‘It really hits them quite hard’: experts explain why for many mid career women with ADHD, perimenopause is not just a life stage – it is when already fragile focus, mood and capacity at work start to fray
Canadian employers are facing a largely unseen performance risk as perimenopause symptoms collide with ADHD in midlife women, amplifying brain fog, fatigue and executive‑function challenges just as many are at the height of their careers.
According to a recent GreenShield survey conducted by Ipsos, women with both conditions are more likely to say their symptoms affect their work performance, report higher rates of reduced productivity, consider leaving their job and take more sick days than those without ADHD.
Canadian neuropsychologist Brandy Callahan, research chair and associate professor of psychology at the University of Calgary, says the survey is added proof of what she’s been hearing from her own research participants, “for literally the last decade. That menopause is an issue that exacerbates their ADHD symptoms, and that it really hits them quite hard.”
Why hormone shifts hit ADHD brains harder
The intersection of perimenopause and ADHD is only recently starting to be looked at by researchers, Callahan explains, meaning employees with both conditions have until now been flying solo and without a safety net. But what has been discovered so far is impactful, she says; there is growing evidence that estrogen and dopamine work together to support thinking and mood – and that when estrogen falls, women with ADHD feel it more.
“Higher dopamine means clearer thinking and better mood, essentially, and estrogen facilitates the activity of dopamine,” Callahan says.
“The reason that this is so impactful for women with ADHD is that ADHD is a condition in which dopamine signaling is already abnormal, so you take a woman whose dopamine transmission in the brain is already less efficient or not typical, and then you throw in reductions in the one thing that can facilitate dopamine … it does make sense intuitively for women with ADHD to experience disproportionate impacts of perimenopause.”
The hidden 'triple shift' and masking
The Ipsos–GreenShield survey shows how those impacts translate into work metrics: women who seek menopause care report reduced productivity, short‑term leave and, for some, thoughts of quitting.
But, for women with ADHD, the reported work impacts – from reduced productivity to higher mean sick days – are even more pronounced.
As Faelyne Templer, former board chair and current volunteer at the Centre for ADHD Awareness, Canada (CADDAC), explains, the impact makes sense because ADHD strikes at the skills most workplaces demand.
“When we think about ADHD and executive functioning, we think about time management, task initiation, being able to start things, finish things, not put things off,” Templer says.
“We’re also talking about emotional dysregulation in many cases as well. So when we think about the kinds of skills and behaviours we need in the workplace, we can see there’s a bit of a disconnect there.”
She stresses that many of these employees are also carrying a “triple shift” outside of work, particularly in the 'sandwich generation' which includes many women in the window for perimenopause onset.
“Women primarily do the bulk of home and childcare … in today's day and age, that's still the case predominantly,” Templer says, adding that multi-generational ADHD diagnoses are also on the rise, with many women discovering their ADHD through their children or elders with the disorder.
“So we have this woman in perimenopause, with ADHD, who is supporting a child, young teenager or young adult, potentially caring for elders," also with the condition, she says. "We've got three generations of ADHD, and then they're working, in a neurotypical environment.”
Callahan adds that the internal strain can be heavier still because many women feel pressure to hide the extent of their symptoms. “Masking” is a common practice among neurodivergent individuals wherein a conscious effort to appear neurotypical will be made, often to their own detriment.
“Women in the workplace tend to feel the need to mask more than men,” Callahan says, “so to hide their symptoms, which women often describe as very taxing cognitively. It takes a lot of effort to present in a way that doesn't feel authentic.”
Designing workplaces and simple accommodations
As the Ipsos-Greenshield report suggests, that combination – higher demands at home, fluctuating cognition at work and the energy cost of masking – helps explain why some mid‑career women with ADHD appear to “hit a wall” around perimenopause.
Women report at least some performance impact from menopause symptoms, while more than half say their employer offers no support for hormonal health and almost a quarter are unsure what exist.
As Templer, also an executive function and leadership coach, explains, workplace design and day‑to‑day practices can either magnify or ease these pressures – especially as more employers insist on in‑office time, where neurodivergent employees confront barriers to work that can be debilitating or even lead to job loss.
“Most office-based environments now have those open concepts,” Templer says, explaining a typical scenario for someone struggling to focus.
“We know that routine is critical for effective management of ADHD. Let's say you do get your desk, and you are sat down there, and then every three seconds, you see somebody just walking by, and that visual distraction takes you out of whatever you're working on. And when you think about the switching cost to bring yourself back, your productivity is shooting through the floor.”
Those details translate into concrete design questions for employers: Can employees who need it have consistent seating? Are there quieter zones or focus rooms available, particularly for work that requires sustained attention? And crucially, why are employees being forced to come to an office if it’s not necessarily beneficial?
For Templer, the goal is to design for the most stretched workers – and lift everyone else in the process.
“When you design for the edges, you get the middle for free,” she says.
“When we think about putting in place accommodative structures, it often benefits more than the community for whom we put those in.”
Education around menopause and ADHD – not just for women
Callahan sees education and dialogue, paired with basic flexibility, as an equally important lever for HR. Training on neurodiversity and women’s health, she says, should be offered to all employees, not just women, so that managers and colleagues understand why certain adjustments may be needed.
Open conversations also reduce the stigma around talking about women's health, normalizing a condition experienced by half of a company's workforce.
“When the topic is less taboo, or when it's more normal, women may feel more comfortable asking for things like flexible start and end times, or the possibility of working remotely if they're having a bad symptom day or something like that,” Callahan says.
“I don't necessarily think they need to be formalized in policy, but I think educating people in the workplace, that's the first step in making people more aware of little changes that can be made.”
For Templer, the bottom line for employers is that these conversations should be about how people do their best work, not necessarily about diagnosis. That approach, she says, aligns inclusive design, legal obligations and business outcomes.
“People can request accommodations without disclosing diagnosis, and there's people who, this is how they work, they don't have a formal diagnosis,” she says.
“By making it safe for people to work in the way that they do best, it's that ‘rising tide that lifts all boats’. Your productivity goes up, your employee engagement goes up, and we know that psychological safety pays off in productivity and engagement.”
