Divergent Menopause (previously The Autistic Perimenopause)

Hello and welcome to Divergent Menopause with Sam Galloway.

Today I'm going to read to you the quadruple empathy problem.

Autism, ADHD, menopause, and why we are still the ones expected to adapt.

Empathy.

According to the Cambridge Dictionary,

the definition of empathy is the ability to share someone else's feelings or

experiences by imagining what it would be like to be in that person's situation.

Empathy

the ability to share someone else’s feelings or experiences by imagining what it would be like to be in that person’s situation

Source: Cambridge Dictionary

This Elder Millennial vividly recalls standing in front of the bathroom mirror in my locked family bathroom, aged 7 or 8 or so. Forcing tears to stream from my eyes, my crying voice rasping, feeling the hot slime from my sinuses dripping down the back of my throat, I didn’t feel sadness. Perhaps we can grow out of alexithymia, but the act of crying on cue did not prompt emotion. Reflected back to me in the mirror was a girl who cried, smiled, and laughed at all the wrong times. Many hours were spent alone learning to morph my face to look how it was expected of me.

“Too much”, “not enough”, “too sensitive” and “insensitive”, were some of the labels attached to me whenever my childhood response was perceived to be misaligned with the social expectation. Learning the rules of emotional expression was arduous and exhausting. Watching the neurotypical girls whisper about me, then trick me into thinking they were my friends before not long later calling me fat, ugly and ginger, was my daytime schooling.

Where was their empathy for me?

Burnout regularly ensued.

Life was endlessly confusing. For reasons still unclear to me, as a girl screaming and crying in pain when I was injured and hurting was deemed over the top. Yet silently sobbing myself to sleep was apparently fine. I learnt that as long as I could hide my emotions from others, I was safe. The agonising intensity of my emotions was not for public consumption, and my pain and anguish was supposed to be kept private.

Crying into the mirror, was an instinctual exercise in social masking. Self-set homework was studied only by the special girls like me, in secret, whilst everyone else got on at home with learning more traditionally academic subjects, and playing with easily found and kept friends. My social skills learning was autodidactic in my early years, but would pay off in time when I took it upon myself to achieve an upper second-class honours degree Bachelor of Science in Psychology.

The classic Psychology undergrad degree A.K.A. the neurodivergent thinking woman’s endeavour to cognitively grasp concepts behind individual and collective human thoughts, motivations, neurology and behaviours. Including (neurotypical) empathy. Using our strengths of curiosity, pattern recognition and intellect, we endeavour to compensate for the neurodevelopmental lagging skills that made too many of our childhoods a misery.

The unrelenting stereotype of neurodivergent people is that we cannot comprehend the emotions of others, never mind be able to empathise with them. It would still be two decades before my autism and ADHD were identified.

Despite our extreme efforts to performatively show our emotions in a dignified, standardised and socially acceptable manner, many female and AFABs pre-diagnosed autistic, ADHD and AuDHD can also gaslight ourselves into thinking that we can’t be neurodivergent. How can we be neurodivergent when we show too much emotion, rather than none at all? Our emotional dysregulation can trigger us to weep, and seeing such intense public displays of empathy can make other people uncomfortable.

Neurodivergent empathy looks different.

But our late identification has prompted family members and society at large to think that we are just jumping on the “latest trend” of autism and ADHD.

For those of us who are exquisitely high masking and often with co-occuring giftedness, the assumption is that we can empathise in a neurotypical way, but we choose not to. Too often, we are regarded as arrogant, manipulative, and over- or under- performative.

When we eventually receive a diagnosis, having fought a lifelong battle to fit in with the people who love us the most yet understand and accept us the least, it becomes clear that neurotypicals also have difficulty showing us empathy.

Our emotions look different.

Our empathy looks different.

Many late diagnosed neurodivergent women and AFABs, consider ourselves to be deep empaths. For decades, we have masked our emotional intensity, and yet we are often the first to donate to worthy causes and to cry at distressing world news stories. The challenge for us isn’t whether or not we can respond emotionally to others. The challenge for us is self-regulating our emotional responses. When the intensity of our emotional responses is socially unacceptable, we are labelled “too much” and/or “not enough”.

Sobbing in work meetings.

Melting down during minor disagreements.

Shutting down when newly bereaved.

Our emotional intensity sets us apart from the majority. To me, this is an advantage to being neurodivergent. But we hide it, moderate our emotional responses, and stop our faces from giving us away, in order to avoid rejection.

When the societal norm is to visibly empathise swiftly then move on, our deep empathy is feared and misunderstood. Public crying is deemed shameful, and being told to “grow up” as kids really meant “keep it to yourself”. Hiding our pain doesn’t stop us from feeling it.

We made it our mission to pass for normal, and we were picked apart regardless.

Our natural response as neurodivergents is pathologised as emotional dysregulation, and we are medicated, therapised and/or shunned to obscure our differences from the world.

Many of us learn to shield ourselves from our emotional triggers, for example, by actively avoiding live footage broadcasts of global catastrophes, and the effects of their aftermath.

Other neurodivergents may enter politics, education and other influential institutions to try and change systems from the inside in a bid to improve life chances for all, reverse the climate crisis and drive other social justice causes that they empathise with deeply.

By midlife, we have learnt to mask and moderate our neurodivergent empathy and emotional responses. Repeated rejections, perceived “failings” on our part and collapsed relationships have taught us to hold it all inside whatever the cost. Lived experience tells us that we are not safe acting as ourselves in the world at this time. It can be hard to know where the line is between who we inherently are, and who we are pretending to be.

We may know when we are okay to be around other people, scheduling our social engagements around our menstrual cycle. Some days and weeks we can’t be trusted to people.

As highly sensitive people, we respond to our hormones with the entirety of our minds and bodies, and so we may avoid certain people and activities when hormonal volatility is predicted.

Hormonal flux becomes unpredictable as we approach the menopause transition. We no longer possess the self-regulatory capacity to moderate our every word, action and facial response. Regressions in functioning occur, and our second nature skills of masking are lost. It can be terrifying to go into meltdowns from triggers that you have coped with masked for decades.

In perimenopause, this can trigger the sense of intense loss of self.

But there is light at the end of the tunnel. In the later stages of neurodivergent perimenopause and beyond, fewer f***s are given. Literally and metaphorically.

We can come back to ourselves, find our neurotribe, and settle into a lifestyle that lends itself to managing our energy expenditure. We align the generous gift that is our empathy where it is validated, wanted and most needed.

Neurodivergent-driven research on the topic of empathy in the menopasue transition is developing, and what follows is a selection of the work on empathy so far.

The Double Empathy Problem

Many of us late diagnosed neurodivergent adults will have come across the theory of the double empathy problem whilst trying to figure out why we have felt so misunderstood for much of our lives. Often attributed as an issue for autistic people when communicating (or trying to) with neurotypicals, the double empathy problem originates from a much wider concept.

First coined “the double empathy problem” by autistic researcher and sociologist Dr. Damian Milton in 2012, Milton drew on the notion that people of different cultures may often struggle to find some common ground, and experience communication breakdowns in the process.

‘Simply put, the theory of the double empathy problem suggests that when people with very different experiences of the world interact with one another, they will struggle to empathise with each other. This is likely to be exacerbated through differences in language use and comprehension.’

UK National Autistic Society: The double empathy problem

Misunderstandings in mixed neurotype relationship dynamics have for too long been considered the fault of the neurodivergent partner. And this goes for all types of neurodivergence, despite the strong link the autistic community has with the double empathy problem. It is just as likely to be an issue for a stereotypically enthusiastic and energetic ADHDer or AuDHDer to be brushed off as “annoying” and “too much”.

The double empathy problem theory provides reassurance that we are not the problem. Our supposed social deficits and communication differences are only apparent and obstructive when we are communicating with people who do not share our neurotype.

This is why finding our neurotribe is invaluable to adults who self-identify as or are diagnosed neurodivergent. “I don’t understand you” is too frequently said to neurodivergents by their neurotypical partners, as though they are just not trying hard enough to make themselves understood. There is often very little flexibility from the neurotypical to try to understand their partner, who may already be struggling and exhausted from every single interaction, every single day.

The time it takes for this awareness to occur can cost us our self-compassion, self-esteem and even our sense of self. Not wanting to face rejection after rejection, we learn from every social exchange with neurotypicals, and tweak our responses accordingly. It is not uncommon for later in life self-identified and diagnosed neurodivergents to have adopted another persona entirely.

Masters of mimicry, and driven by a biological human instinct to be accepted, too many of us spent our formative years studying (and failing) how to appear acceptable, on the social periphery studying peers in the playground, obsessive book character analysis, copying soap opera stars’ mannerisms and so on.

Hopefully our younger neurokin no longer need to do this because surely all the teachers, SENCOs, practitioners and parents are clued up about the double empathy problem by now..?

The Triple Empathy Problem

Have you ever visited a healthcare practitioner and felt like you have not been understood, validated and treated appropriately?

Unfortunately, this has been the norm for neurodivergent patients for all too long. Sometimes complicating factors make us seem too hard for the average doctor to want to work collaboratively with us. Finding healthcare providers who are willing to learn about nuances in health profiles, such as differing cultural and ethnic groups, co-occuring chronic health conditions, mental health conditions and increased likelihood of gender dysphoria and/or being trans can make medical visits feel harder than they need to be.

On average, autistics and ADHDers have shorter life expectancy than neurotypicals. This may be because we do not experience pain and report symptoms in the manner medical professionals are used to. Sensory overload in clinical settings may reduce our capacity to engage. Executive functioning challenges make it a struggle to book and attend appointments, collect prescriptions, and remember to take our meds. There is a myriad of reasons why our life expectancy is shorter due to our neurodivergence, but it is unacceptable and shouldn’t be our burden to carry alone.

Why is this not widely known, and managed as a systemic health crisis?

In 2023, Shaw et al. took the double empathy problem theory, situated it within the medical context, and coined the term the triple empathy problem.

‘Patients struggle to see their doctor’s perspective, and doctors can also struggle to see their patients’ perspectives. For example, when doctors are patients themselves, they experience healthcare with their own medical knowledge. The difficulty is seeing the perspective of a patient without any medical knowledge. Similarly, autistic people struggle to see non-autistic people’s perspectives and vice versa. So, it proves even harder for autistic patients to see their (non-autistic) doctor’s perspective, and even harder for (non-autistic) doctors to see autistic patients’ perspectives… This triple empathy problem may also be at play when autistic people interact with other professions and services, such as education, social care or the justice system.’

Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults: A qualitative study by Shaw et al. (2023)

In my experience, working collaboratively on my medical issues has been best achieved when my healthcare providers are neurodivergent themselves. Unfortunately, it is not always safe for doctors and health practitioners to disclose their own neurodivergence in the workplace. Proactively seeking neuro-affirming medical staff throughout our lifespan to support us could be most effective, giving us the best possible health outcomes. Yet self-advocacy can still be extremely challenging, especially when we are already feeling depleted and sick.

Training is essential for this travesty to be corrected, and there are recommendations for healthcare practitioners to adopt in order for our neurodivergent cultural differences in social communication, pain response and identification plus other variations to be best accommodated.

Building on Shaw et al’s findings, Doherty et al. (2023) developed Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings.

‘This (the Autistic SPACE framework) encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.’

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings by Doherty et al. (2023)

The Doherty et al. paper is packed full of great information on neurodivergent inclusivity that should be compulsory reading for all patients, medical staff, therapists, holistic practitioners and health boards. I strongly encourage you to take a look at the table of Recommendations for supporting Autistic SPACE in practice, because I think you will feel totally validated. (Screenshots of the table are below, with credit to Doherty et al., 2023).

Sensory processing disorder is a form of neurodivergence that co-occurs extremely highly with autism and ADHD, and we all have differing sensory sensitivities and tolerance levels. Hormonal fluctuations during perimenopause and beyond exacerbate these differences, and can make day to day life feel torturous. Temperature dysregulation can worsen, joint pain may feel agonising, and menstrual cramps can combine, putting us into a sedentary lifestyle.

Shutdowns, meltdowns and periods of inertia may increase, forcing our functioning to plummet to a debilitating extent.

Spiralling hormones drive our mood, cognition and energy levels to spiral too. Just when we have the least capacity to understand what is going on for ourselves and self-advocate, we need to do so more than ever before.

The Quadruple Empathy Problem

Widespread symptoms of the menopause transition may affect neurodivergent people to the extreme. The mind and body effects of fluctuating oestrogen, progesterone and testosterone production can lead to regressions and an inability to function. This was certainly the case for me, but I hope you are faring better!

Midlife burnout for neurodivergent women and AFABs is often misattributed to factors other than hormonal flux, and therefore we are prone to being misdiagnosed and medical gaslit, resulting in inappropriate treatment.

In their 2024 study “A perfect storm”: Autistic experiences of menopause and midlife, Brady et al. identified menopause as the fourth dimension of the empathy problem.

Shaw et al. (2023) described a triple empathy problem where autistic people struggle to make themselves understood and understand those of other neurotypes in the context of medical settings.

We found an added dimension where communication challenges were even more profound for some autistic participants transitioning through menopause, combined with what we would characterize as medical misogyny; this could be seen as creating a quadruple empathy problem.

Some participants indicated that menopause was reminiscent of former experiences of hormonal transition like puberty and menarche, transitions in which they had also struggled with communication…

… A key takeaway is the importance of person-centred, autism-informed healthcare that considers intersectionality and accessibility needs. We encourage healthcare professionals to recognize autistic communication styles and the various symptoms of menopause, including those that are less widely discussed, and to be receptive to the fact that menopause may start earlier than is commonly expected.

Brady et al. (2024) “A perfect storm”: Autistic experiences of menopause and midlife

Medical gaslighting of neurodivergent menopause is still prevalent, with women and AFABs being told we are too young to be experiencing symptoms. When neither the practitioner nor the patient are well informed about menopause and/or neurodivergence, the chances of appropriately treating her symptoms are extremely unlikely.

There is also some emerging research into ADHD and menopause, such as the academic paper ADHD in females: Survey findings on symptoms across hormonal life stages by Osianlis et al. (2026). Their results showed that 97.5% of participants perceived a worsening of ADHD symptoms during menopause, but as it was self-reported data, there are limitations in extrapolating these findings. However it does suggest that more research is needed in this area.

As an AuDHDer, I find it concerning that research continues to polarise women and AFABs by their neurodevelopmental conditions. Surely we don’t need to continue studying ADHD and autism separately when both co-occur so strongly. I cannot separate the effects of menopause on my ADHD versus my autism as they are equally integral to my human experience.

If widely applied in medical settings, the Autistic SPACE framework shared above could transform our interactions within the healthcare system, and improve our life chances.

With so many multipliers to the empathy problem, neurotypical people need to take equal responsibility in understanding how neurodivergents perceive and cope in this world which rarely has our best interests at heart. Children should be accepted as they are, without having to waste their childhoods fawning “normal”, regardless of their neurotype.

By the time the younger generation growing up today reach midlife, this all needs to be understood and standard practice within all healthcare institutions. Neurodivergent friendly medical settings and neuro-affirming practitioners will enhance our life chances, whilst providing the validation and supports we have lacked for so long.

I would love to hear from you in the comments!

* Do you relate more to the double, triple or quadruple empathy problem?

* Do you feel the biggest empathy breakdowns happen in your relationships, healthcare, workplace or family?

* Has your menopause transition affected your experience of giving and receiving empathy?

Cheers,

P.S. Please excuse typos and general nonsensical grammar. This essay taken me hours and hours and hours to write, edit, review, rewrite, edit, record the audio voiceover and upload to publish. Whilst I can report an astonishing improvement in my quality of life now that I am in surgical menopause, the lingering effects of the heavy sedation and general anaesthetic from August 2025 are still with me. 😵‍💫

If this resonated, you are not alone — and you deserve spaces where your empathy isn’t pathologised. Paid subscribers help sustain this work and gain access to deeper dives, research breakdowns, and a community that empathises with you.

For anyone who’s ever silently lost their s**t at doctors, hormones, or Ken: this is your AuDHD Barbie, finally done pretending.

Originally titled. "Introducing AuDHD Barbie".

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I am Sam Galloway (she/her), an autistic ADHDer, and I have recently had a hysterectomy. As a neurodivergent perimenopause and PMDD survivor, I offer peer support and share knowledge on how to make it through the hard times.

Thanks for joining me on this wild midlife ride! 🎢

This is a snapshot in time of Barbie in midlife, who is late diagnosed Autistic, with co-occuring ADHD (AuDHD), in the throes of hormonal flux and she does not have enough f***s left to give.

In this spoof piece, let me take you into Barbie’s messy Dream House where our protagonist can safely self-regulate and drop her social mask…

AuDHD Barbie - or just “Barbie” to her friends - ignored her ringing phone, as Ken came through to her voicemail message: “Hi, it’s Barbie. Please do not leave a message. Text me, but only if it is important. Bye.”

“For f**k’s sake, Ken”, Barbie muttered under her breath finally picking up as Ken rang through yet again. “This had better be important”, Barbie seethed down the line. “No, I don’t want to go to the beach party. I already told you! None of my clothes fit me anymore and my stupid period just started. How can I be bleeding again? It is only sixteen days since my last - hello? Ken?!”

The dead phone line was the most soothing sound Barbie had heard all day.

Barbie high fived herself. Period talk always made Ken cut his conversations short. Barbie believed that sand was cursed, and a cold shiver coursed through her body at the thought of ever having to go to another beach party again. This gave some light relief to her otherwise 24/7 hot flush. It was all right for Ken to go, he wasn’t experiencing hormonal mania making him rapidly lose muscle mass, bone density and his entire sense of self.

Yes, things were just fine for Ken as always. Whilst he grinningly pumped iron and mainlined a creatine and protein powder blend on the daily, Barbie was forgetting to eat. Her only exercise was to burn calories through hanger-induced meltdowns. Her lifelong body dysmorphia was now at its peak.

Looking down at her bloated meno belly, Barbie felt that she was retaining more water these days than there was in the entire ocean. ‘Calorie deficit diets’ were no longer working for her. Nor was intermittent fasting, the 5-2, Mediterranean, Paleo, Keto, Whole30, low FODMAP, low histamine, or eating only even numbered quantities of beige foods during even numbered hours of the day.

Barbie collapsed into her sensory swing, kicked off her high heels and threw them across the room. They had been digging into her cankles, and she applied an ice pack to the ankle she had badly rolled earlier that day. Not for the first time, she dry heaved at the sight of the thick dark hairs growing at right angles out of her once dainty feet and toes.

What is wrong with me? she wondered to herself. I used to love beach parties and hanging out with Ken. Now I just want to kill him every time he comes near me! God, he is such a dick.

Barbie excavated the teetering mountain of hot pink dirty laundry to find the remote control for her cooling fan, trying not to disturb her sleeping cats. Turning her fan on to the max helped redistribute the air flow, which was currently carrying the unmistakable odour of the cat s**t in the nearby litter box.

For f**k’s sake, Ken! Barbie thought to herself again, as rage filled every fibre of her being faster than any number of mindful deep breaths could diffuse. Scooping the cats’ s**t is a blue job. Why haven’t you f*****g done it?

Even if she had wanted to, Barbie couldn’t scoop the litter boxes; not with her tennis elbow, frozen shoulder and splinted hypermobile wrist that her doctor had said in no uncertain terms were not symptoms of perimenopause.

“Well, Ms AuDHD Barbie, you are in the prime of your life”, the doctor had told her earlier that day, whilst attempting to look both up her itchy short skirt and down her scratchy scoop neck top. Barbie could feel hives emerging across her chest, but she resisted agitating them with her brittle nails. She would wait until she got home, and then rub them raw until they bled. Bliss!

“Allow me to assure you that you are too young to be experiencing menopause symptoms”, her doctor went on. “And, might I add, that you do not look autistic, and you are far too successful to have ADHD. Your lab results are fine. Your estradiol is at normal levels. You are still a very fertile young woman.”

His lack of eye contact was now vexing her, ironic given that her own reported discomfort at holding a gaze was flagged in her recent autism assessment. Yes, for decades she had masked endlessly, with her iconic plastic moulded smile rouged to constant perfection. But now she felt ready to tear off the mask and stamp on it right there and then in the doctor’s office.

“Look,” the doctor had gone on, “I will note your concerns but, for the record, I am of the professional opinion that you have nothing at all to worry about. You are seeking diagnoses unnecessarily. There is no cure nor treatment for neurodivergence or perimenopause anyway. This trend of over diagnosing autism and ADHD is getting out of hand! We all know that males are 1,000,000 times more likely to be neurodivergent than females. Not to mention the fact that women cope with it. Why would a woman of your standing want a diagnosis when you have managed fine all your life until now?”

Barbie was mute. Situationally, not selectively. Despite scripting the discussion in advance over and over in her head, she could feel her neck and face burning, hot tears pricked her eyes. She sniffed them back. A thousand retorts would fire around her mind like pinballs in the hours and days that would follow, yet for now she froze in despair and panic. Her ever saggier face remained static, fixed with a wry smile. Barbie’s now unfocused eyes were blurring off into the distance, as she wished she could be anywhere else.

“This is all in your pretty little head. How does Ken feel about all of this?”, the doctor went on. “I can increase your SSRI dose but I cannot offer you hormonal therapy because the significant risks are not worth the supposed benefits. You are fine. Keep doing what you are doing. I am here any time you need to see me for support and advice.”

Barbie was already so f*****g sick of being objectified and patronised, but medical gaslighting was a new one on her. She decided not to tell this professional pervert all the other worries she had noted down to prompt the consultation. Bleeding gums. Loose teeth. Itchy ears. Cognitive decline. Urinary incontinence. Insomnia. Losing all her stuff. Suicidal thoughts. And that the sight of Ken in all his so-called glory did nothing for her anymore, and that she was feeling dead inside. Particularly ‘downstairs’. Her vagina was rapidly becoming nothing short of warped, and some prolific Googling of the mind-blowing symptoms of perimenopause had led to a self-diagnoses of vaginal atrophy and pelvic organ prolapse.

If Ken only knew that my vag feels like someone has taken a cheese grater to it, and that my kamikaze uterus is doing it’s best to sacrifice itself, Barbie thought, he might stop calling me all the time and let me live in peace.

No. Despite feeling broken, Barbie hadn’t mentioned her more sensitive gynaecological ailments to this doctor, and instead made a mental note to find a neuro-affirming menopause specialist doctor, and develop her self-advocacy skills.

Back in the sensory sanctuary of her Dream House, Barbie slipped into something a little more comfortable to see her through her impending shutdown. A black hoodie, compression tights that covered her multitude of coffee table bruises, and her noise cancelling earbuds. She zoned out listening to a perimenopause podcast to help her feel sane, informed and less alone.

Barbie took off her shiny sleek blonde wig to free her own matted, unwashed hair, doused her hair in dry shampoo then tied it back out of her face. The regular intrusive thought of shaving her head returned, and she blinked and cleared her throat ten times whilst humming to try to make it stop, whilst pulling out tangled clumps of fallen hair from between her fingers. Barbie was alarmed at the amount of hair she was losing, and her male pattern hair loss and receding hair line made her cry in secret most days. The wig was just easier now than dealing with her own hair, and facing questions about it.

Until she found a better doctor, she didn’t have the right answers anyway.

🩷 How are you feeling about Mattel’s announcement of the new Autistic Barbie? 🩷

Let me know in the comments!

Cheers,

and

Thanks for reading Divergent Menopause. Paid subscribers make this work possible. 💕🐈

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I’m Sam Galloway (she/her) and I am an AuDHD woman four months into surgical menopause (hysterectomy and oopherectomy).

If you are interested about why I needed the surgery, you can read more here.

Thanks for joining me on this wild midlife ride! 🎢

Thank you to everyone who tuned into my live video with Sonia Voldseth, the creator of Menopause & Misogyny!

TL;DR

* This advocacy-focused conversation documents real harm caused by estrogen patch failures and loss of choice in Aotearoa New Zealand.

* When menopausal and neurodivergent women aren’t believed, symptoms escalate into cognitive, emotional, and physical crises.

* Menopause care is essential healthcare. It is not optional, not cosmetic, and not something women should have to fight this hard to access.

Sonia and I are both fortunate enough to live in Aotearoa New Zealand. Sonia, originally from the United States, lives surrounded by mountains in Queenstown on the South Island, and I, London Irish in origin, enjoy beachside life on the Kāpiti Coast near the bottom of the North Island.

Unfortunately Sonia and I have both been affected by the ongoing oestrogen patch debacle. In 2024, we saw a global shortage of oestrogen patches, which I wrote about here. Currently there is laboratory testing underway in response to many people reporting that their menopause symptoms have returned despite staying on the same dose and brand. This has coincided with a new formulation of this vital hormone therapy treatment.

My fellow pedants may notice that today I can’t decide whether to spell it “oestrogen” (UK and NZ) or “estrogen” (US), but please know that I am referring to the same hormone, regardless of the spelling used.

Remarkably, the sedatives and general anaesthetic still have lasting effects on my capacity to write articulately, now four months after my total hysterectomy with bilateral salpingo oopherectomy (cervix, uterus, ovaries and Fallopian tubes removed). Surgical menopause has been life saving to my mental health, energy capacity and general functioning, so I am not complaining. But, rather than feeling able to summarise our discussion myself, instead I include ChatGPT’s offering below.

As ever, for accessibility, you have the options to watch the video (with or without closed captions), listen to the audio and/or read the transcript.

AI-Generated Timestamped Summary

00:00 — Why this conversation matters

02:31 — Progress made… then undone

05:31 — Estrogen patch shortages & loss of choice (NZ)

09:01 — Symptoms returning on the same dose

12:01 — Collective patterns, individual gaslighting

15:31 — Neurodivergent risk & mental health impacts

18:31 — Estrogen as a brain hormone

22:01 — Why “just switch to gel” isn’t simple

25:31 — Sleep collapse as the red flag

28:31 — Admin, advocacy & exhaustion

32:57 — Suspected formulation change (mid-2025)

34:31 — Medsafe reporting & deflection

36:05 — User-error narratives & systemic gaslighting

37:42 — Absorption differences & dosing reality

39:58 — Brain fog, language loss & regression

41:25 — Estrogen receptor saturation explained

44:19 — Menopause is serious, not “just hot flushes”

45:37 — Generational harm & WHI fallout

47:03 — Surgical menopause & compounded harm

48:37 — Aging with quality of life

49:30 — Vaginal estrogen, bladder health & prolapse prevention

52:35 — Prolapse, gatekeeping & specialist care

54:38 — Medical training gaps (global)

55:10 — Vaginal estrogen & cancer-risk reassurance

56:07 — Solidarity over infighting

56:56 — Closing reflections, access & hope

Thank you to fellow AuDHDer and PMDD survivor Kim Pitts for chatting with us in the comments about her personal experience of menopause and medical misogyny. Kim and I have previously chatted live (link below) and here is Kim’s Auti Peri Q&A.

Cheers,

Sam

This work exists through collective care. A paid subscription is a meaningful way to support Divergent Menopause in 2026. Thank you! 💕

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I’m Sam Galloway (she/her) and I am an AuDHD woman four months into surgical menopause (hysterectomy and oopherectomy).

If you are interested about why I needed the surgery, you can read more here.

Thanks for joining me on this wild midlife ride! 🎢

Hello and Happy New Year to you!

And just like that we are in 2026. Hooray, we made it!

Ageing is a privilege, but it isn’t easy.

All we can do some days is take one step at a time, one breath at a time, and keep on keeping on. And that is more than enough.

Around this time last year I wrote an article about Anti-Goals, and it is still being read and shared daily! It is by far my most popular post so far, and it captures the spirit of those of us who reject and repel the January conventions of self-improvement.

Demand avoidance is running high in my life and I have long been wanting to write a follow up article. My brain has forbidden it though, so I have compromised with myself and recorded this follow up video on the topic for now instead.

As always, the video is optional and is accompanied by an audio only podcast alternative, and/or a transcript. For accessibility’s sake, I also include below a timestamped summary provided by ChatGPT.

What’s helping you get through right now?

What do you wish you had more support with?

If you want to share in the comments, you’re welcome to.

One word or an emoji is more than enough.

⏱️ AI-Generated Timestamped Breakdown

00:00 – New Year’s resolutions are nonsense (for many of us)Why January pressure is unrealistic, especially during hormonal flux, and why time is a social construct anyway.

00:01 – Why goal-setting can fail demand-avoidant brainsIntroducing anti-goals and why avoiding harm can be more useful than striving for achievement.

00:02 – When survival becomes the goalWhat anti-goals looked like at my lowest point: reducing pain, anxiety, depression, and suicidal ideation.

00:03 – You can’t reverse a spiral aloneWhy support and a plan matter — and why “starting from scratch” isn’t possible when you’re already overwhelmed.

00:04 – Different baselines, different needsWhy comparing yourself to people “optimising” their lives is harmful when you’re just trying to get through the day.

00:05 – Redefining success at homeFrom magazine-perfect homes to hygienic and safe: using tools (like a robot vacuum) to reduce energy drain.

00:06 – Pain management over fitness goalsWhy “I don’t want to be in pain” is a valid goal — and how medical support, warmth, medication, and pacing mattered more than exercise plans.

00:08 – Addressing the root causeHow hormonal instability drove pain, mood changes, and loss of self-care capacity — and why treating that came first.

00:09 – Hormonal treatment and surgeryMy path through HRT, chemical menopause, and ultimately hysterectomy/oophorectomy — and how stability changed everything.

00:11 – Survival before self-improvementWhy health span matters more than optimisation, and why there is still no clear medical model for neurodivergent menopause.

00:12 – Don’t waste energy on unachievable goalsChoosing meds, blood tests, and basic care over gyms, meal prep, or “doing it properly”.

00:14 – Accepting support is not failureWhy masking through struggle is dangerous — and how getting help allows us to later help others.

00:15 – Hormones as a buffer, not a cureMedication, therapy, cleaners, junk food, respite — whatever helps you get through now is valid.

00:16 – Incremental change, not January transformationsWhy progress is slow, nonlinear, and includes regression — and why that’s not shameful.

00:18 – Spending energy and money wiselyLooking at root-cause support (pelvic physio, hormone care, surgery pathways) rather than short-term coping fixes.

00:19 – What do you need right now?An invitation to reflect, share in the comments, and focus on getting through 2026 and beyond.

💛 Key Takeaway

If you are neurodivergent and navigating perimenopause or menopause, your job is not to optimise yourself.

Your job is to stay alive, reduce suffering, and be kind to yourself while you transition through this phase.

Everything else can wait.

That’s all for now. It is bedtime here and I am delighted to report that my menopausal sleep is phenomenally better than my perimenopausal sleep was this time last year!

I hope that whatever you have planned for today, that you can afford yourself some peaceful time to rest.

Cheers,

Sam

If this post helped you feel a little less alone, a paid subscription is how you support this work and help keep it going. No pressure! Just here if and when it feels right. 😊

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I am Sam Galloway (she/her), an autistic ADHDer, and I have recently had a hysterectomy. As a neurodivergent perimenopause and PMDD survivor, I offer peer support and share knowledge on how to make it through the hard times.

Thanks for joining me on this wild midlife ride! 🎢

I am delighted to be joined again by Allegra Chapman (she/her) from Creative Fix in the final episode of Divergent Creativity in Menopause!

Together Allegra and I have created this four part mini series on the importance of creativity during the menopause transition and beyond.

🎧 1) What is creativity is and why does it matter?

🎧 2) How can creativity fit your needs?

🎧 3) Can you be creative by accident?

🎧 4) Can your creativity change as you change?

In this fourth and final part we talked about:

💕 Creativity shifts as our needs change throughout fluctuating capacity in neurodivergent perimenopause and beyond. Our creative practices can adapt and may become slower, smaller, or look entirely different.

💕 Creativity is a tool for unmasking and self-understanding. It helps us process our emotions (even when alexithymia makes them hard to name), recognise our needs, and navigate a world not built for neurodivergent, disabled or midlife women.

💕 There is no “right way” to be creative. We don’t need to follow neurotypical or traditionally masculine productivity advice. Creativity can look like writing novels or doodling, resting, or simply daydreaming. Whatever works for you is the right way.

Writing an autism adapted suicide safety plan

is creative because you’re thinking about what are your triggers,

what do you need, and what needs to be on hand. And then also about having

a toolkit you know to keep you regulated, regulate your nervous

system and then that that’s also creative to meet your needs. You don’t always

have to be doing something.

Sam Galloway

Further reading and resources

Allegra’s inspiring book ‘Creativity is your self-care: 52 creative therapy exercises exercises to support your emotional wellbeing all year round’ is available to buy here!

If you would like to immerse deeper into Allegra’s creative wisdom, you can sign up to her course, Divergent Creatives.

The online programme to enable neurodivergent or disabled people to build a sustainable and joyful creative practice. If you’re a writer or artist who has more ideas than you know what to do with, but you struggle to finish things, or even to get started, then this course is going to help you get sh*t done!

A group of autistic menopause researchers based in the UK and Canada invited creative submissions reflecting people’s lived experience of this often challenging life transition. They wrote a paper on the submissions called ‘Stepping into who I fully am: A creative exploration of Autistic menopause.’

Creative exploration of Autistic menopause encouraged emotional catharsis, self-understanding, and activism/artivism. Autistic Community Researchers noted transcendent, almost “magical” dimensions of connecting with other Autistic people’s lived experiences. Our creative emancipatory approach enabled Autistic, multimedia responses which traditional research methods would not have elicited…

… Traditional research methods have limitations in capturing lived experiences of the Autistic menopausal transition. In this study creative, multimodal, arts-based approaches enhanced understanding by capturing nuanced interpretations and meanings.

The ability to communicate through creative submissions facilitated participants’ self-expression and they recognised the potential therapeutic value of the creative process, as a “remedy” for Autistic menopause related difficulties.

This study adopted a novel approach to data analysis in which Autistic community researchers used creative, reflexive approaches to respond to arts-based submissions rather than relying on traditional academic methods.

For both Autistic research participants and Autistic researchers, creative methods had the potential to act as a catalyst for activism, artivism, and self-actualisation, encouraging personal transformation and magical transcendence through a process of (to paraphrase one of our participants) “stepping into” who we fully are.

Stepping into Who I Fully Am: A Creative Exploration of Autistic Menopause

Author(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady, Rachel L. Moseley, Julie M. Gamble-Turner

Publication date (Electronic, pub): 27 June 2025

This concludes our series, and we hope you have enjoyed it! Thanks so much again to Allegra for recording this great chat with me, and thanks also to you for reading and listening!

Cheers,

If Divergent Menopause has helped you feel seen, understood, or a little less alone, please consider becoming a paid subscriber. Your support helps me keep this space accessible, and funds time to create more honest writing, Q&As, and resources for our neurodivergent menopause community.

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I am Sam Galloway (she/her), an autistic ADHDer, and I have recently had a hysterectomy. As a neurodivergent perimenopause and PMDD survivor, I offer peer support and share knowledge on how to make it through the hard times.

Thanks for joining me on this wild midlife ride! 🎢

I am delighted to be joined again by Allegra Chapman (she/her) from Creative Fix in the third episode of Divergent Creativity in Menopause!

Together Allegra and I have created this four part mini series on the importance of creativity during the menopause transition and beyond.

🎧 1) What is creativity is and why does it matter?

🎧 2) How can creativity fit your needs?

🎧 3) Can you be creative by accident?

🎧 4) Can your creativity change as you change?

In this third part we talked about:

💕 Taking natural seasonal items home to curate our own arrangements.

💕 Finding beauty in dried flowers over fresh flowers these days as my skin and body become increasingly dry in menopause!

💕 Noting down your accidental creativity using the downloadable sheet in this post from Allegra.

It’s time to reclaim your creative nature and take note of just how much creativity you bring to the world without even realising it. Then, hopefully, you can give yourself permission to explore your creativity further, with more intention, and see where else it wants to take you!

Allegra Chapman

What natural treasures can you find where you live?

🍁🐚🌸

Further reading and resources

Allegra’s inspiring book ‘Creativity is your self-care: 52 creative therapy exercises exercises to support your emotional wellbeing all year round’ is available to buy here!

If you would like to immerse deeper into Allegra’s creative wisdom, you can sign up to her course, Divergent Creatives.

The online programme to enable neurodivergent or disabled people to build a sustainable and joyful creative practice. If you’re a writer or artist who has more ideas than you know what to do with, but you struggle to finish things, or even to get started, then this course is going to help you get sh*t done!

A group of autistic menopause researchers based in the UK and Canada invited creative submissions reflecting people’s lived experience of this often challenging life transition. They wrote a paper on the submissions called ‘Stepping into who I fully am: A creative exploration of Autistic menopause.’

Creative exploration of Autistic menopause encouraged emotional catharsis, self-understanding, and activism/artivism. Autistic Community Researchers noted transcendent, almost “magical” dimensions of connecting with other Autistic people’s lived experiences. Our creative emancipatory approach enabled Autistic, multimedia responses which traditional research methods would not have elicited…

… Traditional research methods have limitations in capturing lived experiences of the Autistic menopausal transition. In this study creative, multimodal, arts-based approaches enhanced understanding by capturing nuanced interpretations and meanings.

The ability to communicate through creative submissions facilitated participants’ self-expression and they recognised the potential therapeutic value of the creative process, as a “remedy” for Autistic menopause related difficulties.

This study adopted a novel approach to data analysis in which Autistic community researchers used creative, reflexive approaches to respond to arts-based submissions rather than relying on traditional academic methods.

For both Autistic research participants and Autistic researchers, creative methods had the potential to act as a catalyst for activism, artivism, and self-actualisation, encouraging personal transformation and magical transcendence through a process of (to paraphrase one of our participants) “stepping into” who we fully are.

Stepping into Who I Fully Am: A Creative Exploration of Autistic Menopause

Author(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady, Rachel L. Moseley, Julie M. Gamble-Turner

Publication date (Electronic, pub): 27 June 2025

Next week Allegra and I will be sharing the fourth and final part of our podcast mini series with you.

Have a great week!

Cheers,

Enjoying Divergent Menopause? Become a paid subscriber to support independent writing on neurodivergent midlife and menopause.

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I am Sam Galloway (she/her), an autistic ADHDer, and I have recently had a hysterectomy. As a neurodivergent perimenopause and PMDD survivor, I offer peer support and share knowledge on how to make it through the hard times.

Thanks for joining me on this wild midlife ride! 🎢

“Care for your needs as a priority, rather than leaving them at the bottom of the list.”

I am delighted to be joined again by Allegra Chapman (she/her) from Creative Fix in the second episode of Divergent Creativity in Menopause!

Together Allegra and I have created this four part mini series on the importance of creativity during the menopause transition and beyond.

🎧 1) What is creativity is and why does it matter?

🎧 2) How can creativity fit your needs?

🎧 3) Can you be creative by accident?

🎧 4) Can your creativity change as you change?

In this second part we talked about:

💕 how societal expectations and internalised ableism combine to make us de-prioritise our creativity

💕 giving ourselves permission to meet our needs, and pacing our creative endeavours around our menstrual cycles/menopause stage

💕 being unable to do our best creative work if we are in neurodivergent burnout.

Everyday creativity can be free, low key and take place both in the home and out and about.

Resources and further reading

Allegra’s inspiring book ‘Creativity is your self-care: 52 creative therapy exercises exercises to support your emotional wellbeing all year round’ is available to buy here!

If you would like to immerse deeper into Allegra’s creative wisdom, you can sign up to her course, Divergent Creatives

The online programme to enable neurodivergent or disabled people to build a sustainable and joyful creative practice. If you’re a writer or artist who has more ideas than you know what to do with, but you struggle to finish things, or even to get started, then this course is going to help you get sh*t done!

Dr Samantha Newman AKA Female GP Monthly Cycling “Your menstrual cycle is a natural process made up of four key stages: Menstruation, Follicular, Ovulation, and Luteal. Knowing how these stages work helps you better understand your body and mind.”

Kate Codrington Menopause facilitator, speaker and author (Moon and Menopause tracking)

Red School Menstrual cycle and menopause awareness

A group of autistic menopause researchers based in the UK and Canada invited creative submissions reflecting people’s lived experience of this often challenging life transition. They wrote a paper on the submissions called ‘Stepping into who I fully am: A creative exploration of Autistic menopause.’

Creative exploration of Autistic menopause encouraged emotional catharsis, self-understanding, and activism/artivism. Autistic Community Researchers noted transcendent, almost “magical” dimensions of connecting with other Autistic people’s lived experiences. Our creative emancipatory approach enabled Autistic, multimedia responses which traditional research methods would not have elicited…

… Traditional research methods have limitations in capturing lived experiences of the Autistic menopausal transition. In this study creative, multimodal, arts-based approaches enhanced understanding by capturing nuanced interpretations and meanings.

The ability to communicate through creative submissions facilitated participants’ self-expression and they recognised the potential therapeutic value of the creative process, as a “remedy” for Autistic menopause related difficulties.

This study adopted a novel approach to data analysis in which Autistic community researchers used creative, reflexive approaches to respond to arts-based submissions rather than relying on traditional academic methods.

For both Autistic research participants and Autistic researchers, creative methods had the potential to act as a catalyst for activism, artivism, and self-actualisation, encouraging personal transformation and magical transcendence through a process of (to paraphrase one of our participants) “stepping into” who we fully are.

Stepping into Who I Fully Am: A Creative Exploration of Autistic Menopause

Author(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady , Rachel L. Moseley , Julie M. Gamble-Turner

Publication date (Electronic, pub): 27 June 2025

It is a pleasure to continue sharing my conversation with Allegra with you. I hope you are enjoying it, and that you are able to fit some crucial creativity around your current needs and within your fluctuating capacity.

Cheers,

If you enjoy these posts and want to fuel more of them, think of a paid subscription like buying me a coffee each month. It’s a small gesture that makes a big difference to keeping Divergent Menopause going strong.

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.

I’m Sam Galloway (she/her) and I am an AuDHD woman ten weeks into surgical menopause (hysterectomy).

If you are interested about why I needed the surgery, you can read more here.

Thanks for joining me on this wild midlife ride! 🎢

October was World ADHD Awareness Month and World Menopause Awareness Month

As you are here, chances are that you are already aware of both Attention Deficit Hyperactivity Disorder (ADHD) and menopause. I wish I had known about them sooner… but better late than never.

We still don’t know enough about how the two intersect, but early research suggests that hormonal flux in neurodivergent brains and bodies may be suboptimal for our mental and physical health. To say that perimenopause sent me absolutely batshit cray cray would be a gross understatement.

Why is awareness still the goal in 2025?

Acceptance and gold standards of care should be where we are already at. Yet awareness it must be, since many of us have friends, family members and even healthcare teams who are not yet aware of the potential for volatility during the neurodivergent menopause transition.

Why is ADHD affected by hormonal flux?

Well, we don’t know yet. But Behrman and Crockett explain in their 2024 research paper, Severe mental illness and the perimenopause, that:

Executive dysfunction and other cognitive problems are commonly reported during the perimenopause; these which can appear very similar to the constellation of symptoms seen in attention-deficit hyperactivity disorder (ADHD)32 and, like ADHD, can respond to stimulants.33

It is unclear whether this is an unmasking of underlying pre-existing ADHD or entirely de novo symptoms.

Given the overlap, it can be hypothesised that those with pre-existing ADHD may experience a worsening of their ADHD symptoms with perimenopause, and it has been shown that people with comorbid ADHD are also more vulnerable to perimenopause-associated psychological symptoms.34

There is much hypothesising in the field, whilst those of us deep in the trenches are falling daily on the battlefield.

We may not know why menopause is such a challenging transition for many neurodivergent people, but we need to be alert to the risks.

This is not a “Yay for ADHD !” article.

Yes, there are advantages to having this condition, as there are also disadvantages.

My ADHD wasn’t diagnosed until I was 39 - two years after my later in life autism diagnosis. I thought naively that by 40 I had all the answers, and would be able to live my best years going forward. I could not have been more wrong!

I was only too glad to finally be aware of my neurotype, yet awareness is only the beginning.

Forty five minutes into my hour long Zoom consult with an Auckland-based psychiatrist, my ADHD assessment was over and it was a done deal. He diagnosed me with ADD (which is an out of date diagnosis now, but whatevs). He hung up and spent the remainder of my allocated session writing up notes for my diagnostic report and filing the pharmaceutical admin to process the special authority number required for me to trial controlled stimulant drugs. Meanwhile, I sat alone in floods of tears weeping for Little Sam who had never stood a chance. Tears are welling up now (or trying to) in my menopausally dry eyes just from thinking back on it.

As an AuDHDer (autistic and ADHD), I have learnt the long and hard way that the impact ADHD can have on our menopause transition can be catastrophic, isolating and feel deeply shameful.

1 in 4 ADHD women have attempted suicide. Things are already hard for us during times of hormonal flux but we often make exceptions for people’s hormonal changes in puberty, pregnancy, postpartum and during menstrual periods and premenstrual dysphoria disorder (PMDD).

Menopausal people also need accommodations and support. Knowing what to expect is crucial in then dealing with it.

You aren’t broken and you don’t need to be fixed. You are enough and not too much. You deserve acceptance not awareness.

To save you the time and energy on obsessively compulsively meticulously researching characteristics of adult ADHD, and the implications perimenopause has on ADHD, I am here to share the low highlights in no particular order:

* It’s not called ADD (attention deficit disorder) anymore. ADD is no longer diagnosable. There are three types of ADHD: hyperactive, inattentive, and combined type. Combined means you are both hyperactive and inattentive.

* Lagging skills versus inability. Neurodevelopment is slower for us. Immature behaviour and executive dysfunction do not determine intellect, regardless of our age. Remember that you have strengths. Play to them when and where you can.

* You might see ADHD in your kids - especially boys - first, because their external hyperactive symptoms can manifest as “disruptive” in the classroom, and the teachers want to shut them down support them.

* Your energy is exceptional and feels abundant, but you can crash hormonally. We can’t run on empty. Those of us who are exceptionally sensitive to hormonal flux will know all too well that we have had “good weeks” and “bad weeks” in our menstruating years. When those changes are catastrophic, it may indicate that we have premenstrual dysphoria disorder (PMDD). Previous patterns of mental health implications caused hormonally such as during menses, menstruation, pregnancy, postpartum, during IVF treatment etc. are indicators of future challenges during perimenopause.

* Hyperactivity can be cerebral, not always physical. Overthinking, anxiety, rumination, sleep issues, scripting phone calls, imagining other worlds and embarking on new and illicit relationships in your head are allways it can manifest. We create these elaborate situations in our minds because our physical surroundings are understimulating or triggering. What’s more interesting than deciding what to cook for dinner yet again? Alternative lives, sliding doors, reimagined reality. When we are externally presenting as inattentive often it’s accompanied by internal hyperactivity which means that we are often combined type, even when diagnosed ADD, as I was.

* Inattentiveness can be painful and shameful. We aren’t mishearing and daydreaming on purpose to annoy others - although they rarely see it that way. Part of the assessment process for ADHD includes presenting our old school reports to inform the diagnostic process. Proof that we have always been considered not good enough. Annually and without fail my end of year reports read, “Must try harder. Could do better. Not reaching potential.” Yet nobody in a classroom is trying as hard as a girl/AFAB who is endlessly having to suppress her rich and stimulating inner world and pass for normal.

* People will tell you you’re wrong about ADHD, especially those with the least amount of experience or knowledge about it. They won’t want you to talk about it with them so, unless it is imperative to the safety of yourself or someone else, don’t waste your finite energy. Find your neurotribe, because they may want to talk about nothing else, and we can all geek out together on the wonders of being neuromagnificent! ⭐️

* We see ADHD in others, usually long before they wish to accept it. They refuse the label, as if you are branding them like cattle, or trying to insult them. Bide your time, realisations can take a while and denial is real. Try to protect your own rejection sensitivity dysphoria (RSD) being triggered when they seem supportive of you being ADHD, yet when it comes to their own identity they are appalled at the suggestion.

* RSD is painful and overwhelming. Rejection sensitivity occurs when we have been rejected, insulted, gaslit, dismissed or any manor of things by someone, whether they did so intentionally or not. We can really stew on it, and then be consumed by it. It feeds our negativity bias and need for cerebral stimulation until we have broken ourselves. I have found the best way to manage this is to recognise it, and stop myself from spiralling. Do what you can to stop building on the idea that you have been slighted. Even if they meant to upset you, screw them. Instead you can: stim, listen to a favourite song that uplifts you and takes you to another time or place, journal it then burn the page, get outside. As I was writing this around Halloween, you may also like to curse them and/or make a voodoo doll and inflict pain on them. Whatever you do, keep it short then move on. If it comes up in your head again, tell yourself you have already dealt with it, and that it is just the hungry RSD looking for your attention.

* Boredom is our kryptonite and our brains will do anything to avoid it.

* Hyperfocus can be productive or not, and it is hard to channel it. Unless it is harming someone, once you get into flow, lean into it. Hyperfocus is a beautiful process and don’t feel bad if you don’t end up with a completed project at the end. Just go to the toilet, drink some water and have something to eat, because you are likely to have forgotten that the concept of time exists, and that you live in human bodily form.

* So-called hard things are easy for us: entrepreneurship; picking up and dropping new hobbies and interests as though our lives depend on it; changing careers; earning multiple degrees; pulling all nighters; spotting neurodivergence in others. These are not superpowers though, and we should not be made to excel beyond our capacity to meet other people’s expectations. Exploiting neurodivergent people’s strengths whilst ignoring our struggles puts us at risk of burnout and abuse.

* So-called easy things are hard for us: sensing the passage of time, and thus punctuality; booking appointments; small talk; meal planning; remembering to take the meds that help us do all of the above. Basically anything requiring executive functioning can become increasingly difficult in perimenopause, not helped by increasing midlife demands of parenting, caring for ageing parents, managing a household, employment and so on.

* Now/not now. Having no sense of time is a common issue. Rather than feeling time pass, I know I either need to do the thing in my calendar now or not now. Dopamine elicited from extreme time pressure is a huge motivator for me, which is why I am finally finishing this article that I intended to publish “for the start of October” a week into November. Time is but a social construct. Again: better late than never…

* Dopamine isn’t always scrolling. Impulsivity means we often get caught speeding or we may overspend (I did both cyclically throughout my twenties). Not thinking through the longer term consequences of our actions is pretty common. When things feel bad, it feels like they’ll never change. Is this why our suicide rate is so high? 1 in 4 women have attempted suicide, and I worry that this is too often down to extreme impulsivity driven by hormonal flux.

* Hormonal flux can drive us downhill rapidly, so be prepared. Some people are sensitive to changing hormone levels - the ups and downs - rather than the levels themselves. Prior to my chemical menopause and now my surgical menopause, my mood, executive functioning and capacity dropped faster than I could sense any internal changes. Rage would escape me unprovoked. Masking was impossible. I couldn’t recognise who I was any more in those moments and within a few short years I had become a husk of my former self.

* ADHDers are rescuers. We can also be naive, easily taking advantage of, trusting and gullible. As change makers and trailblazers, we think we can change others too. We may hone in on a wrong’un and believe we are able to save them from themselves. Sometimes this can end up with us becoming abused, bankrupt and at risk.

* A special interest/hyperfocus can be a person. We can be obsessed for an unknown length of time and all in our head, until it burns out and we are no longer interested. We may then never talk or think about that person ever again.

* Object permanence. We aren’t vindictively ignoring loved ones, but out of sight means out of mind. We can forget people we have known for years even exist. That upsets us as much as it upsets them. If only we had the executive functioning to print, frame and hang photos, seeing their faces might jog our memory…

* Can OCD (obsessive compulsive disorder) mask ADHD? Does hyperactivity plus productivity equal OCD? I’m jealous of ADHDers who also have just enough OCD to keep everything clean and tidy and be consistent. Without that I live in clutter, hoarding and tripping over my own stuff, yet remain unmotivated and disinterested in picking it all up. Add in two neurodivergent kids who take after me, and it’s a wonder we can walk around our home at all! Goblin mode is real. It’s not laziness, it’s different priorities, lagging executive functioning skills and an inability to motivate and mobilise myself. Stimulant medication helps with all of that to some degree, in my case.

* We can be introverted or extroverted, and we will often appear to oscillate between the two. How much of this is masking versus exhaustion? ADHD can be an energy mismatch. Imagine yourself entertaining and running around at home looking after everybody (unless you get hit by a car and get to spend Christmas with your feet up, as I did last year), then you’re exhausted when everyone wants to go out and they wonder why you don’t want to go. You have enabled everyone else to rest, chat and chill whilst you have burnt yourself out. Just say you have a migraine and wave them off at the door. Surely you are due a good solo doom scrolling session now to re-boot? Enjoy!

* When we can make it out of the house, we are first to read the room. We are instinctive and perceptive about events and behaviours before anyone else feels it. We may want to leave before everyone else does when things feel too intense. In our youth, and even into midlife, we might stay out and self-medicate with booze, drugs and/or chocolate fountains to dampen the sensory overload and stress. These are understandable ways of masking and self-soothing, but can be hard habits to break long after they stop serving us. If they ever did.

* Sensory processing disorder (SPD) co-occurs strongly with ADHD, autism and other forms of neurodivergence. This can be tricky to self-identify because we mask so strongly and have decades of unlearning uncomfortable compensatory habits. Sensory seeking and sensory avoiding shapes our world view and capacity to go out into an uncontrollable world. Squinting in bright rooms because we were told wearing sunglasses indoors made us weird, and getting told squinting is weird, and no it’s not too bright. Sticking our fingers in our ears during fireworks displays, being scared of balloons popping at parties and dogs barking (just me?). Swigging cod liver oil from the bottle in my Nan’s cupboard because I sought out strong flavours. You know, normal stuff. 👀

Do yourself a favour and read up on sensory processing difficulties and challenges, which includes interoception and proprioception (see below). If it is accessible to you, work with a neuro-affirming occupational therapist to create a personalised sensory diet, where you include movement snacks and tools such as weighted blankets, safe foods, noise cancelling headphones etc. on hand to regulate your sensory inputs. If it is inaccessible to you, then take a look on YouTube for ideas.

* Interoception refers to interpreting our inner states such as hunger, thirst, pain etc. Some of us have heightened interoception and may feel pain to an extreme, whereas someone with a reduced interoception may report having a high pain tolerance. Sometimes we may not be aware of our interoceptive states, especially whilst we are in hyperfocus mode. To buffer this, it can be useful to set timers to remind us when to eat, go to the bathroom and drink water. Visual prompts are also useful, such as keeping snacks and your water bottle next to you.

* Proprioception refers to interpreting our movements, force and position in space. Have you ever had days where you feel like you walk into every possible obstacle, even when you see them? (No, just me again?) Or sometimes you drop your cutlery whilst using it? Or your cat bites you because you are stroking them a bit harder than usual? Sometimes we can feel a bit off during the luteal phase (after ovulation until the bleed starts) of our menstrual periods, and that can stretch out into perimenopause and beyond. Chances are you are not imagining it, and that hormonal flux is affecting your mind and body in ways you didn’t think possible. You might feel like you are literally losing your grip on life, as well as losing your mind.

* Menopause is here to show us that we matter - we did all along - but now we can channel our energy into ourselves. I know how scary it is to not feel like yourself any more, to have spiralling cognitive limitations and to think these changes are irreversible. They aren’t, and you will adapt to them, learn new accommodations and, I am assured, come out the other side post-menopausally realising that pre-perimenopause, you were dealing with too many responsibilities, were people pleasing to the max, and put your own needs at the bottom of the list, if at all.

* Your brain fog is hormonal, not dementia. There are similarities in symptoms between hormonal brain fog and young onset dementia and, if you are like me, you are likely to make the leap to assume you are on a path of cognitive decline. Neurodivergent people experiencing hormonal flux and decline often feel like they are losing self-care and communication skills. If you are worried about perimenopause, menopause and dementia, you might like to read more here.

* Stimulant medications have been shown to help with brain fog in new onset executive difficulties in menopause. For those of us who become overtly symptomatic of ADHD around midlife, trialling stimulants - the first line treatment - may be beneficial. However, access to psychiatric assessment is a major prohibitive factor.

* Stimulant medication works for 70 to 80% of ADHDers. Many people find them life changing. They are the most effective medication available in all of psychiatry. It’s now believed to rewire neural pathways and strengthen executive functioning skills longer term, rather than only having the short term effects previously thought of. Here is an informative discussion on ADHD medications.

* Non-stimulants can be prescribed whilst awaiting an assessment for ADHD. You will need a doctor who is confident that you present as ADHD based on their professional evaluation in order to trial non-stimulants prescribed off-label. This is useful when a diagnosis is inaccessible, or you are struggling whilst on a long waiting list for assessment. Non-stimulants are the second line treatment for ADHD, and many people who don’t tolerate stimulants do well on them.

* All is not lost. Other things that can optimise our executive functioning in challenging times include coaching, body doubling, energy management, pacing and lifestyle factors such as improving sleep. That last one is sometimes the hardest of all, and insomnia can be an early symptom of perimenopause. Often though, ADHD medication and/or HRT/MHT are needed first to boost your executive functioning, energy levels, sleep and mood before lifestyle changes can be made.

* Hormone replacement therapy (HRT) can provide a buffer. HRT is not a great name since replacing hormones in most people’s case is not the goal, which is why a preferred term for it is menopause hormone therapy (MHT). Rather, HRT/MHT can provide a buffer to support you from hormone levels dropping so low whilst in flux that they cause unbearable symptoms. Transdermal hormones are safe for most people, and life saving for many. When used alongside other necessary medications and lifestyle optimisation, you can begin to feel like your former self again. Whilst many neurotypicals shout on the socials about how they went from a perimenopausal wreck to a goddess in 24 hours, that is not often the case for those of us who are hormonally sensitive and/or complex. Re-saturating oestrogen receptors (which are located in the brain and every part of the body, which is why menopause symptoms are widespread) can take some time. It is not a miracle cure. HRT/MHT needs tweaks and adjustments to dose and delivery system (e.g. patches, pills, gels or pessaries) under the guidance of a knowledgeable and neuro-affirming menopause doctor.

* Taking medication for ADHD and HRT/MHT for menopause isn’t weakness. A so-called natural approach isn’t optimising what your brain can do for itself. We won't receive medals for getting through neurodivergent menopause without appropriate supports, and too many of us don’t make it through alive. We need an individualised toolkit to survive intact, complete with knowledgeable healthcare providers, self-advocacy skills and a network of people who understand, empathise and want to help us. More on self-advocacy and finding the right doctor for you here.

What nuggets of wisdom can you share that may benefit us all?

I would love to read them in the comments!

Click on the ‘view in browser’ at the top of your email and log in if you haven’t already.

Behrman and Crockett conclude in their 2024 research paper, Severe mental illness and the perimenopause, that:

Discussion of symptoms through the prism of the perimenopause may be helpful for patients in understanding their experiences, and lifestyle advice may help with symptoms, which will have a positive impact on mental and physical health; the same is true for new presentations of perimenopause-related mental health difficulties.

If oestrogen levels are balanced with HRT, patients are likely to respond more consistently to medication, perhaps requiring lower doses or less complex regimes and ultimately enjoying better physical and mental health outcomes.

Hang in there

You are already doing your best and, yes, you are good enough!

Even when it all feels too hard and all the jobs are unsurmountable, give yourself credit for keeping on keeping on. Then take a break because, if neurodivergent menopause has taught me anything, it’s that most of the expectations placed on me aren’t worthy of my time and energy. So go and have a rest.

All $hit good things come to an end, including perimenopause.

And thank f$ck for that.

Resources, Further Reading and Listening

* Professor Russell Barkley’s two episodes (#199 and #200) on the I have ADHD podcast

* ADHD for Smart Ass Women podcast

* Jessica McCabe’s How to ADHD YouTube channel

* Kate Moryoussef’s podcast and webinars https://www.additudemag.com/webinar/adhd-burnout-chronic-stress-women/

* ADDitude magazine online and webinars

Divergent Menopause is on a mission to empower, educate and reframe the narrative. Want to support me? The best way is to become a paid subscriber. Your support means the world to me!

I am delighted to be joined by Allegra Chapman (she/her) from Creative Fix!

Together Allegra and I have created this four part mini series on the importance of creativity during the menopause transition and beyond.

1) What creativity is and why it matters,

2) How to fit it in around needs and what activities work for different needs

3) Special interests and “accidental” creativity and stuff that’s creative that you don’t think about

4) How your creative practice changes as your needs change... or how creativity can help with unmasking

Resources:

https://www.scienceopen.com/hosted-document?doi=10.13169/intljofdissocjus.5.1.0004

Allegra’s book

Allegra’s course

Previous articles by Allegra?

Content warning: Discussion of suicidal ideation.

Themes 💕Hormonal literacy | Mental health | Neurodivergent self-advocacy | Medical gaslighting | Access inequality | Post-surgical recovery | PMDD symptom improvement

“When I try to raise awareness — what IAPMD does — their mission is awareness and education.

And I think that’s really where any woman or uterus owner should begin: with knowing.

I know that’s hard — it’s executive function all over the place — but truly, information is everything.

I’ll never forget reading The New Menopause; in it, she says ‘Information is your foot in the door.’

And we just — we have to be able to get that foot in the door.

Whether you do that through peer support or whatever means you can, that’s one of the only ways right now to really start the conversation.

It’s unfortunate, and so tragically unfair.

But just know that there’s always a conversation that can be had.

We just have to — unfortunately — sometimes be the ones to start it, which is such b******t.

But still, there’s always a way to begin.”

Kim Pitts

If this conversation helps you feel seen, please share or comment below. Your story could help someone else survive their PMDD too.

Kim and I have been planning to discuss PMDD and our resulting hysterectomies for a while now, and we finally figured out the timezones between her location of Oregon, US and mine in Wellington, Aotearoa New Zealand.

Links to all the resources and further reading we discussed are at the end of this post.

Our chat is available in multiple formats for accessibility:

* Video with subtitles/closed captions available

* Podcast/audio only

* Transcription

* Plain timestamped summary table*

* Substack-formatted timestamped summary*

* Generated by ChatGPT as an executive functioning tool on my part. Sorry, Kim! I know you gave AI the finger during our chat!

🩸 PMDD, Hysterectomy & Neurodivergent Menopause

A Conversation with Kim Pitts

⏱️ 00:00 – 02:00 | Introductions

Sam (Aotearoa NZ) and Kim (US) open the chat.Both are neurodivergent women who chose surgical menopause (hysterectomy) to stop PMDD symptoms and save their mental health.This is peer support, not medical advice.

🩺 02:00 – 04:00 | Surgery Stories

Kim shares how her US doctor fought for her right to a hysterectomy despite insurance barriers.Sam reflects on recovery, her four laparoscopic scars, and the strange post-op moment of thinking, “Where’s the baby? Oh wait — no more uterus!”

💊 06:00 – 10:00 | Progesterone Intolerance

Sam explains how progesterone caused bloating, digestive pain, and depression.Kim agrees—progesterone can be lifesaving or intolerable depending on the body.They unpack the delicate HRT balancing act and how mental health depends on getting the right dose and delivery.

🧠 10:00 – 13:00 | Medical Gatekeeping

Sam details the challenge of navigating public vs. private healthcare, using index cards to remember key points at appointments.They talk about executive dysfunction, prescription chaos, and how neurodivergence complicates healthcare admin.

💬 13:00 – 17:00 | What Is PMDD?

Kim defines Premenstrual Dysphoric Disorder (PMDD) — a neuroendocrine disorder where hormonal fluctuations trigger severe mood symptoms.Often mistaken for PMS, it requires careful tracking, but that’s hard for ADHD and autistic women.

📝 17:00 – 22:00 | Hormones, Neurodivergence & Tracking

They discuss multiple hormone sensitivity theory, links between ADHD/autism and PMDD, and why symptom tracking is often impossible.Kim used old text messages as evidence to identify her cycles.

⚖️ 22:00 – 27:00 | Self-Advocacy & Self-Gaslighting

Sam shares how she doubted her own symptoms right up to surgery.Both reflect on medical gaslighting, the exhaustion of self-advocacy, and the relief of being believed.Finding the right doctor = survival.

⚠️ 25:00 – 33:00 | Suicidality & Survival

Content warning: Discussion of suicidal ideation.They discuss how PMDD, autism, and ADHD overlap with high suicide rates for midlife women (ages 44-58).They stress the need for hormonal treatment first, not just SSRIs, and for open peer conversation.

🫀 36:00 – 40:00 | Hysterectomy Research & HRT Myths

Kim explains how outdated studies scared women — early hysterectomy patients weren’t given HRT, so they suffered bone and heart issues.Modern practice should include immediate hormone replacement for safety and quality of life.

💸 43:00 – 46:00 | Funding Barriers

Kim shares how she accessed surgery through a hospital financial-assistance program in the US.The approval felt like “relief and disbelief.”They dream aloud of a nonprofit fund to help others afford lifesaving PMDD surgeries.

🔄 47:00 – 52:00 | Before Surgery: Life in Cycles

Sam recalls living between inertia, shutdown, and rage, with shrinking windows of good days.After constant bleeding and progesterone crashes, surgery brought instant hormonal stability and mental clarity.

🩺 52:00 – End | Takeaways & Solidarity

* Blood tests are a snapshot, not the full story.

* Lived experience matters more than lab numbers.

* Peer advocacy can bridge dangerous medical gaps.

* Both women close with gratitude — for surviving, for community, and for being heard.

Resources and Further Reading

* International Association for Premenstrual Disorders (IAPMD) website

* PMDD Symptom tracker from IAPMD website (above)

* The New Menopause - Navigating Your Path Through Hormonal Change with Purpose, Power and the Facts book by Dr Mary Claire Haver

* Your Periods, ADHD & the Multiple Hormone Sensitivity Theory Dr Nighat Arif video

* MENO-D A rating scale to detect depression in menopause by Professor Jayashari Kulkarni

* Progesterone intolerance Dr Loiuse Newson article

Please take good care of yourself.

Want to support me? The best way to support my advocacy and peer support work at Divergent Menopause is to become a paid subscriber. Thank you again for your support! It means the world to me. 💕

P.S.: That was intense, so here’s a photo of Harry! I have invested my paid subscriber contributions on some equipment to make my desk more ergonomically accessible post-hysterectomy. Huge thanks to my paid subscribers for making this possible!