By Jennifer Hammonds, LCSW
This picture has a story—one that still makes me shake my head a little.
The other day, I had an important letter that needed to go in the mail on my way to work. The night before, I did everything “right”: sealed it, stamped it, put it in my purse, and left myself a reminder on the front door. Halfway through my commute, I realized I had forgotten to drop it off. Frustrated, I glanced at my purse and the envelope wasn’t there.
When I got to work, I called my husband to search the house: the floor, the office, even the porch. Hours later, a thought occurred: Could I have put it in the mailbox on autopilot? Surely not. A text from my husband confirmed it: not only was the letter in the mailbox, it wasn’t even addressed. My brain fog had officially reached new levels.
Looking back, this moment was funny but also part of a bigger story. Years earlier, I had spoken with my primary care physician about new symptoms: heart palpitations, trouble sleeping, itchy skin. I was told it was likely work stress. Later, at my gynecology visit, I asked what felt like an uncomfortable question: Could this be perimenopause? I was reassured I was too young and reminded that stress affects everything.
Then came hot flashes, weight gain, and most unsettling – brain fog.
“I have to be smart at my job,” I said. “What is wrong with me?”
My husband was supportive but confused. Memory lapses, poor focus, and lack of follow-through were uncharacteristic. At one point he suggested, “Maybe you need one of those memory clinic assessments like the ones you do at work.” Cue panic.
Around this time, I started seeing emerging research and personal stories about women’s health. For the first time, I recognized myself. Motivated, I sought a gynecologic provider with expertise in women’s health. I finally received education, hormone testing, and validation. In coordination with my PCP, we developed a treatment plan that included hormone therapy and Vyvanse, as declining estrogen appeared to unmask longstanding inattentive ADHD. Combined with behavioral strategies I already knew, I began to feel more like myself than I had in years.
As I felt better personally, I reflected professionally. How many times had I attributed similar presentations in midlife women to anxiety or stress alone? How often had workups stopped at a normal TSH? How many “scatterbrained” patients were experiencing cognitive load and executive dysfunction related to menopause? Or even unmasked ADHD?
In conversations with female colleagues, we began shifting our clinical lens. Viewing menopause through a cognitive load framework helped us better differentiate menopause-related cognitive changes from ADHD. Treatment became more tailored, often combining hormone therapy with ADHD-specific pharmacologic and behavioral interventions. Patients felt heard, and we felt less frustrated as vague cognitive complaints became navigable.
A colleague and I hope to present this work in the coming months, but even now, our approach to women in midlife (and the questions we ask) has changed.
As a long-time therapist, I am trained to keep personal experiences private, so sharing this story requires vulnerability. But in family medicine and behavioral health, lived experience sharpens clinical instincts. This journey has made me a more thoughtful, patient-centered clinician—and a more empathetic partner to the women I serve.
STFM Blog 