The Unseen Storm
- Amelia Loveland
- Oct 1, 2025
- 46 min read
Updated: Dec 19, 2025
The Neurobiological Intersection of Late-Diagnosed AuDHD and Perimenopause
An Analysis of Burnout in Neurodivergent Adult Females
Abstract
The convergence of late-diagnosed ADHD and autism (AuDHD), chronic social masking, and perimenopause represents an unrecognised source of burnout in neurodivergent women. This paper argues that for many such women, the perimenopausal hormonal transition acts as a critical neurobiological trigger that dismantles long-standing coping strategies, resulting in what we term a "life collapse." We provide a review of the literature regarding the mechanisms by which decreasing estrogen negatively impacts the dopaminergic, serotonergic, GABAergic, and cholinergic systems, exacerbating ADHD and autism symptoms and rendering decades of high-energy masking impossible to sustain. We discuss how societal issues such as gendered diagnostic bias and epistemically-based discrimination lead to delayed diagnoses and subsequent increased levels of stress and secondary mental health problems. Finally, we advocate for a paradigm shift away from the traditional deficit-based approach to working with individuals who have neurodevelopmental disabilities, and instead toward a neurodiversity-affirmative model that incorporates trauma-informed therapies, environmental accommodations, and strategic use of Hormone Replacement Therapies (HRT) and ADHD medications. We conclude that although this intersection can be experienced as a crisis, it can also represent a turning point toward greater self-awareness and authentic expression, ultimately leading to a sense of identity that enables survival to transform into actual thriving.
1. Introduction: Unveiling a Hidden Crisis
The intersection of late-diagnosed AuDHD (the co-occurrence of autism and ADHD), chronic masking, and the physiological changes of perimenopause creates a distinct and profoundly debilitating form of burnout that has remained largely invisible within both clinical practice and academic research. This confluence of factors, described as a "triple threat," manifests as what many women experience as a perfect storm—one that has long been misunderstood, dismissed, or pathologised by both individuals experiencing it and the medical community tasked with providing care (Brady et al., 2024).
Recent empirical research has begun to illuminate the complex mechanisms underlying this phenomenon (Craddock, 2024). Craddock conducted an interpretative phenomenological analysis demonstrating that clinicians and social norms can dismiss or overlook women's neurodivergence, producing epistemic injustice and delaying diagnosis until midlife or later. This research provides crucial evidence for what many women have experienced subjectively: that their neurodivergent traits have been systematically misunderstood or pathologised through gendered lenses.
The central premise of this analysis is that for many women, the perimenopausal transition is not merely a new stressor added to an already complex neurological profile, but rather a physiological catalyst that fundamentally disrupts the carefully constructed coping mechanisms developed over a lifetime of undiagnosed neurodivergence. This disruption occurs at multiple levels—neurochemical, psychological, social, and existential—creating a cascade of effects that can lead to what many women describe as a complete "life collapse" (Craddock, 2024).
The significance of this work extends beyond academic inquiry. As diagnostic practices evolve and awareness of neurodivergence in women increases, we are witnessing a surge in late-life diagnoses, with many women receiving their first formal recognition of autism or ADHD during their fourth, fifth, or even sixth decades of life (Bargiela et al., 2016).
Groundbreaking phenomenological research has revealed that perimenopause itself acts as a diagnostic catalyst, with hormonal changes frequently disrupting carefully constructed masking abilities and prompting women to seek assessment for long-standing neurodivergent patterns. This finding suggests that the perimenopausal transition represents a critical intervention window where previously masked traits become visible and diagnostic opportunities emerge (Moseley et al., 2020).
Cassidy et al. conducted a scoping review that reports late diagnosis in women is associated with increased rates of depression and self-harm behaviours, highlighting the urgent clinical implications of delayed recognition (Cassidy et al., 2020).
Furthermore, the COVID-19 pandemic has served as an additional catalyst, stripping away many of the environmental supports and social structures that enabled masking behaviours, while simultaneously increasing stress and reducing access to healthcare services (Moseley et al., 2020). This has accelerated the recognition of neurodivergence in women while also intensifying the challenges associated with hormonal transitions, creating what researchers have termed a "diagnostic tsunami" of late-identified neurodivergent women.
2. The Landscape of Late-Diagnosed AuDHD in Women: Historical Context and Current Understanding
2.1 The Historical Invisibility of Female Neurodivergence
The delayed diagnosis of autism and ADHD in women represents one of the most significant oversights in modern psychiatric and neurological practice, rooted in decades of research bias, diagnostic inadequacy, and systemic discrimination (Craddock, 2024). Craddock provides compelling evidence that this invisibility is not accidental but rather the result of gendered expectations and diagnostic frameworks that systematically exclude women's experiences from our understanding of neurodevelopmental conditions.
The foundations of our current diagnostic frameworks were established during an era when women's experiences were routinely marginalised within medical research (Craddock, 2024). Leo Kanner's seminal 1943 paper describing autism included only one girl among eleven cases, while Hans Asperger's work, though including girls, was largely ignored in English-speaking countries until the 1980s (Kanner, 1943; Wing, 1981). Similarly, early research on ADHD focused predominantly on hyperactive boys, creating a template that would influence diagnostic criteria for decades to come (Hinshaw et al., 2006).
This male-centric approach to research and diagnosis created what researchers now recognise as a "diagnostic shadow"—a space where women's experiences of neurodivergence remained invisible, misinterpreted, or pathologised through entirely different frameworks (Lai et al., 2015). The consequences of this invisibility extend far beyond missed diagnoses; they encompass decades of self-blame, inappropriate treatments, secondary mental health conditions, and profound identity confusion (Bargiela et al., 2016).
2.2 The Unique Presentation of AuDHD in Females
The recognition that autism and ADHD present differently in females represents a paradigm shift in our understanding of these conditions. Rather than representing "milder" versions of male presentations, female presentations reflect distinct phenotypes shaped by biological, psychological, and social factors that interact in complex ways (Goodman, 2023; Young et al., 2020).
McKinney et al. conducted a participatory study of girls aged 11-14 and found that camouflaging components (assimilation, masking, compensation) are present by early adolescence, with assimilation (pretending to fit in) distinguishing neurodivergent from neurotypical girls (McKinney et al., 2024). This research provides empirical evidence for the early onset of masking behaviours that have been observed clinically but were previously difficult to quantify.
Autistic females are more likely to develop sophisticated masking strategies from an early age, learning to camouflage their differences through careful observation and imitation of their peers (Dean et al., 2017). This masking often extends to special interests, which may focus on socially acceptable topics such as animals, books, or celebrities, making them less conspicuous than the mechanical or mathematical interests often seen in males (Hiller et al., 2014).
The sensory processing differences that characterise autism may also present differently in females, with many learning to suppress visible responses to sensory overwhelm while experiencing significant internal distress. This suppression can lead to delayed reactions, where meltdowns or shutdowns occur hours after the triggering event, making the connection between cause and effect less apparent to observers (Bargiela et al., 2016).
2.3 The Masking Phenomenon: Performance as Survival Strategy
Camouflaging is one of the key variables which contribute to delayed diagnosis in neurodivergent women. Recent empirical studies have provided quantification of previous qualitative descriptions.
Ross et al. investigated the relationship between camouflaging and mental health in autistic children and adolescents using large sample sizes (Ross et al., 2023). They found that camouflaging predicted internalizing symptomatology (anxiety, depression, somatic complaints) after controlling for age and IQ. This provides strong evidence that camouflaging behaviors have serious mental health implications.
Structural modeling by Pyszkowska showed that camouflaging is highly correlated with autistic burnout and anxiousness and may act transdiagnostically (not limited to ASD) to produce exhaustion and distress (Pyszkowska, 2025). This study suggests that the effects of masking and the masking phenomenon itself may extend beyond the initial assumption, potentially having a wide impact on several neurodivergent populations.
Critically, recent qualitative studies have shown that years of camouflaging creates a unique form of vulnerability during perimenopause when changes in hormone levels can drastically disrupt the cognitive and emotional resources that are required to sustain camouflaging behaviors (Moseley et al., 2020). As a result of the disruption of these resources, individuals experience a loss of their carefully crafted coping mechanisms and thus the emergence of previously masked autistic and ADHD traits.
The Specific Behaviours of Masking
There are numerous examples of masking behaviors. Studies indicate that while masking behaviors allow individuals to navigate social environments, they often require considerable cognitive and emotional expense and have been referred to as a "constant effort" that drains the energy available for other activities.
Social Masking
(Hull et al., 2017; Hull et al., 2017; D. Miller & Rees, 2021).
Preparation of conversations and social interactions ahead of time.
In order to reduce the uncertainty and fear associated with the unknown, many people develop elaborate pre-visualisations of potential conversations prior to engaging in them. A common aspect of these visualisations include mentally rehearsing possible social interactions and memorizing "proper" responses to avoid the social paralysis of not knowing what to say.
Compelling oneself to make eye contact despite being uncomfortable.
Despite the physical discomfort or perceived threat associated with direct eye contact, many individuals feel compelled to make eye contact with others in order to appear attentive and polite. However, the cognitive efforts involved in sustaining eye contact can be so taxing that they impair the ability of the person to attend to auditory stimuli, thereby requiring a trade-off between appearing to listen and actually listening.
Imitating facial expressions and body language exhibited by others.
By observing others and identifying what would be considered the "correct" emotional response, many individuals mimic the facial expressions and body language that they observe in others, such as laughing when others laugh even though they do not fully understand the context of the laughter. In doing so, individuals treat social expression as a mechanical imitation task rather than as an automatic response and attempt to camouflage themselves in order to appear like others.
Silencing one's natural voice characteristics (i.e., tone, volume, pace).
Many individuals regulate their natural prosody, volume, and/or pitch in order to conform to social norms of speech and avoid being perceived as "too loud" or "too monotone". This regulation of one's natural voice requires considerable mental energy to maintain throughout a conversation and stifles authentic expression.
Participating in social "small-talk" that is perceived as empty or annoying.
The participation in social communication that serves to establish rapport and build relationships, such as making comments about the weather or the upcoming weekend, is often viewed as a necessary social script, even when there is no inherent value or interest in the topic. Individuals recognise the necessity of participating in these types of conversations in order to build rapport with others and therefore continue to participate in them even when they are meaningless or uninteresting.
Simulating understanding of social cues while internally confused.
When social cues or subtext are misinterpreted, individuals may simulate understanding through nodding and smiling in order to avoid the stigma of appearing slow or socially inept. The simulation of understanding leaves individuals internally confused about the exchange that took place.
Sensory Masking
(D. Miller & Rees, 2021; Pearson & Rose, 2021)
Suppressing outward signs of sensory overload.
Many individuals hide outward signs of sensory overload, such as pain or nausea, caused by environmental stimuli (e.g. fluorescent lighting, perfume, or chaotic noise) in order to avoid drawing attention to their sensory sensitivities. Individuals internalise the distress of their sensory sensitivities to maintain a stoic appearance.
Withstanding socially acceptable but physically unpleasant clothing, lighting, or sounds.
Many individuals will withstand clothing, lighting, or sounds that are socially acceptable but that cause them great physical discomfort (e.g. wearing tight waistbands or synthetic fabrics) in order to avoid appearing disheveled. The desire to fit in often outweighs the discomfort and individuals experience chronic, low-grade sensory irritation as a result of the continued stimulation.
Concealing stimming behaviors or redirecting them into more socially acceptable behaviors.
Stimming behaviors, including self-regulatory movements (e.g. hand flapping or rocking), are often suppressed or redirected into more socially acceptable forms (e.g. tapping a pen or wiggling toes within shoes). Suppressing natural regulatory mechanisms deprives the body of its primary means of regulating the nervous system and contributes to increasing cumulative stress.
Controlling facial expressions during sensory overload.
During episodes of sensory overload, many individuals exert great control over their facial muscles to maintain a neutral or pleasant expression. This disconnection between internal chaos and external calm prevents others from recognising that the individual may need assistance or a different environment.
Executive Function Masking
(Livingston et al., 2019)
Creating detailed organisational systems in order to compensate for naturally occurring executive function deficits.
In order to compensate for difficulty with working memory or intrinsic time awareness, many individuals develop complex color-coded systems to organise their daily lives. These are not simply preferred methods of organisation, but are crucially important survival mechanisms that provide the structure necessary for individuals to complete their daily responsibilities.
Working much longer than their neurotypical peers to accomplish the same goals.
Many neurodivergent individuals work far longer hours, sometimes voluntarily and sometimes unpaid, in order to accomplish the same level of output as their neurotypical peers. Many individuals experience the sensation of paddling furiously beneath the surface of the water in order to maintain the illusion of effortless competence above the water.
Hiding struggles with time management and planning.
Anxiety related to time blindness often manifests in behaviors such as arriving at appointments well in advance to avoid tardiness. Time blindness can be manifested through excessive checking of clocks and alarm clocks to the point where managing time becomes a source of chronic stress rather than a routine process.
Using excessive amounts of lists and checklists in an attempt to compensate for forgetfulness.
Fear of being unable to remember to complete essential tasks leads some individuals to develop extensive lists of reminders and to take photographs of things (e.g. doors that are locked or stoves that are turned off) in addition to developing repetitive checking behaviors. These behaviors are motivated by a deep concern regarding being judged as unreliable or "spacey."
Emotional Masking
(Hull et al., 2017; Pearson & Rose, 2021)
Suppressing meltdowns or shutdowns until alone.
Meltdowns or shutdowns that occur when individuals are alone, often referred to as the "coke bottle effect", are a manifestation of the tremendous amount of energy required to hold emotions in check while interacting socially. The energy that is expended to delay the meltdown or shutdown leaves individuals exhausted, limiting the time and energy available for social relationships and personal activities.
Performing emotional responses that are expected in social settings.
Many individuals exhibit emotional responses in social settings that they intellectually recognise are the expected responses, regardless of whether they are experiencing those emotions themselves. This performance of empathy or enthusiasm is cognitively expensive and results in a feeling of dissociation from one's true self.
Hiding extreme interests or emotional reactions.
Extreme interest in topics or extremely positive emotional responses to stimuli are often concealed by individuals as a result of previous negative experiences being labeled "obsessive" or "weird". When individuals suppress their enthusiasm for a topic, they are cutting off a major source of enjoyment and connection with others in order to avoid overwhelming others with their interests.
Downplaying or denying internal distress.
When asked how they are feeling, many individuals respond with "I am fine" and dismiss their own needs in order to avoid being seen as difficult or high maintenance. This repeated dismissal of their own needs further reinforces the invisible nature of their struggles and limits their access to necessary accommodations.
The long-term energy requirements of sustaining masking behaviors are enormous and cumulative. Recent reviews suggest that masking behaviors are heterogeneous, that inconsistent quantitative findings exist and that transactional models should be developed that distinguish between the motivation to mask, the effort to mask, and the perceived success of masking (Khudiakova et al., 2025).
2.4 The Cost of Invisibility: Secondary Mental Health Impacts
The failure to recognise and appropriately support neurodivergence in women has profound consequences for mental health and wellbeing. Seers and Hogg conducted in-depth interviews with late-diagnosed women, documenting early marginalisation, identity disruption, and that receiving a diagnosis can be a turning point, enabling self-understanding and community connection (Seers & Hogg, 2021).
Depression is widespread among undiagnosed neurodivergent women, often developing as a result of chronic stress, social isolation, and the exhaustion associated with masking (Bargiela et al., 2016). This depression may be characterised by feelings of inadequacy, confusion about one's identity, and a sense of being fundamentally different from others without understanding why. This depression is often treatment-resistant because it stems not from chemical imbalances alone but from the ongoing stress of living inauthentically.
Anxiety disorders are similarly prevalent, often manifesting as social anxiety, generalised anxiety, or specific phobias related to sensory experiences or social situations (Hull et al., 2017). The constant hypervigilance required for masking can create a chronic state of arousal that manifests as anxiety symptoms. Many women develop elaborate avoidance strategies to manage their anxiety, further limiting their life experiences and reinforcing feelings of inadequacy.
Perhaps most tragically, the failure to recognise neurodivergence often leads to misdiagnosis with personality disorders, particularly borderline personality disorder (BPD) (Dudas et al., 2017; Fusar-Poli et al., 2022). The emotional dysregulation, identity confusion, and relationship difficulties that can result from unrecognised neurodivergence may be misinterpreted as personality pathology, leading to treatments that not only fail to address the underlying issues but may actually be harmful.
3. Understanding Neurodivergent Burnout: Beyond Traditional Conceptualisations
3.1 What Is Neurodivergent Burnout? – Differentiating from Traditionally Defined Occupational Burnout.
Unlike traditional models of occupational burnout — defined as occupational burnout being caused by chronic workplace stress leading to emotional exhaustion, depersonalisation, and decreased personal accomplishment — neurodivergent burnout is caused by chronic stress due to living in an environment that is inherently mismatched to one’s neurological needs.
Studies demonstrate how camouflaging is an antecedent to autistic burnout (Pyszkowska, 2025). Studies also demonstrate how camouflaging (masking) is energetically expensive and contributes to feelings of exhaustion. These studies empirically support what many neurodivergent people experience subjectively.
It is important to note the difference here — rather than examining the burnout as a lack of adequate coping strategies on the part of the individual — neurodivergent burnout is a direct result of prolonged attempts to function in environments designed for neurotypical brains while suppressing one’s true neurological expression (Raymaker et al., 2020).
3.2 The Masking/Burnout Cycle
The relationship between masking and burnout is a cycle and a self-fulfilling prophecy. According to Seers and Hogg, qualitative accounts of loss of authenticity, social withdrawal, impaired coping and loss of daily functioning were all linked to continuous use of masking behaviors and delayed recognition of neurodivergence (Seers & Hogg, 2021).
Unfortunately, this cycle is usually invisible to others and is often invisible to the person who is experiencing it, especially if the masking behaviors have become automatic and subconscious. It can be very hard to identify the gradual progression of decline until a crisis point is reached.
Typically, the cycle will follow these steps (Hull et al., 2017; D. Miller & Rees, 2021; Raymaker et al., 2020):
Phase One - Initial Masking
The individual develops and sustains masking behaviors and successfully navigates social and work environments while suppressing their neurodivergent characteristics.
Phase Two - Increasing Effort
As the demands of life increase (i.e. career advancement, relationships, parenthood), the amount of effort needed to continue to mask increases and draws upon greater amounts of the individual's physical, emotional, and mental energy.
Phase Three - Resource Depletion
The continued effort to sustain the masking behaviors begins to deplete the individual's physical, emotional, and mental resources. The individual may begin to feel increased fatigue, irritability, or have trouble completing tasks they could complete previously.
Phase Four - Compensation
To compensate for the depletion of resources, the individual will try to work harder to maintain their performance, and thus deplete their remaining resources.
Phase Five - Crisis
Eventually, the individual will reach a point at which they can no longer sustain the masking behaviors. This may be evident as a sudden inability to perform at work, maintain relationships, or take care of themselves.
Phase Six - Burnout
At this time, the individual will exhibit the total spectrum of burnout symptoms including extreme fatigue, emotional instability, cognitive dysfunction, and significant functional decline.
To break this cycle of masking/burnout, one must first understand the underlying forces that create this cycle, and then develop a plan that includes an acceptance of the need to stop masking, and find ways to express oneself authentically, and accommodate the environment to meet one’s neurodivergent needs.
3.3 The Neurobiological Mechanism of Burnout
Understanding the neurobiological mechanism behind neurodivergent burnout is necessary to develop effective treatments. The chronic stress produced by masking and the chronic mismatch of the environment to the individual’s neurological needs produce changes in the brain that are measurable, and occur primarily in regions involved in the stress response system, executive function, and emotional regulation.
Chronic activation of the hypothalamic pituitary adrenal (HPA) axis — which controls the body’s stress response — produces dysregulation of the HPA axis (Taylor & Corbett, 2014). Typically, when a stressor occurs, cortisol levels will rise, but once the stressor is resolved, cortisol levels will decrease back down to normal levels. However, in cases of chronic stress (as in the case of a neurodivergent person who is constantly using masking behavior), the HPA axis can become hyperactive (producing excessive cortisol) or hypoactive (providing insufficient cortisol) (Mahony & O'Ryan, 2022).
Both of these types of dysregulation will have numerous systemic effects. For example, chronically elevated cortisol levels can suppress the immune system, cause cardiovascular disease, gastrointestinal issues, and impair cognition (Croen et al., 2015). On the other hand, chronically low cortisol levels can cause fatigue, mood disturbances, and difficulty responding to new stressors. Both of these effects have been documented in individuals experiencing neurodivergent burnout (Lai et al., 2019; G.E. Miller et al., 2007).
4. The Hormonal Revolution: Perimenopause and the Neurodivergent Brain
4.1 Understanding Perimenopause: More Than Hot Flashes
The term perimenopause — literally “the time around menopause” — refers to the period when a woman’s reproductive hormone levels fluctuate dramatically, creating a state of turmoil in virtually all bodily systems. Of particular concern is how these hormonal fluctuations affect the brain (Kooij et al., 2019; Maki & Henderson, 2012).
Research conducted by Moseley et al. demonstrates the connection between autism and menopause — the perimenopausal/menopausal changes women experience often cause them to begin seeking professional evaluation or to identify long-standing neurodevelopmental patterns that were previously unrecognisable — thus serving as a diagnostic "inflection point" for women experiencing reproductive transitions (Moseley et al., 2020). This research provided the first empirical evidence for the anecdotal observations of clinicians: that hormonal transitions will often precipitate the identification of neurodevelopmental disorders.
Perimenopause usually begins in a woman's early-to-mid-40s; however, this onset can range anywhere from the mid-30s to the early 50s (Harlow et al., 2012; Santoro, 2016). At this time, the ovaries' function becomes less predictable, resulting in erratic levels of estrogen and progesterone (Hale et al., 2014). These irregularities are not a smooth decline into postmenopause but rather a wildly unpredictable series of spikes and troughs that can disrupt more than the relatively stable lower levels of postmenopause (Prior, 1998).
When this hormonal chaos interacts with the existing neurological profile of a neurodivergent woman, she experiences a compounded effect that can be extremely destabilising (Moseley et al., 2020). The areas of the brain and neurotransmitter systems impacted by the decline of estrogen are often the very same areas that are already operating differently in autism and ADHD (Chapman et al., 2025; Hampson, 2018).
4.2 Estrogen: The Master Regulator of Brain Function
Estrogen plays a far broader role in brain function than just its role in reproduction. It is the primary regulator of multiple neurotransmitter systems essential for cognitive function, emotional regulation, and sensory processing. Brinton et al. suggest that the perimenopausal-induced disruptions to estrogen-related bioenergetic and neural networks can create a variety of symptoms that include mental, affective, sleep, and sensory symptoms that have direct relevance to the expression of neurodevelopmental disorder symptoms (Brinton et al., 2015).
Modulation of Dopamine Systems
Estrogen functions as a natural modulator of dopamine systems, enhancing both the creation of dopamine receptors and their sensitivity. Thus, for individuals with ADHD who have already had issues with the regulation of their dopamine systems, the loss of estrogen can drastically exacerbate ADHD symptoms such as decreased motivation, attention deficits, and executive dysfunction (Kooij et al., 2019). The prefrontal cortex, which relies extensively on dopamine to perform at optimal levels, is especially vulnerable (Hampson, 2018). This helps explain why women with ADHD often describe a sharp deterioration in ADHD symptoms during perimenopause — namely, increased distractability, executive dysfunction, and difficulties with regulating emotions.
Effects of Serotonin System Interactions
Estrogen also regulates serotonin production, transport, and receptor sensitivity (Moseley et al., 2020). Serotonin is important for regulating moods, sleep, appetite, and social behavior — all of these behaviors tend to be challenging for neurodivergent individuals. The decrease in estrogen can lead to a reduction in the available amount of serotonin, which contributes to symptoms of depression, anxiety, sleep disturbances, and increased social difficulties (Cho et al., 2025). For autistic women who have differences in serotonin function, this hormonal change can have a profound impact on their emotional stability and social functionality.
Effects on the GABA System
Estrogen also regulates the gamma-aminobutyric acid (GABA) system, which inhibits excessive neural firing and facilitates the state of being calm and attentive (Maguire, 2019). When estrogen declines, GABA function can be disrupted, leading to increased anxiety, agitation, and diminished impulse control (Barth et al., 2015). This disruption to the GABA system can provide insight into the intense anxiety and sensory overload experienced by many neurodivergent women during perimenopause.
Role of Acetylcholine in Cognitive Function
Estrogen enhances the synthesis and function of acetylcholine, a neurotransmitter involved in attending to stimuli, learning, and remembering (Newhouse & Dumas, 2015). The decrease in estrogen can contribute to the "brain fog" commonly described by women during perimenopause — characterised by a lack of focus, memory lapses, and a general decline in mental clarity (Dumas & Newhouse, 2011). The cognitive burdens placed upon women with ADHD or autism due to the decline in estrogen can be debilitating.
4.3 The Intersection: When Hormones Meet Neurodivergence
Benevides et al. conducted a critically important study examining administrative data and identified that symptomatic menopause is under-documented in populations of autistic individuals, with factors of health care access and intellectual disability status affecting documentation (Benevides et al., 2024). This research identifies considerable obstacles to disclosure and acknowledgement of menopausal symptoms in neurodivergent women — further emphasising the clinical "invisibility" of this intersection.
The combination of hormonal fluctuations and neurodivergent characteristics produces specific patterns:
Amplification of Pre-existing Characteristics
Many women report that their ADHD or autistic traits become much more prominent during perimenopause (Osianlis et al., 2025). What was once manageable levels of attention deficit/hyperactivity may now become extreme, the magnitude of sensory sensitivities may increase exponentially, and emotional regulation may become dramatically more difficult (Moseley et al., 2020).
Revealing of Latently Expressed Characteristics
Women who have effectively concealed their neurodevelopmental characteristics may find that the hormonal changes of perimenopause render concealing their characteristics impossible, allowing previously hidden characteristics to emerge for decades (Moseley et al., 2021). Women often view this process as both terrifying and liberating as they come to understand aspects of themselves they never did before.
Emergence of New Symptoms
Some women develop what seem to be completely new symptoms during perimenopause — symptoms that could actually be manifestations of neurodevelopmental characteristics that were previously suppressed or compensated for through high levels of estrogen (Kooij et al., 2019).
Cognitive Cascade Effects
The cognitive changes caused by perimenopause can have cascade effects on other areas of function (Mosconi et al., 2017). For example, memory difficulties may impair job performance, attention difficulties may interfere with interpersonal relationships, and the inability to regulate executive functions may make managing day-to-day life increasingly more difficult (Greendale et al., 2009).
5. The Triple Threat: Convergence and Catastrophe
5.1 The Perfect Storm: When Systems Collide
The convergence of late-diagnosed AuDHD, chronic masking behaviours, and perimenopausal hormonal changes creates a dynamic that transcends the sum of its parts. This intersection is not merely a list of concurrent stressors; it is a synergistic interaction where each factor systematically dismantles the coping mechanisms required to manage the others (Brady et al., 2024).
Recent qualitative evidence documents how this compounding effect creates a specific trajectory of "life collapse," where women feel they are deteriorating "for no reason."
To understand this mechanism, we must view it as a chain reaction:
The Fragile Foundation:
Undiagnosed neurodivergence creates a baseline of chronic stress and identity confusion, requiring immense energy to maintain "normal" functioning (Crompton et al., 2020).
The Depleted Reserve:
Decades of chronic masking have already drained the cognitive and emotional reserves necessary for resilience, leaving no "buffer" for new stressors (Brady et al., 2024; Pearson & Rose, 2021).
The Knockout Blow:
Hormonal changes then directly attack the neurochemical systems (dopamine, GABA, serotonin) that were holding this precarious balance together (Kooij et al., 2019).
5.2 The Catalyst Effect: When Compensation Fails
The perimenopausal transition often acts as the ultimate catalyst that exposes the unsustainability of masking behaviours and compensatory strategies. Moseley et al. found that reproductive transitions frequently serve as diagnostic inflection points, with women often seeking assessment or recognising neurodivergent patterns during these periods of hormonal change (Moseley et al., 2020).
Women who have successfully navigated decades of challenges through sheer determination, intelligence, and carefully constructed coping mechanisms suddenly find that these strategies no longer work. This failure is not due to personal weakness or lack of effort, but rather reflects the neurobiological reality that the brain systems supporting compensation have been fundamentally altered by hormonal changes (Livingston et al., 2019).
The catalyst effect manifests in several ways:
Cognitive Overload
Tasks that were previously manageable become overwhelming as working memory, attention, and processing speed decline (Greendale et al., 2009). Women may find themselves unable to multitask, follow complex instructions, or maintain their previous levels of organisation and productivity (Kooij et al., 2019).
Emotional Dysregulation
The careful emotional control that many women have maintained through masking becomes impossible to sustain (Brady et al., 2024). Emotions that were previously suppressed or managed may emerge with startling intensity, leading to meltdowns, panic attacks, or periods of profound depression (Gordon et al., 2015).
Sensory Overwhelm
Sensory sensitivities that were previously manageable may become unbearable as hormonal changes affect sensory processing systems (Hampson, 2018). Environments that were tolerable become overwhelming, leading to increased isolation and functional decline (Moseley et al., 2020).
5.3 The Diagnostic Revelation: Recognition Through Crisis
Paradoxically, the crisis created by the intersection of AuDHD and perimenopause often becomes the catalyst for diagnostic recognition. As masking behaviours collapse and authentic neurodivergent traits become visible, women may finally receive the diagnoses that have eluded them for decades.
Seers and Hogg documented that receiving a diagnosis can be a turning point enabling self-understanding and community connection, despite the grief and loss associated with late recognition (Seers & Hogg, 2021). This research highlights the transformational potential of late diagnosis, even during crisis periods.
The diagnostic journey often follows a characteristic pattern:
Crisis Recognition:
The severity of symptoms during the perimenopausal transition often forces women to seek help, either from healthcare providers, mental health professionals, or through their own research into their experiences (Moseley et al., 2020).
Initial Misattribution:
Initial attempts to understand the crisis may focus on hormonal changes, life stress, or mental health conditions, missing the underlying neurodivergence (Au-Yeung et al., 2019).
Research and Recognition:
Many women begin researching their symptoms online and encounter information about autism and ADHD in women (Lewis, 2016). This research often leads to a profound moment of recognition as they see their lifelong experiences reflected in descriptions of neurodivergence (Leedham et al., 2020).
Formal Assessment:
Armed with this new understanding, women may seek formal assessment for autism or ADHD. The assessment process can be complicated by the intersection with menopausal symptoms, requiring skilled clinicians who understand both conditions (Lai & Baron-Cohen, 2015).
Reframing and Relief:
Receiving a neurodivergent diagnosis often provides immense relief and a framework for reframing a lifetime of experiences (Leedham et al., 2020). What was previously understood as personal failure or character flaws can be reconceptualised as neurological differences requiring accommodation rather than elimination (Crompton et al., 2020).
6. Clinical Manifestations: The Lived Experience of the Triple Threat
6.1 The Phenomenology of Crisis: Understanding Subjective Experience
In addition to clinical manifestations, the lived experience of the triple threat — AuDHD and perimenopause — presents a unique phenomenological experience for many individuals, and also for health care professionals who provide treatment for them (Craddock, 2025). The subjective experience of this crisis is characterised by a total disintegration of not only specific abilities and coping mechanisms, but of the very sense of self developed over the course of decades of masking and compensating (Moseley et al., 2020).
Research conducted by Craddock recently documented empirically the subjective experience of these crises, noting that women commonly described their experience of crisis as feeling as if their “life is falling apart for no reason” or that they felt as if they were “falling apart at the seams,” with the use of such language reflecting the true confusion that follows the experience, given that the root causes of this — undiagnosed neurodivergence and hormonal changes — are often invisible and unrecognised.
The phenomenological characteristics of this crisis include:
Existential Confusion
This type of existential confusion includes a profound and all-encompassing questioning of identity, purpose, and reality that typically occurs when the mask that an individual has worn for decades begins to fail. Women may feel that they do not recognise themselves or know where they fit into the world as the gap between their internal experiences and external personas grows so large that reconciliation is no longer possible. The phenomenon of "identity fragmentation" is central to women diagnosed later in life who frequently express feelings of being "aliens" or "impostors" in their own lives (Craddock, 2024; Seers & Hogg, 2021).
Cognition Disintegration
This refers to the terrorising experience of previously reliable cognitive functions — such as memory, focus, and verbal fluency — becoming unreliable or disappearing. For women who have used their intelligence to mask executive dysfunction ("high functioning"), the loss of these functions appears to be an irreparable loss of the self. The inability to accomplish tasks that were once simple results in extreme anxiety and a fear of developing early onset dementia, a frequent misinterpretation among women in this cohort (Greendale et al., 2009; Moseley et al., 2020).
Emotional Volatility
Women experience intense, seemingly excessive emotions as a reaction to stimuli or mood crashes that appear to occur randomly. The intensity and unpredictability of emotional responses are caused by the synergy of estrogen fluctuation disrupting the amygdala and the loss of cognitive resources needed to suppress emotional reactions. As a result of the loss of cognitive resources, the emotional environment becomes chaotic and frightening, resulting in a "narrowed window of tolerance" for stress (Brady et al., 2024; Gordon et al., 2015).
Somatic Disruption
Symptoms that manifest physically and may seem unrelated to psychological distress, such as severe fatigue, chronic pain, gastrointestinal disorders, and sensory hypersensitivity, are part of the manifestation of the crisis. These symptoms are often indicative of "autistic burnout" — where the body ceases to operate non-vital functions due to chronic allostatic overload. They represent the physiological price paid for decades of masking that are now amplified by the inflammatory response to estrogen deprivation (Osianlis et al., 2025; Raymaker et al., 2020).
Social Disconnection
With the energy for social camouflage decreasing, there is a growing sense of an inability to connect with others or sustain relationships that have been important to women in the past. Women may avoid social interactions not out of a lack of interest in connecting with others but because the cognitive "cost" of interacting has become too great to bear. The consequences of social disengagement can lead to isolation and the painful review of relationships that were likely based on the masked, not authentic, aspects of her personality (Pearson & Rose, 2021; Crompton et al., 2020).
Temporal Disorientation
Temporal disorientation is another feature of this crisis, defined as an inability to perceive time, plan for the future, or assess past experiences within the context of current knowledge and understanding. The decline in dopamine function is responsible for worsening "temporal blindness" (a hallmark symptom of ADHD) which renders the future indistinct and the present overwhelming (Toplak et al., 2006). In addition, the diagnostic process disrupts the biographical timeline of a woman, requiring that she reevaluate memories through the new perspective of neurodivergence, creating temporary instability of her self-timeline (Barkley et al., 2001).
6.2 Cognitive Symptoms: When the Mind Revolts
The cognitive symptoms of the AuDHD-perimenopause interface are often the most distressing and disabling. These symptoms arise from the collapse of executive functions that have been weakened for years and are now further disrupted by hormonal fluctuations.
Collapse of Executive Functions
The executive function deficits characteristic of ADHD are greatly intensified during perimenopause (Epperson et al., 2015). Women may find that they cannot prioritise tasks or make decisions, attend to a task for extended periods, recall appointments or obligations, organise their physical or electronic environments, use time efficiently or estimate how long a task will take, or initiate tasks that they wish to complete. Because of the severity of these difficulties, compared to previous levels of difficulty, these difficulties create significant limitations in functioning in work, home, and social environments (Kooij et al., 2019; Moseley et al., 2020).
Deterioration of Working Memory
Decline in working memory — the capacity to retain and manipulate information in memory — is frequently observed (Greendale et al., 2009). Decline in working memory may be evidenced by losing track of conversations mid-sentence, forgetting what one is doing while doing it, failure to follow sequential instructions, difficulty with complex calculations or problem solving, and difficulty with reading comprehension and retention.
Reduced Processing Speed
Many women report that their thinking has become "slow" or "cloudy". Information processing that was formerly fast and effective has become laborious and requires a great deal of effort. This may be especially distressing for women who have relied upon speed of thought and intellectual agility (Weber et al., 2014).
7. Evidence-Based Interventions: Clinical and External Support
Having explored the mechanisms and manifestations of the AuDHD-perimenopause intersection, we now turn to evidence-based interventions that can provide meaningful support. The following sections outline medical, psychological, and lifestyle approaches grounded in a neurodiversity-affirming framework.
7.1 The Paradigm Shift
AuDHD-perimenopause intersection treatment will require a complete paradigm shift from traditional pathological-based models to neurodiversity-affirming care (Brady et al., 2024). This means that, rather than attempting to eliminate neurodivergent traits or forcing women to conform to neurotypical norms, the goal is to support women in expressing themselves authentically, and provide them with reasonable accommodations and interventions for those areas of real difficulty (Pellicano & Den Houting, 2022).
Recent studies suggest that this neurodiversity-affirming model is supported by research. For example, Seers and Hogg (2021) stated that obtaining a diagnosis can be a transformative event, allowing self-awareness and connections to supportive communities, and thus, may be more effective than interventions that focus on deficits, as opposed to acceptance-based models.
Neurodiversity-Affirming Models Have Three Main Principles:
Acceptance Over Normalisation
As opposed to using behavioral interventions to suppress what are perceived as "symptoms" of neurodivergence (like stimming or special interests) and attempting to normalise women who are neurodivergent, this model accepts and supports the authentic expression of neurodivergent women, and attempts to alleviate those areas in which they are truly distressed. This principle reduces the emphasis placed on eliminating or suppressing "symptoms" and shifts the emphasis to women's overall mental wellness and the alleviation of camouflaging behaviours that lead to burnout (Leadbitter et al., 2021; Pellicano & Den Houting, 2022).
A Strengths-Based Perspective
This model also acknowledges that neurodivergent traits are often accompanied by numerous strengths and abilities, such as hyperfocus, recognising patterns, and having deep empathy, which should be encouraged and utilised, rather than suppressed. Additionally, by reframing these characteristics as variations in cognition, rather than deficits, women can begin to utilise their natural neurological styles to navigate the perimenopausal transition, rather than fighting against their own brains (Cope & Remington, 2022; Russell et al., 2019).
Environmental Modification
This model emphasises making environmental changes to accommodate women, rather than requiring them to modify their behavior to fit into environments that are hostile or unsupportive. Using the social model of disability as a basis for intervention, this model advocates for creating changes to sensory environments, communication expectations, and work-place structures to decrease the allostatic load that creates disability (den Houting, 2019; Raymaker et al., 2020).
Development of Self-Advocacy Skills
Supporting women in the development of self-advocacy skills is essential in ending the invisible struggles that many women endure. Developing women's ability to express their needs in terms of sensory and executive function requirements to employers and family members, transforms them from being passive recipients of care into active authorities regarding their own nervous systems (Crane et al., 2019).
Trauma-Informed Care
It is essential to recognise that many neurodivergent women have experienced developmental trauma and micro-traumas resulting from years of invalidation and sensory violations. As such, care must assume a history of trauma and avoid therapies that promote compliance or masking. Instead, care must focus on safety, validation, and healing the nervous system from the cumulative stress of living without a diagnosis (Pearson & Rose, 2021; Rumball et al., 2020).
7.2 Medical Support
Medical supports will represent a primary component of holistic treatment, specifically addressing both the endocrine changes of perimenopause and the neurobiological characteristics of neurodivergence (Kooij et al., 2019). To integrate these types of interventions, there will need to be collaboration among specialists in women's health, psychiatry, and neurodevelopmental disorders.
Hormone Replacement Therapy (HRT)
HRT represents one of the most effective treatments for women at the intersection of neurodivergence and perimenopause. Restoration of estrogen and progesterone can provide substantial relief from both menopausal and neurodivergent symptoms (Maki & Henderson, 2012; Panay & Studd, 1997).
Benefits of HRT for Neurodivergent Women:
Restore Dopamine Function, Improve ADHD Symptoms
Stabilise Mood and Emotional Regulation
Improve Cognitive Function and Memory
Reduce Anxiety and Sleep Disturbances
Decrease Sensory Sensitivity and Increase Stress Tolerance
Limitations of HRT for Neurodivergent Women:
Women may be sensitive to certain medications and therefore may need to undergo careful titration and monitoring
Some women may find transdermal preparations more preferable than oral medications, due to gastrointestinal side effects
Timing and type of progesterone may be particularly important for mood stability
Monitoring is essential to maximize the benefits and minimise the risks of HRT.
Medications for ADHD
In order to manage ADHD during perimenopause, medication management will require particular attention to the interaction between stimulant medications and the fluctuating hormones of perimenopause (Kooij et al., 2019; Roberts et al., 2018).
Stimulant Medications:
May lose efficacy during perimenopause, as a result of decreasing estrogen levels
May require dosage adjustment, especially around menstrual cycles
Extended release medications may provide more consistent symptom management
Combining with HRT may improve efficacy.
Non-stimulant Medications:
May be preferable for women experiencing anxiety and/or sleep disturbances
Provide more consistent symptom management throughout hormonal fluctuations
May be particularly useful for managing emotional regulatory challenges.
7.3 Psychological Support
Psychological interventions for women at the intersection of AuDHD and perimenopause must address multiple levels of need: recovery from developmental trauma, development of authentic self-expression, acquisition of practical coping strategies, and integration of identity.
Trauma-Informed Therapy
Many neurodivergent women have experienced developmental trauma from years of misperceiving their neurodivergent traits, rejecting them, and forcing them to conform to neurotypical norms. Recent studies indicate that late diagnosis is often associated with confusion or trauma, and thus, there is a need for trauma-informed approaches to post-diagnosis support (Craddock, 2024).
Acceptance and Commitment Therapy (ACT)
ACT is particularly well-suited for neurodivergent women, as it emphasizes acceptance of internal experiences while taking actions based on valued goals (Byrne & O'Mahony, 2020). ACT has been shown to reduce the struggle against neurodivergent traits, develop psychological flexibility, allow for the expression of authentic self, and build resilience and coping skills.
Other Therapies
EMDR (Eye Movement Desensitisation and Reprocessing) to process traumatic memories (Rumball, 2018)
Somatic therapies to treat traumatic experiences stored in the body (C. J. Price & Hooven, 2018; Quadt et al., 2021)
Internal Family Systems (IFS) therapy to heal various parts of the self (D. Price, 2022)
Narrative therapy to reinterpret life events in a more compassionate way (Cashin, 2008; Dallos & Vetere, 2014).
7.4 Bio-Regulatory Support: Building Capacity of the Nervous System
Due to the dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and the depletion of neurotransmitters discussed in Section 3, lifestyle interventions will be considered as bio-regulatory scaffolding, rather than as moral mandates for "good health." However, this will require acknowledgment of the executive function and sensory barriers that make standard recommendations inaccessible.
Neurotransmitter Precursor Support via Nutritional Sources
Nutritional support will attempt to reduce neuroinflammation and provide the precursors to produce neurotransmitters, while respecting women's sensory food aversions (Boyle et al., 2017; Kennedy, 2016; Minihane, 2025).
Anti-inflammatory Dietary Adjustments
Since estrogen withdrawal results in systemic inflammation, dietary adjustments that reduce inflammation may support healthy brain functioning.
Executive-Friendly Food Preparation Strategies
Recognising that preparing meals can be a challenge for many women, the goal will be to identify simple ways to incorporate "low-effort" sources of omega-3 fatty acids and magnesium (essential for regulating anxiety and sleep).
Nervous System Regulation Through Physical Activity
Instead of focusing on physical activity as a method for weight loss, physical activity will be framed as a mechanism to regulate the nervous system and increase dopamine production (Mehren et al., 2020).
Stimulation through Rhythmic Movements
Engaging in rhythmic activities (such as running or swimming) may provide women with socially acceptable methods to engage in large motor "stimming" that can aid in regulating the nervous system.
Re-establishing Somatic Connection
Using practices such as yoga or tai chi to help restore interoception (awareness of internal bodily sensations) that may have been compromised in neurodivergent women.
Optimising Sleep Architecture
Both menopause and ADHD are characterized by sleep disturbances, so optimising sleep will be a clinical priority (Caruso et al., 2019; Shanahan et al., 2021).
Respect for Chronotype
Interventions may involve establishing routines and schedules that are aligned with each woman's natural chronotype (e.g., "night owls" that are common in ADHD) rather than requiring women to adhere to a non-aligned schedule.
Creating Sensory Safety in the Environment
Alongside addressing sleep hygiene issues, modifying the sleep environment to create a safe space for hypersensitive women (e.g., weighted blankets, blackout curtains) will be just as important as creating a safe sleep environment.
8. Redefining Recovery: The Internal Journey
As much as medical treatments offer protection and support from physical and psychological collapse, actual healing is the inner process of reintegration of the identity of each woman and her personal experiences with her neurodivergence.
8.1 Redefining Recovery: From Functionality to Flourishing
For women who have experienced both perimenopause and the intersection of Autism and Hyperactivity Disorder (AuDHD), the traditional medical definition of recovery will need to be completely redefined. Medical professionals traditionally define recovery in terms of returning a person to the same or better functioning status as before. However, for this group of women, this previous level of functionality was most often achieved through the use of unsustainable masking behaviors.
Recently, there has been a growing consensus among researchers and clinicians that the goals of autism treatment should be focused on supporting the development of autistic flourishing—i.e., supporting each individual's ability to grow and thrive on their own terms, not necessarily on neurotypical standards (Pellicano et al., 2022). This redefinition of recovery recognises that recovery does not involve "fixing" what is perceived as "broken," but rather finding a way to integrate one's autistic identity with the current menopausal changes and develop a new and authentic way of being.
8.2 The Unmasking Process: Disassembling the Performance
Unmasking is a core part of the recovery process but is also an intense psychological transformation. It is not merely a matter of choosing to remove a behavior; unmasking is a complicated disassembly of a learned survival behavior developed over several decades (Pearson & Rose, 2021).
Acknowledgment and Mourning
Unmasking begins with acknowledgment of the great price paid for the social roles/behavior adopted and performed for so many years. Miller and Rees indicate that for many women, the moment of recognition of the loss of those years of performance is accompanied by an overwhelming feeling of loss for the years of performance of a role that had never been their true identity (D. Miller & Rees, 2021).
The Identity Void
When the mask is dropped, a frightening void is created that the individual must fill by discovering who she is without the coping mechanisms of her past performances. This "disintegrating of the identity" is both a necessary step toward rebuilding a cohesive identity and a painful one (Seers & Hogg, 2021).
8.3 Developing Resilience: Protective Factors
In the context of this study, resilience refers to the development of internal resources that protect against the potential of burnout, not simply "to get through" the challenges (Russell et al., 2019).
Self-Compassion as a Therapeutic Tool
Empirical studies have identified self-compassion as a critical resource to build and maintain resilience for autistic adults. Self-compassion training significantly reduces symptoms of depression and anxiety in autistic adults compared to other forms of cognitive behavioral therapy (CBT). Instead of judging themselves harshly for their sensory limitations, women may begin to treat their limitations with compassion and thereby end the cycle of self-doubt and internalised ableism (Cai & Brown, 2021).
Regulation of Emotions
Learning to tolerate discomfort and not suppress emotions is essential. Studies show that when autistic adults are allowed to validate their emotional reactions instead of hiding them, their "windows of tolerance" increase. In turn, the frequency of meltdowns decrease (Byrne & O'Mahony, 2020; Price & Hooven, 2018).
9. Societal Implications and Future Directions
9.1 The Hidden Epidemic
The intersection of late-diagnosed AuDHD and perimenopause represents a hidden epidemic. Benevides et al. have contributed essential data to understanding the extent to which symptomatic menopause has been reported in the autistic population (Benevides et al., 2024), thus establishing that there is a "clinical invisibility" of this condition, in that the hundreds of thousands of women who are now being diagnosed with "treatment-resistant depression" or "midlife crisis" could potentially be having this same neuro-hormonal collision (Brady et al., 2024).
9.2 Overcoming Systemic Obstacles
To address this it is necessary to challenge the intersection of ageism and ableism (Craddock, 2024) within existing diagnostic models. The framework currently used to diagnose conditions does not allow for women’s experiences, and menopause care is not often informed by an awareness of the needs of neurodiverse individuals. Healthcare providers will require education and training to recognise sensory sensitivities as a biological phenomenon that should be environmentally accommodated rather than viewed as difficult behavior (Raymaker et al., 2020).
9.3 Enhancing Research
Longitudinal studies examining both hormonal fluctuations and the changes in executive functioning in autistic populations are needed, as well as moving away from relying on retrospective qualitative data (Moseley et al., 2020). One area of research that is particularly needed and would benefit from further investigation is whether hormone replacement therapy (HRT) can act as a protective agent for neurodegenerative symptoms of ADHD (Osianlis et al., 2025; Kooij et al., 2019).
9.4 Creating a Neurodiversity Affirming Culture
In the end, the aim is for a culture that affirms and celebrates neurodiversity. Den Houting indicates that we must go from "awareness" to "acceptance," creating a world where all neurotypes are recognised and valued as a normal component of human diversity (Den Houting, 2019). In terms of menopause, this would mean a work environment that supports employees with "brain fog" without judgment and a health care system that recognises a woman's increased sensitivity as a sign of menopause rather than a symptom of another condition (Cope & Remington, 2022).
10. Conclusion: From Crisis to Transformation
10.1 Synthesis of Key Findings
This comprehensive analysis has examined the complex intersection of late-diagnosed AuDHD and perimenopause, revealing a phenomenon that represents both a significant crisis and an opportunity for transformation in how we understand and support neurodivergent women.
The key findings synthesised throughout this work illuminate several critical insights supported by emerging empirical research:
The Triple Threat is Real and Devastating
The convergence of undiagnosed neurodivergence, chronic masking behaviours, and hormonal changes creates a synergistic effect that can lead to profound burnout and life disruption. Pyszkowska provides empirical evidence that camouflaging serves as an antecedent correlated with higher scores on autistic burnout scales, while Moseley et al. demonstrate that hormonal transitions frequently serve as diagnostic inflection points (Moseley et al., 2020; Pyszkowska, 2025).
Masking is Unsustainable and Ultimately Harmful
McKinney et al. found that masking components are present by early adolescence, while Ross et al. demonstrated that camouflaging predicts internalising symptoms after controlling for age and IQ (McKinney et al., 2024; Ross et al., 2023). This research provides robust evidence for the mental health costs of sustained masking behaviours.
Late Diagnosis Can Be Transformational
Despite the challenges, Seers and Hogg documented that receiving a diagnosis can be a turning point enabling self-understanding and community connection, highlighting the transformational potential of recognition even when it occurs during crisis periods (Seers & Hogg, 2021).
Recovery Requires Paradigm Shift
The research consistently supports neurodiversity-affirming approaches that prioritise authentic self-expression over normalisation, environmental accommodation over individual adaptation, and acceptance over elimination of neurodivergent traits (Pellicano & Den Houting, 2022).
10.2 The Imperative for Action
The findings of this analysis create a moral and practical imperative for immediate action across multiple domains. The suffering experienced by women caught in this intersection is preventable and treatable, but only if we act decisively to address the systemic barriers and knowledge gaps that have contributed to their invisibility.
Craddock provides compelling evidence that epistemic injustice and gendered expectations systematically delay diagnosis until midlife or later, while Benevides et al. demonstrate that symptomatic menopause is under-recorded in autistic populations (Benevides et al., 2024; Craddock, 2024). These findings highlight the urgent need for systemic change in recognition, assessment, and treatment approaches.
10.3 The Transformation Potential
While this analysis has focused extensively on the crisis and suffering associated with the intersection of AuDHD and perimenopause, it is important to recognise the profound transformation potential that this experience offers. The research by Seers and Hogg demonstrates that late diagnosis, despite its challenges, can enable self-understanding and community connection that transforms women's relationship with themselves and their futures (Seers & Hogg, 2021).
The growing recognition of this intersection has the potential to drive broader societal transformation through increased awareness, research advancement, service development, and cultural shifts towards greater acceptance of neurodiversity (den Houting, 2019).
10.4 A Vision for the Future
Looking towards the future, we can envision a world where the intersection of neurodivergence and life transitions like menopause is understood, anticipated, and supported rather than experienced as a crisis. This vision is supported by emerging research that provides both the scientific foundation and the clinical frameworks necessary for positive change (Pellicano et al., 2022).
The evidence base reviewed in this analysis demonstrates that with appropriate recognition, assessment, and support, women experiencing this intersection can not only recover from crisis but can thrive in ways that may never have seemed possible during their years of masking and struggle (Seers & Hogg, 2021).
10.5 Final Reflections: The Evidence for Hope
The empirical research reviewed throughout this analysis provides substantial evidence for hope. Studies demonstrating the benefits of diagnosis (Seers & Hogg, 2021), the effectiveness of neurodiversity-affirming approaches (Pellicano & Den Houting, 2022), and the potential for hormonal interventions to restore functioning all point towards the possibility of positive outcomes for women experiencing this intersection (Kooij et al., 2019; Maki & Henderson, 2012).
The journey from crisis to transformation requires courage, support, and appropriate interventions, but the research demonstrates that this transformation is not only possible but probable when women receive appropriate recognition, understanding, and care (Seers & Hogg, 2021).
The unseen storm of AuDHD and perimenopause need not remain unseen (Brady et al., 2024). Through continued research, clinical innovation, advocacy, and social change supported by robust empirical evidence, we can transform this crisis into an opportunity for growth, understanding, and authentic living.
The women experiencing this intersection deserve nothing less than our full commitment to understanding their experiences, addressing their needs, and supporting their journey towards thriving rather than merely surviving (Pellicano et al., 2022).
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