Women at Work

She has been good at her job for years. Not just adequate. Really good. Experienced, reliable, knowledgeable. The person others turn to when something complicated needs sorting out.

Then something changes.

She is exhausted. Her concentration is less reliable. She forgets things she would once have remembered. Noise and interruptions that were irritating before are now almost unbearable. She is struggling to switch between competing priorities. She is sleeping badly and arriving at work already exhausted and overwhelmed.

She starts making mistakes.

Her confidence drops. Relationships become strained. Her manager notices.

And somewhere in the organisation, someone uses the words “performance issues”.

What happens next is revealing.

HR may begin thinking about performance management. The manager wonders whether she is coping. The OHS manager suggests the EAP. Someone recommends that she see her GP. If menopause is recognised, she might be directed towards a menopause policy or employee support resource. If she discloses ADHD or autism, the conversation may move toward the disability employment policy and reasonable adjustments.

Each response can be entirely well-intentioned.

But what if we are dividing into separate organisational problems something the worker is experiencing all at once?

And what if, by starting with the question “What is wrong with her?”, we miss the more useful question:

What has changed in the relationship between this person and her work?

We separate the things the worker experiences together

October creates an interesting collision of workplace conversations.

It is Mental Health Month. National Safe Work Month. ADHD Awareness Month. It is also Breast Cancer Awareness Month.

Different campaigns. Different professional disciplines. Different organisational owners.

Yet real people stubbornly refuse to organise their lives according to our departmental structures.

A worker does not leave her ADHD with Diversity and Inclusion before walking into a WHS meeting. She does not hand her menopause symptoms to HR before beginning a cognitively demanding task. Anxiety does not wait politely outside while performance management takes place. Sleep disruption, caring responsibilities, chronic illness, grief, trauma, hormonal change and workload do not arrive in neatly labelled folders.

They interact and collide with each other in both predictable and unpredictable ways and never at convenient times.

Our organisations, however, often separate them. We like to put things in boxes and label them. This goes in the HR box, that goes in the OHS box. Something else goes in the DEI box and finally the last problem, well that goes in the reasonable adjustments box.

If only life were so simple.

We have HR, OHS, well being, disability and inclusion, workers’ compensation, employee relations and performance management. Each box contains one part of the jigsaw puzzle.

No-one sees the complete picture until all the pieces are brought together.

Menopause is a useful example. A recent systematic review led by Monash University examined the evidence linking menopausal status and symptoms with work ability and productivity. Importantly, the researchers highlight the need for care in making broad claims about menopause and work: menopausal status itself should not be treated as synonymous with impaired performance, and the quality and consistency of the evidence matter (Taylor et al., 2025).

In other words, this is not an argument that women of a certain age inevitably become less capable at work. Quite the opposite. It is an argument against making assumptions about capability at all.

The woman who suddenly “isn’t coping” may not have suddenly changed

This becomes particularly interesting when we consider neurodivergence.

ADHD in women has historically been under-recognised, and research into female ADHD across the lifespan remains considerably less developed than it should be. A major 2025 review described the interaction between ADHD, hormonal fluctuations, mood and cognition as an important but still under-researched area. It identified delayed diagnosis, executive-function difficulties and reproductive hormonal transitions, including perimenopause and menopause, as important areas requiring further investigation (Kooij et al., 2025).

A 2025 systematic review was more cautious still. It found suggestive evidence that sex hormones may be associated with changes in ADHD symptoms, particularly around puberty and the menstrual cycle, but noted that the evidence base consisted of only 11 studies and specifically called for more research into menopause (Osianlis et al., 2025).

More recent clinical literature suggests that perimenopause may exacerbate or sometimes expose previously less visible ADHD difficulties, including inattention, emotional regulation difficulties, sleep disturbance and subjective cognitive complaints. But there are still no randomised controlled trials specifically addressing ADHD pharmacotherapy in perimenopausal women (Wynchank & Kooij, 2026).

So, we need to resist turning an emerging relationship into another simplistic workplace stereotype.

But we should also pay attention to what it may be telling us.

Imagine a woman who has spent 25 years building highly effective ways of getting through the working day. She double-checks everything.  She works longer than other people realise. She rehearses before meetings. She writes endless lists. She arrives early because she knows she loses track of time. She uses anxiety to create urgency. She avoids certain environments. She takes work home to finish it without interruptions. She watches colleagues carefully to work out what is expected socially.

She has become so good at compensating and masking that nobody, perhaps including her, recognises how much effort successful performance requires.

Then the equation changes.

Perhaps sleep deteriorates. Hormonal fluctuations affect symptoms. Caring responsibilities increase. The job becomes more complex. The organisation restructures. A supportive manager leaves. Hybrid working ends. Workload increases. Her physical health changes.

Strategies that worked for years no longer work quite so reliably.

From the organisation’s perspective, her performance has changed.

From her perspective, the cost of maintaining that performance may simply have become unsustainable.

That distinction matters enormously.

What looks like deteriorating capability may be deteriorating sustainability

Research involving autistic people experiencing menopause provides an important parallel. Early qualitative studies found that some autistic participants reported increased sensory sensitivities, difficulties with everyday functioning, greater challenges with emotional regulation and a reduced ability to camouflage or mask during menopause (Moseley et al., 2020).

More recent research continues to find both similarities and differences between autistic and non-autistic menopausal experiences. A 2026 study involving 15 autistic and 14 non-autistic adults found shared difficulties, including psychological changes and inadequate information, alongside additional challenges reported by autistic participants, such as uncertainty-related anxiety, healthcare barriers and the accumulated effects of living for years without an autism diagnosis (Piper & Charlton, 2026).

Another qualitative study of 21 autistic adults experiencing or having experienced perimenopause reported increased sensory sensitivities which, for some participants, compounded other menopausal symptoms (Cusano et al., 2025).

These are small qualitative studies. We should not generalise their findings to every autistic woman. But neither should employers ignore what they reveal. Because they point towards something occupational health and safety professionals already understand. Risk is produced by an interaction between the person, the task, the environment and the conditions under which work is performed.

Psychosocial hazards do not land evenly

This is where the conversation moves beyond menopause awareness and into work design. Safe Work Australia identifies psychosocial hazards including high job demands, low job control, poor support, lack of role clarity, poor organisational change management, poor organisational justice, poor physical environments and workplace conflict. Employers operating under the model WHS framework are required to manage psychosocial risks, just as they manage other workplace risks (Safe Work Australia, 2022).

But identifying a hazard is only the beginning. Workers do not necessarily experience the same exposure in the same way. Consider a workplace with constant interruptions.

For one employee, they are mildly annoying. For another, the repeated attentional switching creates a substantial additional cognitive demand.

Consider unclear priorities. One employee may comfortably infer what matters most. Another may spend considerable cognitive effort trying to resolve competing instructions and ambiguous expectations.

An open-plan office might be energising and motivating for one worker and a relentless source of sensory overload for another.

Rigid scheduling may be inconsequential for one worker but remove the very strategies another uses to manage concentration, fatigue, medication, sensory load or sleep disruption.

Low job control can be particularly relevant here. Safe Work Australia specifically identifies rigid processes, limited ability to alter workflow and a mismatch between autonomy and a worker’s abilities as potential manifestations of low job control. Its suggested controls include giving workers greater control over workflow and building flexibility into processes (Safe Work Australia, 2022).

Similarly, lack of role clarity includes changing expectations, conflicting instructions and unclear priorities, precisely the conditions that can increase cognitive demands on workers who already expend substantial effort organising, prioritising and switching attention (Safe Work Australia, 2022).

None of this requires us to invent a special category of “neurodivergent psychosocial hazards”. The hazards already exist. What changes is the level of risk. Exposure, experience and consequence vary in individuals. So, a low risk to one may be a high risk to another. Risk is not universal.

This is consistent with the systems approach I have argued for previously. Neurodiversity needs to be considered within occupational health and safety systems, worker consultation, performance management and work design rather than treated solely as an individual adjustment issue.

Mental health is part of this picture. It isn’t the whole picture.

This distinction becomes especially important during Mental Health Month. Neurodivergence is not a mental illness. Menopause is not a mental illness. A difficult job is not a mental illness. Poor work design is certainly not a mental illness.

Yet every one of these things can interact with psychological health.

If we wait until a worker develops significant anxiety, depression, exhaustion or psychological injury before acting, we may find ourselves treating the outcome while leaving the contributing conditions untouched.

That is the danger of allowing every difficult workplace experience to collapse into the language of “mental health”. It subtly relocates the problem. High workload becomes stress. Stress becomes anxiety. Anxiety becomes the worker’s mental-health problem.

And before long the organisational response is counselling, resilience training or medical treatment, while nobody has changed the work.

This is not an argument against treatment, counselling or EAPs. They can be extremely valuable. It is an argument for remembering where injury prevention begins.

With work.

This is where occupational health belongs

Occupational health is sometimes reduced to a gatekeeping function. Is this person fit for work? When can she return? What restrictions does she have? Does she have a diagnosis?

Those questions sometimes need answering. But occupational health can do considerably more.

Its real value sits at the interface between health, person and work.

Instead of asking only, “What medical condition does she have?”, we can ask:

What functions are currently affected? What demands does her job place on those functions? What has changed? Which parts of the work remain easy? Which now require disproportionate effort? What barriers are present? What happens on a good day compared with a difficult one? And what could we change about the work to reduce the mismatch?

That approach also avoids a trap I see repeatedly in neurodiversity practice, waiting for somebody to arrive with a diagnosis and a letter from their doctor requesting adjustments, before allowing the organisation to become flexible.

We don’t wait for workers to disclose a pre-existing musculoskeletal injury before identifying, assessing and controlling that hazards associated with manual tasks. We act proactively to reduce risk before anyone is injured.

A workplace does not need to know why somebody concentrates better with uninterrupted work time before considering whether uninterrupted work time is possible.

It does not need a diagnostic report to make instructions clearer.

And a worker should not have to reveal deeply personal information before a manager becomes curious about why a previously successful employee is struggling. Good work design does not require everybody to prove that they are different.

From a well being initiative to risk management

October will inevitably bring workplace events. There will be mental-health morning teas, menopause webinars, Safe Work Month activities and ADHD awareness posts. And that’s good! Awareness matters.

But awareness without systems change has a very low ceiling. Yoga cannot resolve impossible workloads. A mindfulness app cannot create role clarity. Resilience training cannot make an inaccessible process accessible. An EAP cannot give a worker control over a job that has been designed with none. And a menopause-awareness session cannot compensate for a manager who responds to changing performance by immediately escalating pressure.

Safe Work Australia’s guidance is explicit that psychosocial risks should be eliminated where possible and otherwise minimised so far as is reasonably practicable, including through good work design. It also requires consideration of how hazards interact and combine (Safe Work Australia, 2022).

That last point deserves more attention. A worker experiencing high job demands, low control, poor sleep, sensory overload, caring responsibilities and hormonal change does not experience six separate risk factors.

She experiences Tuesday.

And if she is also neurodivergent, the cognitive, sensory or emotional demands of that Tuesday may be different again. We cannot teach people to cope their way out of poorly designed work.

So, what should employers do?

The answer is not to create another awareness month, another silo or a 47-page “Women with ADHD Going Through Menopause Policy”.

Start with the work. When an experienced worker’s performance changes, resist the urge to immediately decide what the change means. Ask what has changed around the person as well as within them.

Consult properly. Ask workers how work is experienced rather than assuming that a risk assessment conducted for an imaginary average worker tells you how everyone experiences the job.

Build flexibility around function wherever possible rather than making every variation dependent upon disclosure and diagnosis.

Give managers enough understanding of neurodivergence to recognise that executive functioning, sensory processing, communication and attention can influence how work is experienced, without turning managers into amateur diagnosticians.

And connect the systems that organisations have spent years separating.

OHS should be talking to HR. HR should understand work design. Wellbeing should understand psychosocial risk, and everyone should understand neurodivergence.

Performance management should have a doorway back to support and risk assessment when a previously capable employee begins struggling.

Neuroinclusion should not sit somewhere off to the side as a diversity initiative. It belongs in the way work itself is designed and managed.

That is why neuroinclusive policy design needs to consider accessibility, variable capacity, alternative communication pathways, reasonable adjustments and the possibility of diverting someone towards support before a formal process unintentionally compounds their distress.

Perhaps she was never the problem

So, return to the woman we met at the beginning. The experienced worker who is exhausted. Forgetting things. Missing deadlines. Overwhelmed by interruptions. Beginning to wonder whether she is still capable of doing a job she has done successfully for years.

Perhaps she is experiencing perimenopause. Perhaps she has ADHD that was identified late in life. Perhaps she is autistic and has spent decades camouflaging. Perhaps anxiety has developed. Perhaps she is caring for ageing parents and teenage children while working in a role that has quietly expanded by 30 per cent. Perhaps several of those things are true. Or perhaps none of them are.

We do not need to diagnose her from across the conference table to recognise the most important principle. Human capability is not produced by the person alone.

It emerges from the interaction between the person, their health, the demands of the job, the environment in which it is performed, the resources available to them and the way the organisation responds when something changes.

For years, she may have fitted the system extraordinarily well. The question now should not simply be why she can no longer fit it.

Perhaps it is time to ask whether the system still fits her.

Register today for our complimentary webinar

On 28 October, I’ll be continuing this conversation with Rachael Cook and Emma McCartney in our complimentary webinar, Women at Work: Menopause, Mental Health, Neurodiversity and More.

We will explore what happens when women’s health, neurodivergence, psychological health and work intersect, and what employers, occupational health professionals, Hr professionals and leaders can do differently when they stop treating those experiences as separate problems.

Because women do not experience work in silos. Perhaps it is time our workplace systems caught up.