse premenstrually or during perimenopause.
A trauma history that complicates concentration or emotion regulation.
Co‑occurring anxiety/depression, and a desire to explore integrated support.

These experiences are common in adult ADHD and can improve with tailored care.^2,10

Next steps (Charlestown, Newcastle & Hunter Region)

If you’re a woman exploring a late‑diagnosed ADHD pathway—or you want cycle‑aware, trauma‑informed support through PMDD and perimenopause—you can enquire about an appointment with Laura Nolan at Mind‑Care Charlestown.

Book an appointment with Laura

Enquiry & bookings: via our contact page

Appointments: Our clinic in Charlestown, or online, servicing Newcastle & Hunter Region.

Focus areas: Women with ADHD, ADHD & Trauma, PMDD & Perimenopause considerations.

References 1-8

ADHD Guideline Development Group. (2022). Australian evidence-based clinical practice guideline for Attention Deficit Hyperactivity Disorder (ADHD). Australian ADHD Professionals Association. (https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf)
National Institute for Health and Care Excellence (NICE). (2019). Attention deficit hyperactivity disorder: Diagnosis and management (NG87). (https://www.nice.org.uk/guidance/ng87/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-pdf-1837699732933)
Royal Australian and New Zealand College of Psychiatrists (RANZCP). (2023). ADHD across the lifespan: Position statement (PS #55). (https://www.ranzcp.org/clinical-guidelines-publications/clinical-guidelines-publications-library/adhd-across-the-lifespan)
Attoe, D. E., & Climie, E. A. (2023). Miss. Diagnosis: A systematic review of ADHD in adult women. Journal of Attention Disorders, 27(7), 645–657. (https://doi.org/10.1177/10870547231161533)
Holden, E., & Kobayashi-Wood, H. (2025). Adverse experiences of women with undiagnosed ADHD and the invaluable role of diagnosis. Scientific Reports, 15, Article 4782. (https://www.nature.com/articles/s41598-025-04782-y.pdf
Su, Z., Wang, Y., Wang, B., Han, C., Zhang, H., Gu, Y., … Shi, Y. (2025). Executive function and neural oscillations in adults with ADHD: A systematic review. Frontiers in Neuroscience, 19, 1617307. (https://doi.org/10.3389/fnins.2025.1617307)
Children’s Hospital of Philadelphia (CHOP). (2023, April 13). What are executive functions and how are they related to ADHD? (https://www.chop.edu/sites/default/files/adhd-exec-5-what-are-efs-and-how-are-they-related-to-adhd.pdf)
Magdi, H. M., Abousoliman, A. D., Ibrahim, A. M., Elsehrawy, M. G., EL-Gazar, H. E., & Zoromba, M. A. (2025). Attention-deficit/hyperactivity disorder and post-traumatic stress disorder adult comorbidity: A systematic review. Systematic Reviews, 14, Article 41. (https://link.springer.com/article/10.1186/s13643-025-02774-7)