The ADHD Perimenopause Connection & Why Women Get Diagnosed Later in Life | Mandi Dixon
If you've always managed just fine but suddenly feel like everything is falling apart in your 40s, the problem might not be perimenopause alone, it could be revealing ADHD that's been masked your entire life.
This conversation with therapist Mandi Dixon revealed a critical connection between ADHD and perimenopause that's leaving countless women struggling without answers. Dixon's work focuses on the intersection of neurodivergence and hormonal changes, addressing why so many women receive their first ADHD diagnosis during midlife transitions.
The discussion explored how ADHD in girls and women presents differently than in boys - with internal hyperactivity like daydreaming and anxiety rather than external disruption. This leads to years of successful masking, where women learn to follow rules and appear organized while struggling internally. The hormonal support of estrogen helps maintain these coping mechanisms until perimenopause strips away that scaffolding.
Dixon introduced the concept of "ugly perimenopause" - the severe mental health struggles that go beyond typical mood changes and require immediate attention. She emphasized that the highest suicide rates in women occur between ages 46-54, making this a critical period for intervention and support.
The conversation highlighted how neurodivergent women experience more intense perimenopause symptoms due to nervous system sensitivity. Sensory overload becomes overwhelming - from cooking exhaust fans to children's noise levels. Rejection sensitive dysphoria, already challenging for ADHD individuals, intensifies with hormonal fluctuations, making criticism feel devastating.
Dixon's therapeutic approach combines traditional counseling with EMDR (Eye Movement Desensitization and Reprocessing) therapy, which uses bilateral stimulation to help reprocess trauma. This technique proves particularly effective for both mental health recovery and physical conditions like pelvic pain where trauma responses interfere with healing.
The discussion addressed the "menno divorce" phenomenon, with Dixon explaining that divorce often results from pre-existing relationship issues becoming intolerable once women stop accommodating poor treatment. Perimenopause doesn't cause problems but reveals them, giving women clarity about what they will and won't accept.
Dixon stressed that neurodivergent women require specialized menopause care, describing them as "orchids" who need delicate handling during hormone therapy. The combination of hormonal treatment with mental health support often provides the best outcomes, with some women needing long-term antidepressant therapy as a "safety net" alongside hormone replacement.
Highlights:
Why ADHD gets missed in girls due to internal vs. external symptoms.
The "ugly perimenopause" requiring immediate mental health intervention.
Sensory overload and rejection sensitivity intensifying with hormone changes.
EMDR therapy for trauma processing and pelvic pain recovery.
How menopause empowerment reveals relationship problems rather than causing them.
Neurodivergent women needing specialist hormone care and patience with treatment.
The importance of combining hormone therapy with mental health support.
Suicide risk peaks between ages 46-54 in women.
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