ADHD, Perimenopause and Work: What Should Proper Support Actually Look Like?

13 Aug

You open your laptop on Monday morning and already feel behind. There are three things that need doing, but you can't work out which one to start with. You read an email twice and still can't work out what it's asking you to do. Your manager asks when something will be finished and, for some reason, your brain just stops.

Then you make a mistake you wouldn't normally make, and spend the rest of the day worrying about it. Your anxiety is through the roof, your confidence has disappeared and your rejection sensitive dysphoria is worse than you've ever known it. You're second guessing everything you say in meetings and wondering whether your manager thinks you're incompetent.

And you're thinking, what is happening to me?

This isn't how it's always been. You've been doing your job for years. You've built a career, taken on responsibility and found ways to manage the things that don't come naturally to you. If masking was an Olympic sport, you'd have won gold. Along the way, you've developed all sorts of strategies to compensate for your ADHD, often without even realising that's what you were doing.

When you've spent years compensating for ADHD, you can become incredibly good at looking like you're coping. You might have systems to make sure you don't forget things, work longer hours because tasks take you longer than they seem to take other people, or leave everything until the last minute because that's when you finally get the dopamine and pressure you need to get started.

You might prepare excessively for meetings so you don't lose your train of thought, or be exceptionally organised at work simply because you've had to.

From the outside, none of this necessarily looks like ADHD. It looks like what it is, which is someone who plans meticulously so they're good at their job.

Until suddenly, you're not.

There's a growing body of research looking at the relationship between ADHD and hormones. Oestrogen interacts with the brain systems involved in attention, motivation and executive function, including dopamine pathways. As oestrogen fluctuates during perimenopause, changes in these systems may make ADHD symptoms that were previously manageable much harder to manage (Osianlis et al., 2025; Chapman et al., 2025).

This is important. It's not that you've suddenly become less organised or less capable. Your brain is dealing with significant hormonal changes that can affect the very systems you've been relying on to compensate for your ADHD.

Executive function includes things like prioritising, working memory, planning, task initiation and regulating your attention and emotions. When those systems become less reliable, everyday work can suddenly require a huge amount more effort.

When you start to struggle at work

You tell your manager you're struggling, but they see missed deadlines rather than executive function difficulties. You explain that you're finding it difficult to prioritise, and you're told you need to be more organised.

You ask for some flexibility around when or where you work, and it's interpreted as wanting special treatment. You make a mistake and suddenly you're being performance managed.

Meanwhile, you may also be dealing with poor sleep, anxiety, migraines, brain fog and exhaustion as part of perimenopause.

I've lost count of the women I work with who've ended up signed off sick, caught up in grievance or capability procedures, or seriously considering leaving careers they've spent years building.

So what does proper support actually look like?

Good ADHD support at work isn't about lowering expectations or making someone's job easier. It's about removing unnecessary barriers so that someone can actually do the job they're capable of doing.

Where workplace training often gets it wrong

An organisation might bring someone in to talk about neurodiversity and everyone learns that people with ADHD might benefit from noise reducing headphones, working somewhere quieter, written instructions or regular breaks.

Those things can be useful. But if that's where the conversation ends, we've missed the point.

Not every person with ADHD wants noise reducing headphones. Not everyone finds bright lights difficult. Not everyone needs a quiet room, closed curtains or the option to work from home. Not everyone needs the same structure, flexibility or adjustments.

We're individuals.

The diagnosis doesn't tell you what the person needs. You have to ask them.

A useful conversation isn't, "What adjustments do people with ADHD usually need?" It's, "What's making it harder for you to do your job, and what would make that easier?"

For one person, that might mean clear written instructions rather than a long list of verbal requests. For another, regular check-ins with their manager to help prioritise competing demands. Someone else might need fewer interruptions, flexibility around their working environment, or more control over when they do certain types of work.

The important thing is that the adjustment is based on the individual, not a generic list of things that supposedly help people with ADHD.

When perimenopause arrives, it can affect our ADHD so significantly

Hormonal changes can affect sleep, concentration, memory, mood, energy and the ability to regulate stress. For women with ADHD, these changes can make previously manageable symptoms much harder to compensate for.

That doesn't mean the person has suddenly become less capable, or that their standards have dropped, and it certainly doesn't mean they're now rubbish at their job.

It means something's changed, and the way they need to work may need to change with it.

If someone's been a highly capable employee for years and suddenly starts struggling, the first question shouldn't be, "What's wrong with them?"

It should be, "What's changed, and how can we help now?"

Awareness isn't the same as understanding

Having a neurodiversity policy doesn't necessarily mean an organisation understands neurodivergence.

Having an employee network doesn't mean managers understand how ADHD can present in women. Having someone deliver a one hour awareness session doesn't necessarily mean anyone knows what to do when an employee is actually struggling.

Managers need to understand executive functioning, working memory, emotional regulation, masking and the way ADHD can present in women, particularly women who've spent decades compensating.

They also need to understand that the person sitting in front of them may not look like the stereotypical picture of ADHD. They may have had a successful career, be highly intelligent, organised and conscientious, and have spent years working extremely hard to achieve the same outcomes as everyone else.

That's why generalised advice isn't enough. Understanding without individual attention just becomes a different kind of box ticking.

Why this matters to employers too

This isn't just about being kind to employees. It's also about keeping good people.

If someone's spent years building expertise, developing relationships, solving problems and contributing to an organisation, losing them because nobody understood what was happening is a waste of talent.

Research has found associations between ADHD and difficulties with occupational functioning, including productivity, sickness absence and presenteeism, where someone is physically at work but struggling to function at their usual level (Fuermaier et al., 2021; Chan and Langberg, 2024).

When someone reaches burnout, goes off sick, enters a formal capability or grievance process, or eventually leaves, the cost to the organisation can be considerable.

Sometimes the adjustments needed to prevent that are remarkably small. A bit more flexibility, clearer communication, more structure around priorities, a different working environment, or a manager who understands what they're actually looking at.

What are you entitled to?

If you're struggling at work, you don't have to wait until you're at breaking point before asking for support.

ADHD can meet the definition of a disability under the Equality Act 2010 where it has a substantial and long term adverse effect on someone's ability to carry out normal day to day activities. Where the legal criteria are met, employers have a duty to consider reasonable adjustments.

The same protection isn't limited to ADHD. In 2022, the Employment Appeal Tribunal ruled in Rooney v Leicester City Council that menopause symptoms can also meet that same legal definition of disability. This isn't just a point of principle either. In a separate case, an employee at Direct Line was awarded over sixty thousand pounds after her employer failed to make reasonable adjustments for her menopause symptoms.

Those adjustments should be based on individual need, not a standard ADHD checklist.

You can also speak to Occupational Health. If you're in paid employment, it's worth looking at Access to Work, a government scheme that can potentially fund practical support such as ADHD coaching, assistive technology and other workplace support, depending on your circumstances.

You're also entitled to ask for flexibility, and you don't have to earn that right through years of service. Since April 2024, requesting flexible working has been a day one right. Asking to work differently isn't a favour your employer is granting you. It's something the law already gives you permission to raise.

You don't have to be signed off sick or already be in a formal process before you start looking at what support might be available. ACAS also provides guidance for employers and employees around neurodiversity and reasonable adjustments.

Larger organisations are also facing new obligations. The Employment Rights Act 2025 will require employers with 250 or more staff to publish Equality Action Plans, expected to include menopause support, with reporting becoming mandatory from spring 2027. It'll take time to bed in, but it signals that menopause support at work is moving from good practice towards a legal expectation.

You shouldn't have to reach breaking point

You shouldn't have to wait until you're signed off sick. You shouldn't have to get to a grievance or capability process. You shouldn't have to resign from a job you've worked hard to build.

Many of the women I work with aren't asking for their job to be made easier. They want to be able to do the job they're more than capable of doing.

They want their manager to understand why something that looks simple to everyone else can sometimes be incredibly difficult for their ADHD brain. They want reasonable adjustments that actually address the things they're struggling with. And they want to stop spending all their energy trying to look like they're coping.

However, there's something else that matters just as much as the practical adjustments.

Trust.

You need to work somewhere where you can be honest about what you're struggling with without worrying about the eye rolls, the judgement or what people might say about you behind your back.

You need to know that your manager believes you when you explain what's happening. That they trust you to know what you need. And that they still trust you to do your job.

That trust needs to work both ways.

None of this is deliberate, and it's not about being difficult. Most women push through and stay quiet rather than raise it, worried about being seen as a burden or making a fuss over nothing. Staying quiet like that takes a real toll on your mental health.

When women have spent years being told, directly or indirectly, that they're disorganised, forgetful, too emotional or not trying hard enough, being believed can make an enormous difference.

We don't want special treatment. We want to be understood, supported and trusted to do our jobs properly.

And when that happens, the woman who looked like she was struggling can often get back to doing what she was doing all along, a really good job.

If you're struggling at work and wondering whether ADHD, perimenopause or both might be part of what's happening, start by asking a different question.

Not "Why can't I cope anymore?"

But "What's changed, and what support would help me do my job?"

References

Acas (2025) Neurodiversity at work. London: Acas.

Chan, E.S.M. and Langberg, J.M. (2024) 'Predicting occupational outcomes for individuals with ADHD: the role of hyperactivity/impulsivity and executive functioning', Journal of Occupational Rehabilitation.

Chapman, L., Gupta, K., Hunter, M.S. and Dommett, E.J. (2025) 'Examining the link between ADHD symptoms and menopausal experiences', Journal of Attention Disorders.

Fuermaier, A.B.M., Tucha, L., Butzbach, M., Weisbrod, M., Aschenbrenner, S. and Tucha, O. (2021) 'ADHD at the workplace: ADHD symptoms, diagnostic status, and work-related functioning', Journal of Neural Transmission, 128(7), pp. 1021–1031.

Osianlis, E., Thomas, E.H.X., Jenkins, L.M. and Gurvich, C. (2025) 'ADHD and sex hormones in females: a systematic review', Journal of Attention Disorders, 29(9), pp. 706–723.

Employment Relations (Flexible Working) Act 2023.

Employment Rights Act 2025.

Lynskey v Direct Line Insurance Services Ltd, Employment Tribunal (2023).

Rooney v Leicester City Council [2022] EAT 0070/20.