How ADHD is Different in Women | Adult ADHD Therapy

How misdiagnosis and menopause impact women’s experience with adult attention-deficit/hyperactivity disorder (ADHD) and how therapy can help.

At Vitality Collective, many of the women who come through our doors (or connect with us via our online therapy) arrive feeling overwhelmed, exhausted, and confused by a lifelong pattern of “trying so hard” without the results they expect. Often, they are brilliant, sensitive, and deeply caring individuals who have been misdiagnosed or overlooked for years. And sometimes, after years of struggling with self-doubt, anxiety, or burnout, they receive a diagnosis that helps everything click into place: ADHD.

Attention-Deficit/Hyperactivity Disorder (ADHD) in women often presents in ways that differ significantly from the stereotypes we sometimes see portrayed in media. This misunderstanding can delay recognition and treatment for years—even decades. As a therapy practice working across British Columbia, we see this pattern again and again. Understanding how ADHD shows up differently in women isn't just important—it's essential for healing.

How ADHD presents in women

While ADHD is commonly associated with hyperactivity, impulsivity, and disruptive behaviour—traits more frequently noticed in boys—women and girls often present with what’s called the inattentive subtype. Rather than bouncing off walls or interrupting constantly, women with ADHD may appear “spacey,” disorganized, or forgetful. These traits are often misattributed to personality flaws, laziness, or even anxiety and depression, rather than a neurodevelopmental condition.

Girls with ADHD might have been the ones described as “chatty,” “emotional,” or “too sensitive,” rather than disruptive. These patterns continue into adulthood, where a woman might find herself struggling with time management, executive functioning, emotional regulation, and chronic overwhelm. But because her symptoms don’t fit the conventional mold, she may not realize it’s ADHD.

Masking and Misdiagnosis

One of the most significant challenges women face with ADHD is masking. From a young age, girls are socialized to be compliant, polite, and organized. As a result, many women become adept at hiding their symptoms, often to the detriment of their mental health. This masking can look like excessive planning, perfectionism, people-pleasing, or overcompensation. It may even look like success—until it becomes unsustainable.

Because of this, ADHD in women is frequently misdiagnosed as depression, anxiety, bipolar disorder, or even borderline personality disorder. And while co-existing conditions are common (especially anxiety and depression), when ADHD is the root cause and it goes unaddressed, therapy and medication can fall short.

Our BC therapists often hear their clients say things like, “I thought it was just me,” or “I never realized this wasn’t normal.” The relief that comes with an accurate diagnosis is palpable. It reframes a life story from one of perceived failure to one of resilience in the face of an invisible struggle.

Executive Dysfunction and Emotional Regulation

For women with ADHD, executive dysfunction can be especially frustrating. These are the brain’s “management” skills: starting tasks, organizing time, prioritizing responsibilities, and switching between activities. A woman might sit down to write an email and end up cleaning out her inbox for hours, missing the actual task she meant to complete. Or she may procrastinate not out of laziness, but because initiating tasks feels neurologically overwhelming.

Emotionally, women with ADHD often feel things deeply and intensely. They may cry easily, struggle with rejection sensitivity, or become emotionally flooded under pressure. These experiences can be misunderstood as mood disorders or “overreacting,” when in reality, they are very common in ADHD brains.

When these challenges intersect with roles like parenting, caregiving, or working in high-demand environments, the result is often burnout, guilt, and self-criticism. Many of our clients tell us they feel like they’re “barely holding it all together,” while blaming themselves for it.

Hormones and ADHD 

Hormonal fluctuations can significantly impact ADHD symptoms. Estrogen plays a key role in regulating dopamine, a neurotransmitter central to attention and emotional regulation. During puberty, menstruation, pregnancy, postpartum, and especially perimenopause, many women notice shifts in their ability to focus, manage emotions, or maintain energy. Recent research published in Hormones and Behavior (Eng et al., 2024) suggests that rapid drops in estrogen—particularly around ovulation and before menstruation—may worsen executive function, impulsivity, and inattention in females with ADHD. These changes can also interact with emotional highs and lows, further intensifying symptoms at specific points in the cycle. Many women only receive their ADHD diagnosis during perimenopause, when symptoms intensify and long-standing coping strategies become less effective. This is not a personal failure—it’s a biological reality. Recognizing this connection helps validate the experience and opens the door to more targeted support.

ADHD Diagnosis and Therapy

At Vitality Collective, we believe that receiving an ADHD diagnosis is an important step in reclaiming your story. Many of the women we work with have spent years blaming themselves for struggles they didn’t understand. A diagnosis can be the first step toward compassion, clarity, and meaningful change. Here, we begin to finally understand why certain things have felt so hard, and what can be done to help.

In therapy, we help clients process what the diagnosis means for them personally. That often includes reviewing their life story through a new lens: relationships, career decisions, academic challenges, and emotional experiences often start to make more sense. As therapists, we guide this exploration with sensitivity, helping you connect the dots without judgment.

We also focus on practical tools: psychoeducation to help you understand how ADHD works, skill-building to support executive functioning, and support around medication decisions if that’s something you're considering. But equally important is the emotional work: grieving the years spent misunderstood, and learning how to nurture the parts of you that were never the problem to begin with.

Our goal isn’t to “fix” you—it’s to help you build a life that feels aligned with how your brain and nervous system naturally function. Together, we co-create sustainable systems, boundaries, routines (or non-routines!), and habits that actually work for you. 

ADHD & Neurodivergent Therapy | ADHD BC Counsellors 

Therapy offers more than coping strategies—it offers a place to heal. For many women with ADHD, the most damaging aspect hasn’t been the symptoms themselves, but the way they’ve been misunderstood or dismissed by family, partners, teachers, employers, or even themselves. These early experiences often lead to a deep sense of shame or a lifelong pattern of self-blame. In therapy, we gently untangle these narratives.

At Vitality Collective, we create space to explore the emotional layers of living with undiagnosed or late-diagnosed ADHD. Together, we unpack internalized messages like “I’m lazy,” “I’m broken,” or “I should have tried harder.” We explore where these beliefs came from and how they’ve shaped your identity, relationships, and self-worth. This work isn’t always easy, but it’s powerful.

We may use Internal Family Systems, compassion-focused therapy, or narrative therapy to help clients shift from shame to self-understanding. We also help you name and celebrate the strengths that may have gone unnoticed for years, like your creativity, insight, humour, persistence, or empathy. In a society that hasn’t always known how to support neurodivergent minds, learning to see your own gifts clearly can be profoundly healing.

Therapy also becomes a space to experiment and get curious: What actually works for you? What rhythms, routines, and relationships help you thrive? We hold space for both structure and flexibility, and we collaborate with you to build strategies that respect your nervous system’s needs, not override them.

Adult ADHD Therapy | Vancouver, Surrey, Chilliwack and Kelowna Counsellors 

If you’ve ever felt like you're working twice as hard to keep up, or constantly falling behind no matter how hard you try, please know this: you are not alone. So many women spend years struggling quietly before they find the language to describe what’s really going on. ADHD in women is real, it’s under-recognized, and it’s worth paying attention to.

Whether you’re newly diagnosed, wondering if ADHD might be part of your experience, or simply looking for answers, Vitality Collective is here to support you. Our practice is neurodivergent-affirming, and our team of compassionate, trauma-informed therapists is experienced in working with ADHD through a gender-sensitive lens. We offer therapy in Vancouver, Surrey, Chilliwack, Kelowna and virtually across British Columbia, so support is always within reach wherever you are. To get started, please fill out our New Client Inquiry Form.