ADHD in women: Insights from an ADHD coach

Have you ever been to a traditional Greek restaurant where the plate-spinning ceremony turns into a plate-smashing ceremony? The performer places and spins a plate on top of a slender stick, and as the performance progresses, they add more and more plates to rods. They monitor and adjust the rods closely to ensure no plates smash. A plate starts to wobble precariously until one of the plates slips from its perch, crashing to the ground with a resounding shatter. The balancing act is unsustainable, and the crash is inevitable.

This is a common experience for many women in their 30s and 40s, but especially for women with undiagnosed ADHD. Instead of ceramic plates, we're juggling overrun meetings, babysitters, ageing parents, bills, relationships, school WhatsApp feeds… the list is bottomless.

Brain shame and ADHD

My clients often describe feeling "brain shame". "I should be able to juggle my career with parenting", "I should be able to make a home-cooked meal", "I should remember to send birthday cards" are a few of the many "shoulds" I've heard. Gender expectations and a comparison with neurotypical standards become the perfect storm.

There's also a lot of guilt and self-blame. Because we are conditioned as women to be accommodating and easygoing, a brain-based difference that can involve needing more time to process information, sensory sensitivities, and impulsivity, flies in the face of "good girl" expectations. It's an internalized, quiet presentation of ADHD, and we develop coping strategies to compensate for our symptoms and mask up. Masking can take the form of perfectionism, people-pleasing, or workaholism. The strategies can last for decades but with a cost of exhaustion, overwhelm, and anxiety.

Hormonal fluctuations through the menstrual cycle, pregnancy, and menopause often exacerbate ADHD symptoms. This can affect cognitive function, sleep schedules, and emotional regulation. Very few healthcare providers understand the intersectionality between hormonal fluctuations and ADHD, but it's estimated that 40% of women with ADHD suffer from PMDD (Premenstrual Dysphoric Disorder). PMDD is a severe form of PMS in which intense physical and psychological symptoms occur after ovulation.

Physical symptoms range from extreme bloating and breast tenderness to fatigue and changes in sleep patterns, while psychological symptoms include feelings of hopelessness, anxiety, extreme irritability, and frustration. When I went to my local GP, who happened to be a man in his 60s, he'd never heard of PMDD, and I ended up showing him a wiki article and leaving with nothing from him but a "thanks for that, I learned something new today with this PMDD term!"

Coaching and ADHD

So when women get to coaching, the overall picture can look like one of shame, confusion, frustration, and guilt. For many women, the most radical act is not to fix or change their brain, but rather to embrace their authentic ADHD selves.

We work to look at ways to navigate the world on their terms. The great strengths of ADHD are creativity, abstract thinking, courage, and problem-solving. I believe these are innate in ADHDers but for some, they've been buried or bashed out of them. But they are there and they are rediscoverable.

Mindset shifting around the fear of being inconvenient or indulgent and in leaning into ADHD is a big piece to work on in the first few sessions. Then it gets really exciting. Because once the mindset blocks have been tackled, the visioning can begin. Giving yourself permission to imagine leaning into your most authentic ADHD self is a wildly empowering exercise. We learn to turn inwards and embrace our knowing and start to live from our imagination.

Authenticity is most shared value in women with ADHD. Anything that feels out of integrity and inauthentic can make us deeply miserable. Once we recommit to living, step by step, small action after small action in authenticity, we invite freedom and joy back into our lives. Being more unapologetically you is a radical act as a woman and even more so as a woman with ADHD.