For weeks, I’d been thinking about giving up nursing, every single day. I didn’t want to go into work any more. I’d completely lost my confidence, I felt anxious walking in, my RSD (rejection sensitive dysphoria) was really bad and I was overthinking everything. I wasn’t sleeping properly, I felt so low, and I couldn’t see any other way out.
It had been going round and round in my head for weeks, and I hadn’t said it out loud to anyone. Then I spoke to a friend on the phone. She listened, and then she said, “Right, you come off the phone now, you ring the doctor straight away and you tell them you can’t work.” So that’s exactly what I did, and I honestly think that phone call saved my life.
The career I’d worked so hard for
I was 49, and I’d been a nurse in the NHS for 20 years. I’d worked my way up to a senior role, I was proud of what I’d built, and I knew I was good at my job. I was still a safe practitioner, and my patients still got good care. It just felt like I was driving with the handbrake on, getting to the same place but using twice the fuel.
I was signed off work for three months. I could have taken up to six months’ paid sick leave, and I wish now that I’d taken it. Like so many women, I went back early because I felt guilty that I was letting people down. Going back took so much courage, and I was nervous and really emotional. Apart from a couple of lovely, caring colleagues, hardly anyone even said hello, and nobody asked how I was. It had been such a huge thing for me to walk back in there, and it felt like nobody cared whether I was there or not.
I remember thinking, I don’t want to work somewhere like this, I’m worth more than this. It was really clear to me that I was in the wrong environment, and I handed in my notice soon after that.
What I didn’t know then
What I didn’t know then was that I had ADHD, and that I was in perimenopause. It was a long time afterwards before I understood how the two were linked, and how much my hormones had been affecting everything. I was really lucky to have a fantastic GP. He was really lovely, and while he didn’t know a lot about ADHD, he had a really good understanding of the menopause and HRT. He started me on the right HRT and organised a follow up appointment soon after to see how I was feeling, and I felt really supported. I know how fortunate I was, as so many women don’t get that.
So why does perimenopause make ADHD so much harder? Oestrogen helps the brain make and use dopamine, the chemical messenger that helps with focus, motivation and getting things started. Dopamine is already at the heart of how ADHD works, so when oestrogen fluctuates and falls, the brain loses some of its support (Kooij et al., 2025).
Progesterone has a calming effect and can help with sleep. When that fluctuates and drops, your sleep is inevitably affected, and everything feels so much harder when you’re running on less sleep. You feel more overwhelmed, your emotions are harder to manage, and you can’t remember things the way you used to. Planning, prioritising and getting organised all become a real struggle. That lack of sleep has such a huge impact on everything.
For me, the strategies I’d created that had held it all together for years just stopped working. The lists, the routines and the coping tricks I’d relied on since I was young didn’t work any more, and I couldn’t understand why.
Are women with ADHD more affected by perimenopause?
The research is still catching up. A 2025 review found evidence that ADHD symptoms are linked to hormone changes in women, particularly around periods and puberty, but very few studies have looked at menopause yet (Osianlis et al., 2025). That gap is a big part of the problem.
What we do have is starting to tell us a lot. A large study from Iceland followed over 5,000 women aged 35 to 55. Women with ADHD had higher perimenopause symptom scores, and more than half had severe symptoms, compared with around three in ten women without ADHD. Their symptoms also seemed to start earlier, with the biggest difference in women aged 35 to 39 (Jakobsdóttir Smári et al., 2025).
A UK study from King’s College London found that the worse women’s ADHD symptoms were, the worse their menopause symptoms tended to be. The researchers also suggested that women with ADHD may put things like brain fog and forgetfulness down to their ADHD, rather than recognising that perimenopause might be playing a part (Chapman et al., 2025). In my case, I didn’t even know I had ADHD, so I had no idea where to start.
Why so many women are leaving work
I’m far from the only one. A UK survey of over 4,000 women aged 45 to 55 found that one in ten women who’d worked during the menopause had left a job because of their symptoms. That’s an estimated 333,000 women across the UK, and over four in ten said it had affected their ability to do their job (Fawcett Society, 2022).
These are women with years of skill and experience, walking away from jobs they’re brilliant at. That’s a huge loss to workplaces and to the economy. They’re bright, capable women and really valued members of staff. With the right support, and employers who understand ADHD and perimenopause, so many of them could stay. It’s so sad that they’re being lost for something that isn’t their fault, and that could so often be put right.
Nobody joined the dots for me. Not my colleagues, not the healthcare professionals I saw, and not me. I was a nurse, and I’d spent my whole career spotting when something wasn’t right with other people, yet I still didn’t see it in myself. So many of the signs of ADHD and perimenopause overlap: forgetting things, struggling to focus, feeling overwhelmed, not sleeping, emotions all over the place. When they show up together, it’s really easy for both to be missed, or for one to be blamed for everything. From the outside, it can just look like someone who’s not coping.
How can we start joining the dots sooner?
Start by getting to know your own patterns. Keep a note of how you’re sleeping, how your mood is, how well you’re focusing and where you are in your cycle, if you still have one. Patterns are much easier to spot written down, and they’re much harder for anyone to dismiss.
It also helps to look at your whole life, not just the last few months. ADHD is usually there from childhood, even if it was never picked up. Looking back at school reports, old jobs and how you coped growing up can help you see whether what’s happening now is new, or something that’s always been there and is now much harder to manage. If you think you might have ADHD, an assessment can be a really important step. Getting a diagnosis, even later in life, can help so much of your past make sense, and it opens the door to the right support.
HRT can make a real difference too. For many women, it helps with things like sleep, mood and hot flushes, and getting your hormones more settled can take some of the pressure off everything else. It doesn’t treat ADHD itself, but it can make everything feel more manageable.
Get your information from trusted sources. There’s a lot out there, and not all of it’s accurate. The NHS, the British Menopause Society and ADHD UK are good places to start. Dr Helen Wall’s book, Menopause and ADHD: How to navigate hormone flux and neurodivergence, is a really good read. Kate Organ is an ADHD and menopause specialist I trust and recommend, and you can find her on my website [link].
Talk to someone you trust. Saying it out loud to one person can change everything. It did for me. Finding other women who get it can help too. Hearing someone else describe exactly what you’re going through can be such a relief, and it helps you realise you’re not the only one.
If you’re feeling the way I did, like there’s no way out, please don’t wait. Talk to your GP, call NHS 111 or ring the Samaritans on 116 123.
What good support at work looks like
You don’t have to have all the answers or a diagnosis to ask for support at work. Reasonable adjustments, like flexible hours, working from home, written instructions, regular breaks and a calmer space to work, can make a real difference. If you’ve been off sick, a proper phased return, with someone checking in on how you’re doing, can make all the difference to whether you stay. An occupational health referral can help your employer understand what you need, and Access to Work, a government scheme, can help pay for extra support, such as specialist equipment or ADHD coaching.
The law is on your side too. In 2024, the Equality and Human Rights Commission published guidance making it clear that menopause symptoms can count as a disability if they have a long term and substantial impact on your day to day life. When that’s the case, employers have a legal duty to make reasonable adjustments (Equality and Human Rights Commission, 2024). ADHD can also count as a disability under the Equality Act.
The hardest part is when you work somewhere that doesn’t understand. That’s where education makes such a difference. Workplaces need training on neurodivergence and hormones together, not just one or the other, alongside menopause policies that recognise neurodivergence, and menopause and neurodiversity champions people can go to. When managers understand what’s going on, they can spot it sooner and help people stay in jobs they love.
Back to that phone call
I often think about how many other women are walking away from careers they’re brilliant at, for exactly the same reason. I think about that phone call too, and how one friend saying “ring the doctor now” changed everything for me. If I could talk to myself back then, I’d tell her she wasn’t failing. Her brain and body were going through huge changes that nobody had explained to her. I hope that if you’re feeling that way right now, you can remember that too.
Free downloads
I’ve got two free downloads that can help. One explains how your hormones affect ADHD. The other is a printable sheet showing which signs are ADHD traits and which are perimenopause symptoms, so you can take it to appointments and show clearly how each one affects you.
You can access these by clicking the link below.
perimenopause and menopause — SARAH WEST-ADHD.COM
References
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. doi: 10.1177/10870547251355006.
Equality and Human Rights Commission (2024) Menopause in the workplace: guidance for employers. London: Equality and Human Rights Commission.
Fawcett Society (2022) Menopause and the Workplace. London: Fawcett Society.
Jakobsdóttir Smári, U., Valdimarsdottir, U.A., Wynchank, D. et al. (2025) ‘Perimenopausal symptoms in women with and without ADHD: a population-based cohort study’, European Psychiatry, 68(1), e133.
Kooij, J.J.S., de Jong, M., Agnew-Blais, J. et al. (2025) ‘Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease’, Frontiers in Global Women’s Health, 6, 1613628.
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.
