Abstract Objective This systematic review aims to examine the existing literature on the impact of perimenopause/menopause on cognitive function, identify overlaps with adult ADHD symptoms, and provide evidence-based recommendations for distinguishing between the two conditions, guiding clinical practice and identifying considerations for selection of neuropsychological testing with this population. Data Selection A search of electronic databases, including PubMed, PsycINFO, and MEDLINE, will be conducted to identify relevant peer-reviewed studies published between 2000 and 2024. Studies examining cognitive changes during perimenopause/menopause, diagnostic challenges in distinguishing perimenopause/menopause-related cognitive decline from adult ADHD symptoms, and interventions for accurate assessment and management will be included. Data extraction and synthesis will be performed following PRISMA guidelines. Data Synthesis The analysis will review a range of literature on the cognitive changes associated with perimenopause/menopause, including deficits in attention, memory, and executive function, which may overlap with symptoms of adult ADHD. Attention will be paid to looking for distinct patterns of cognitive impairment and hormonal profiles between perimenopause/menopause-related cognitive decline and adult ADHD. Various screening tools and neuropsychological assessments will be examined for their utility in differentiating between the two conditions. Conclusions The current systematic review, with its focus on the impact of menopause and perimenopause on women’s cognitive functioning, particularly executive functioning, has the potential to significantly advance our understanding in this area. It will be able to provide clinical recommendations and considerations for individuals administering and interpreting neuropsychological testing with this population. Recommendations for best practices will be proposed, potentially revolutionizing the way we approach and manage these conditions.