“I just don’t feel like myself anymore.”
Patient’s tell me this often, but for some neurodivergent women, that sentence can mean something particularly significant.
Perhaps you have noticed that things you have always found difficult suddenly feel almost impossible.
Your concentration has disappeared. Your tolerance for noise has changed. Social situations that you previously managed now leave you completely exhausted. Your emotions feel harder to regulate. Your routines have become much more important, yet somehow much harder to maintain.
Perhaps you have ADHD and feel as though your usual strategies for keeping everything together have stopped working.
Or perhaps you are autistic and find that sensory sensitivities, social demands or changes to your routine have become much harder to cope with.
It can be very easy to assume that this is simply part of getting older, stress, burnout, ADHD, autism or anxiety.
Sometimes it is.
But sometimes there is another piece of the puzzle: perimenopause.
And I think this is an area of women’s health that deserves much more attention.
Does menopause affect autistic women differently?
We are still learning about this.
The research into menopause and autism is relatively new, but there is now enough evidence to know that we should not simply assume that every woman experiences the menopause transition in the same way.
A particularly important piece of research has come from Swansea University.
In 2025, researchers from Swansea University’s School of Health and Social Care published a systematic review looking specifically at autism and the menopause transition. They reviewed eight research studies alongside seven pieces of grey literature.
The researchers identified three important themes: a lack of knowledge about menopause, experiences of a broad range of menopause symptoms, and inadequate treatment and support. Importantly, they also highlighted that the evidence base remains small and that there are currently no studies properly evaluating specific menopause treatments for autistic people.
That last point is important.
We don’t have all the answers yet.
But we have enough evidence – and enough women telling us about their experiences – to know that this deserves to be taken seriously.
“Why does everything suddenly feel so much harder?”
This is perhaps one of the most important questions.
The symptoms of perimenopause are familiar: changes in periods, hot flushes, night sweats, sleep disturbance, headaches, low mood, anxiety, fatigue and difficulties with concentration and memory.
But imagine experiencing those changes alongside existing difficulties with sensory processing, executive function, emotional regulation or social interaction.
The overall effect can be much greater than any individual symptom suggests.
Research involving autistic women has described experiences such as increased sensory sensitivities, difficulties with emotional regulation, problems coping with everyday demands and a feeling that previously effective coping strategies are no longer working as well.
The Swansea review found that these difficulties could affect daily activities, work, relationships and mental wellbeing.
That doesn’t mean that menopause causes these difficulties.
Rather, the hormonal changes of perimenopause may add another layer of difficulty to things that a woman has already been managing throughout her life.
When the strategies you’ve always used stop working
This is something I think is particularly important when we talk about autistic women.
Many autistic women have spent years developing ways of navigating a world that doesn’t always fit comfortably with the way they experience it.
They may have developed routines, coping mechanisms and strategies that work extremely well.
They may also have become very good at masking – consciously or unconsciously adapting their behaviour to fit in socially or to hide difficulties that other people may not see.
Then perimenopause arrives.
Sleep becomes worse.
Concentration becomes harder.
Your emotional responses may feel more difficult to control.
Sensory sensitivities may become more intrusive.
Your ability to cope with noise, social interaction or unexpected changes may decrease.
And suddenly the strategies that have worked for years don’t seem to be enough.
That can be incredibly unsettling.
You may start to wonder:
“What’s wrong with me?”
But perhaps the more useful question is:
“What’s changed?”
You haven’t necessarily become less capable.
The demands on your brain and body may simply have changed.
And what about ADHD?
There is an interesting overlap here too.
Many of the symptoms women associate with ADHD – difficulties with concentration, working memory, organisation, motivation, emotional regulation and sleep – can also occur during perimenopause.
That can make it difficult to work out what is happening.
Is it your ADHD?
Is it menopause?
Is it stress?
Is it poor sleep?
Or is it a combination of all of them?
The answer may be a combination.
There is growing clinical interest in the relationship between changing oestrogen levels and ADHD symptoms. The British Menopause Society included a dedicated session on “ADHD and autism in the context of managing the menopause” in its 2026 educational programme, specifically addressing oestrogen fluctuations, the brain and ADHD symptoms.
But it is important not to overstate what we know.
We cannot currently say that falling oestrogen causes ADHD symptoms, or that HRT is a treatment for ADHD.
What we can say is that hormonal fluctuations may interact with brain function, and some women with ADHD report that their symptoms become more difficult to manage during the menopause transition.
That is something worth discussing rather than simply dismissing.
You may not have “new” symptoms – they may just feel different
One of the difficulties with recognising menopause in neurodivergent women is that there can be considerable overlap between existing characteristics and menopausal symptoms.
For example, difficulty concentrating might be attributed to ADHD.
Poor sleep might be considered part of a long-standing sleep problem.
Anxiety might be assumed to be unrelated to menopause.
Feeling overwhelmed might be attributed to autism or stress.
And fatigue can have almost any explanation.
This doesn’t mean that every change is menopause.
It means we need to look at the whole picture.
If something has changed noticeably around the time your periods begin changing, or you develop other symptoms associated with perimenopause, it is reasonable to consider whether hormonal changes could be contributing.
At the same time, we shouldn’t put every new symptom into the “menopause” box.
Thyroid problems, anaemia, medication effects, depression, anxiety and sleep disorders can all cause symptoms that overlap with perimenopause.
A good menopause consultation should look at the whole person, not just their hormones.
What does the research tell us about symptoms?
A 2025 UK study comparing autistic and non-autistic people found that autistic participants reported more bothersome psychological and physical menopause symptoms.
Interestingly, the researchers did not find a difference in vasomotor symptoms such as hot flushes.
I think this is an important finding because it reminds us not to create a new stereotype that autistic women necessarily experience every menopause symptom more severely.
The picture is more complicated than that.
The differences may be particularly noticeable in areas such as psychological wellbeing, physical symptoms and the ability to manage the changes taking place.
That fits with what many women describe: it isn’t necessarily one dramatic symptom.
It is the feeling that everything has become harder to manage at the same time.
Sometimes the healthcare appointment itself can be difficult
This is something we need to acknowledge as healthcare professionals.
If you find certain environments overwhelming, struggle with processing lots of information at once, find unexpected questions difficult or prefer written information, a traditional medical appointment may not always feel particularly accessible.
And there is evidence that autistic people experience difficulties accessing reproductive and sexual healthcare.
Research involving autistic adults has highlighted unmet needs around reproductive healthcare, including difficulties discussing reproductive health and menopause and a lack of appropriate accommodation of autistic differences.
So if you are neurodivergent and find medical appointments difficult, that doesn’t mean you are being difficult.
It may simply mean that the appointment needs to work differently for you.
What can make a menopause appointment easier?
There is no right way to have a medical appointment.
If it helps, you can:
• write down your symptoms before you come
• bring a list of your medications
• note changes in your periods
• write down the things that have changed in your ability to cope
• ask for information to be given to you in writing
• take someone with you if that helps
• tell your clinician if you find certain communication styles difficult
• explain if noise, lighting or busy environments are particularly distracting
• ask for time to process information before making a treatment decision.
You don’t have to explain or justify every aspect of being neurodivergent.
Simply telling your healthcare professional “I process information better if you give me time to think about it” can be enough.
What about HRT?
This is where I think we need to avoid two extremes.
Being autistic or having ADHD does not automatically mean that you need HRT.
But being neurodivergent should not mean that your menopausal symptoms are dismissed either.
The usual principles of menopause treatment still apply.
If you have symptoms that are affecting your quality of life and HRT is medically appropriate for you, it may be one option worth discussing.
For some women, improving symptoms such as poor sleep, hot flushes, night sweats or other menopausal symptoms may make it easier to manage the other demands of daily life.
But HRT isn’t a treatment for autism or ADHD.
It is a treatment for menopausal symptoms, and whether it is appropriate depends on your individual circumstances.
And if you don’t want HRT, that is also a perfectly reasonable conversation to have.
There are non-hormonal approaches to managing many menopausal symptoms, as well as lifestyle and practical measures that can make a real difference.
Lifestyle matters too
I am always wary of telling women that exercise, eating well and getting enough sleep will somehow solve everything.
They won’t.
But they can be an important part of the bigger picture.
Regular physical activity, good nutrition, maintaining muscle and bone strength, protecting sleep and finding ways to manage stress can all support health during the menopause transition.
For a neurodivergent woman, I would also think about reducing unnecessary demands.
Sometimes the most helpful intervention isn’t another supplement or another medication.
It might be making your environment quieter.
Changing how you structure your day.
Building in recovery time after socially demanding activities.
Protecting your sleep.
Or accepting that the coping strategies you used in your twenties may need to change in your forties or fifties.
That isn’t failure.
It’s adaptation.
The Swansea research gives us an important message
I was particularly interested to see this area being researched here in Wales.
Swansea University researchers are leading participatory work looking at autistic people’s gynaecological and obstetric health across the lifespan, including the transition from menstruation through to menopause. The research involves autistic people in shaping the research itself, which is particularly important when we are trying to understand experiences that have historically received very little attention.
A 2025 systematic review from the Swansea team also looked specifically at menstruation and autism, highlighting the limited existing evidence and the need for better understanding of autistic people’s reproductive health experiences.
That matters because we need research that doesn’t simply study neurodivergent women from the outside.
We need to understand what women themselves are experiencing and what actually helps.
The research is still developing, but it is encouraging to see this work taking place in Wales and beginning to address an area that has been overlooked for far too long.
You don’t have to choose between “it’s my autism” and “it’s the menopause”
Perhaps the most important thing I would say to a woman sitting in front of me is this:
It doesn’t have to be one or the other.
You can be autistic and going through perimenopause.
You can have ADHD and be going through perimenopause.
You can have both.
Your neurodivergence doesn’t disappear because you reach menopause, and menopause doesn’t somehow explain away everything you are experiencing.
But hormonal changes may alter how you experience your existing symptoms and how well your usual coping strategies work.
Recognising that can be incredibly validating.
It can also open up more choices.
The bottom line
We are still learning about menopause and neurodivergence.
The research is relatively new, and we need much more of it – particularly research looking at which treatments actually help.
But that doesn’t mean we should wait for every question to be answered before listening to women.
If you are autistic or have ADHD and you feel that perimenopause has changed the way you think, sleep, cope, concentrate or experience the world, it is worth talking about.
You are not imagining it.
You are not necessarily “just struggling more with your autism”.
And you are not failing because the strategies that worked for you before don’t seem to be working now.
Sometimes the menopause transition changes the landscape.
Our job as healthcare professionals is to recognise that, listen carefully and work with you to find out what is happening – and what might help.
You deserve menopause care that understands the whole person, not just the symptoms on a checklist.
REFERENCES
- Grant A, Axbey H, Holloway W, et al. (2025). Autism and the Menopause Transition: A Mixed-Methods Systematic Review. Autism in Adulthood. Swansea University researchers reviewed the available evidence on menopause and autism, highlighting the limited evidence base and the need for better understanding and support.
- Moseley RL, Druce T, Turner-Cobb JM. (2020). “When my autism broke”: A qualitative study spotlighting autistic voices on menopause. Autism, 24(6), 1423–1437. A UK qualitative study exploring autistic women’s experiences of menopause, including changes in sensory sensitivity, emotional regulation, coping and everyday functioning.
- Moseley RL, Druce T, Turner-Cobb JM. (2021). Autism research is “all about the blokes and the kids”: Autistic women breaking the silence on menopause. British Journal of Health Psychology, 26(3), 709–726. A qualitative study exploring awareness, experiences and support needs around menopause among autistic women.
- Charlton RA, Happé FG, Shand AJ, Mandy W, Stewart GR. (2025). Self-Reported Psychological, Somatic, and Vasomotor Symptoms at Different Stages of the Menopause for Autistic and Non-autistic People. Journal of Women’s Health, 34(5), 622–634. A UK study comparing reported menopause symptoms in autistic and non-autistic participants.
- Grant A, Williams G, Axbey H, et al. (2024). Participatory longitudinal qualitative interview study to understand Autistic gynaecological and obstetric health: the Autism from menstruation to menopause study protocol. BMJ Open, 14, e088343. Swansea University-led research exploring autistic people’s experiences of gynaecological and reproductive healthcare across the lifespan.
- British Menopause Society. ADHD and autism in the context of managing the menopause. The BMS has highlighted the emerging clinical evidence and considerations around ADHD, autism and menopause as part of its professional menopause education programme.
- National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). NICE guidance on the diagnosis, assessment and management of menopause, including HRT and non-hormonal treatment options.
- NHS. Menopause. Patient information covering menopause symptoms, diagnosis and treatment options.
A NOTE ABOUT THE EVIDENCE
Research specifically looking at menopause in autistic and ADHD populations is still developing. The evidence base remains relatively small, particularly when it comes to understanding which treatments are most effective for neurodivergent people.
This means we should be careful not to present emerging findings as established fact. What the research does tell us is that neurodivergent people’s experiences of the menopause deserve to be recognised, listened to and investigated, and that menopause care should be individualised.