Something I hear from clients quite often — usually said quietly, and with more than a little shame attached — goes something like this:

"I don't understand why it's got so much harder. I was managing better before."

If you recognise that feeling, I want to say something clearly before we go any further: this is not because you have gone backwards. It is not because the work you have already done has come undone. It is because your brain chemistry is changing — in ways that interact with what was already there — and nobody thought to tell you about it.

For women in midlife who have a history of binge eating or emotional eating, and who also have ADHD (diagnosed, suspected, or the kind that has only recently started making sense of your life), perimenopause can feel like an ambush. The urges become louder. The strategies that used to work stop working. The shame quietly intensifies.

This is not a personal failing. It is a neurological one — and understanding the biology behind it is, in my experience, one of the most genuinely useful things I can offer a client. Not because knowledge alone changes behaviour, but because it removes shame from the equation. And shame, as anyone who has ever tried to heal their relationship with food will know, makes everything harder.

What happens to your brain during perimenopause

The way perimenopause is often described — as a gradual, gentle decline in oestrogen — is not quite accurate. What actually happens is that oestrogen becomes erratic. It fluctuates unpredictably, sometimes within the same week: spiking, dropping, swinging between the two without following a clear pattern.

This matters enormously, because oestrogen is not just a reproductive hormone. It plays a significant role in regulating dopamine — the neurotransmitter that governs motivation, reward, and crucially, self-regulation.

When oestrogen fluctuates erratically, so does dopamine regulation. The brain's ability to modulate impulses, tolerate discomfort, and sit with a craving without immediately acting on it becomes less reliable. Focus wavers. Emotional steadiness becomes harder to maintain. Food urges — the kind that feel sudden, urgent, and impossible to reason with — become more difficult to navigate.

For women who do not have ADHD, this can still be a challenging period. For women who do have ADHD, the picture is considerably more complex.

How ADHD affects dopamine regulation in the first place

ADHD involves a dopamine system that works differently — not deficiently, but differently. The system is less consistent in its response to everyday stimuli. Ordinary rewards — a quiet meal, a rest, a gentle evening — do not produce the same reliable signal that they might in a neurotypical brain.

This is why self-regulation is genuinely harder in ADHD. Sitting with a food urge without acting on it requires the brain to tolerate discomfort, access impulse control, and trust that the feeling will pass. All of these draw heavily on the same dopamine systems that, in ADHD, are already working with less consistency and sensitivity.

This is also why highly palatable food — the specific textures, the combinations of fat, salt, and sugar that make it feel almost impossible to stop — can feel so compelling for people with ADHD. It provides a fast, strong signal. Strong enough to cut through the dysregulation. Strong enough to produce the satisfaction that more ordinary input often does not quite reach.

This is not a character flaw. It is the brain doing something logical: finding an input that actually works.

When ADHD and perimenopause meet: the perfect storm

Add erratic oestrogen to a dopamine system that was already working differently, and you get what I often describe to clients as a perfect storm.

These two things do not arrive separately and politely take turns. They converge. ADHD, perimenopause, and — in many cases — years of history with binge eating, diet culture, and a complicated relationship with food all interact at once.

The result is that the strategies women relied on in their thirties — the structured routines, the food rules, the sheer willpower required to get through a difficult evening — simply stop working the way they did. Not because those women have weakened or gone backwards. But because the neurological scaffolding those strategies depended on has shifted underneath them.

A recent piece in Get the Gloss captured this well: during perimenopause, oestrogen stops following its usual rhythm and becomes erratic, directly affecting focus, emotional regulation, and mood — and hitting particularly hard when ADHD is already part of the picture.

Why "trying harder" is not the answer

One of the most unhelpful things about how binge eating is typically discussed is that it is still so often framed as a failure of self-control. If you just had more willpower. If you just planned your meals better. If you just tried a new approach.

For women navigating ADHD and perimenopause simultaneously, this framing is not just unhelpful — it is actively harmful. Because it misidentifies the problem entirely.

The problem is not insufficient effort. The problem is a dopamine system under significant neurological pressure, managing an oestrogen environment that is in genuine flux. Asking that system to perform more reliably by applying more willpower is a bit like asking someone with a broken leg to walk faster.

What actually helps is a different kind of question. Not "why can't I control myself?" but "what is my brain trying to do here, and what does it actually need?"

That shift — from shame and self-blame to curiosity and compassion — is, in my experience, where real change becomes possible.

A note on recovery being non-linear

Healing a relationship with food is rarely a clean upward line. It has always been non-linear. But for women in midlife with ADHD, perimenopause adds a layer of genuine neurological complexity that can make the journey feel particularly disorienting.

If you have been doing this work — in therapy, in self-reflection, in the quiet private effort to understand yourself better — and you feel like perimenopause has knocked something loose, I want you to know: it probably has. And that is not a reflection of how much or how little work you have done. It is a reflection of how significant the hormonal shift of midlife actually is.

You are not starting from scratch. You are navigating new terrain with everything you have already learned. That is different — and it matters.