The Unseen Storm

Why Perimenopause and Late-Diagnosed AuDHD Lead to Burnout in Women

(The Abridged Version)

Perimenopause poses significant challenges for many women. For those who receive late diagnoses of both autism and ADHD (AuDHD), the transition can provoke a distinct form of burnout. This occurs as hormonal changes disrupt lifelong coping strategies, resulting in not only physical symptoms but also deep exhaustion and identity loss. The convergence of perimenopause and unrecognised neurodivergence creates a perfect storm for burnout that is often overlooked.

The Hidden Neurotype

Because autism and ADHD criteria were based on male presentations, these conditions have long been underdiagnosed in women [1][2][3]. As a result, many women with AuDHD learn to “mask”—suppressing their natural behaviour to fit in, often unconsciously [4]. This masking drains emotional and physical reserves and sets the stage for burnout [5][6].

Detecting these conditions is especially difficult because signs of AuDHD in women are often internalised: rather than disruptive behaviour, women tend to struggle with organisation, time management, and social exhaustion [7][8]. Misdiagnosis is common; women are frequently mislabelled as anxious, depressed, or lazy [4]. This mislabelling leads to years of self-doubt and fatigue as they try to cope like their neurotypical peers.

Burnout: More Than Stress

Neurodivergent burnout presents differently from typical work-related burnout. Rather than arising from overwork alone, it results from the chronic emotional toll of masking and unmet needs, both intensified in perimenopause [16][17]. As oestrogen declines and neurotransmitter function further deteriorates, especially for women with ADHD, symptoms such as mental fog and emotional swings worsen [9][10][11]. 

This convergence makes it nearly impossible to sustain old coping mechanisms.

Common signs of neurodivergent burnout include lower sensory tolerance, social withdrawal, increased anxiety, and disconnection from self and surroundings [5][16]. Some women even lose previously acquired skills, turning everyday tasks into major hurdles.

A Crisis—But Also an Opportunity

For many women, perimenopause marks the breaking point where accumulated pressures become overwhelming. Yet this crisis also crystallises why late-diagnosed AuDHD and hormonal changes so often result in burnout. Identifying the core issue transforms collapse into an opportunity for self-understanding and targeted recovery.

Strategies for Recovery

Recovery from neurodivergent burnout benefits from a holistic approach. Hormone Replacement Therapy (HRT) can stabilise symptoms, and ADHD medicines may help—even for those undiagnosed [9][13]. Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) support emotional regulation and lessen the burden of masking [18].

In addition to medical and therapeutic interventions, lifestyle changes are essential. Sleep hygiene, a balanced diet, hydration, and regular exercise support brain health and emotional well-being [9][14][15].

Building a supportive community—through peers who understand AuDHD and perimenopause or neuro-affirming professionals—can reduce isolation and foster belonging [19].

Crucially, recovery requires acceptance: letting go of masking, setting boundaries, and building environments that support neurodivergent needs.

The goal is to live authentically—not just survive, but thrive.

References

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2. Bargiela, S. N. (2015). Young women’s experiences of having Autism Spectrum Disorder [Doctoral dissertation, University College London]. UCL Discovery.

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12. Salinero, A. E., Zuloaga, D. G., Thrasher, C. A., Britton, G. B., Kritzer, M. F., & Mielke, M. M. (2024). Treatment with brain specific estrogen prodrug ameliorates cognitive effects of surgical menopause in mice. Hormones and Behavior, 162, 105594. https://doi.org/10.1016/j.yhbeh.2024.105594

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14. Brinton, R. D. (2009). Estrogen-induced plasticity from cells to circuits: Predictions for cognitive function. Trends in Pharmacological Sciences, 30(4), 212-222. https://doi.org/10.1016/j.tips.2008.12.006

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16. Raymaker, D. M., Teo, A. R., Steckler, N. A., Lentz, B., Scharer, M., Delos Santos, A., Kapp, S. K., Hunter, M., Joyce, A., & Nicolaidis, C. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132-143. https://doi.org/10.1089/aut.2019.0079

17. Higgins, J. M., Arnold, S. R. C., Weise, J., Pellicano, E., & Trollor, J. N. (2021). Defining autistic burnout through experts by lived experience: Grounded Delphi method investigating #AutisticBurnout. Autism, 25(8), 2356-2369. https://doi.org/10.1177/13623613211019858

18. Quinn, P. O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in women and girls: Uncovering this hidden diagnosis. The Primary Care Companion for CNS Disorders, 16(3), PCC.13r01596. https://doi.org/10.4088/PCC.13r01596

19. Millenet, S., Laucht, M., Hohm, E., Jennen‑Steinmetz, C., Brandeis, D., Banaschewski, T., & Schmidt, M. H. (2018). Sex‑specific trajectories of ADHD symptoms from adolescence to young adulthood. Journal of the American Academy of Child & Adolescent Psychiatry, 57(7), 475-485. https://doi.org/10.1016/j.jaac.2018.04.011

20.  Rucklidge, J. J. (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America, 33(2), 357-373. https://doi.org/10.1016/j.psc.2010.01.006