ADHD symptoms often intensify in perimenopause, but the conversation has been oversimplified to estrogen alone. This session expands the lens to examine the full neuroendocrine landscape driving cognitive and emotional changes in midlife women. Attendees will explore how fluctuating estrogen interacts with progesterone sensitivity, altering GABA signaling and emotional regulation; how declining testosterone contributes to reduced motivation, drive, and cognitive resilience; and how chronic stress reshapes the HPA axis, leading to cortisol-driven executive dysfunction. We will also examine emerging evidence linking perimenopause neuroendocrine changes, immune signaling, and neuroinflammation to worsening ADHD symptoms, alongside the role of mitochondrial function and brain energy metabolism in attention, focus, and mental fatigue. Designed for clinicians and professionals working with adult ADHD populations, this session moves beyond theory into application. Participants will learn how to recognize distinct biological drivers behind symptom changes, differentiate hormonal shifts from baseline ADHD patterns, and identify clinical clues that support more personalized care. By the end of this session, attendees will have a clearer, systems-based understanding of why ADHD can feel more severe in perimenopause and how to approach care in a way that reflects the complexity of women’s physiology, rather than relying on one-hormone explanations.