Divergent Menopause (previously The Autistic Perimenopause)

This episode is a real-time check-in from autistic burnout, recorded from bed under a weighted blanket.Sam shares:Early warning signs of burnout (pain, posture collapse, sensory overwhelm, urinary urgency)How menopause, hormones, burnout, autism and ADHD overlapWhy burnout can feel cyclical and retraumatisingThe grief of losing your “high-functioning” selfWhy doing less is not failureHow internalised ableism worsens burnoutPractical ways to stabilise instead of “fix” burnoutWhy neurodivergent burnout recovery is the opposite of neurotypical adviceThis is not a polished recovery guide. It’s what burnout actually looks like while you’re in it. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

In this episode, I’m relaunching The Divergent Menopause Q&A: a community-driven series sharing real lived experiences of neurodivergent menopause.This is an open invitation to contribute your story.We talk about:Why neurodivergent menopause is so underrepresentedThe risks of silence and lack of supportThe importance of lived experience alongside researchWhat to expect if you take partIf you’ve ever felt unseen, dismissed, or alone in this stage of life this space is for you.Take part in the Q&A: The Divergent Menopause Q&AContent note: Mentions of mental health and suicide risk.Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.I am Sam Galloway (she/her), an autistic ADHDer (AuDHDer), and a surgical menopause survivor. I write Divergent Menopause to share what many of us are never told until we have to find out the hard way.Thanks for joining me on this wild midlife ride! 🎢The Divergent Menopause Q&ATell us your story!Hi All,If you have been here a while you might remember that I used to host an interview series called Auti Peri Q&A. You can find all the interviews here. When I changed the name of my publication to Divergent Menopause I knew that I would want to share the voices of others because if you’ve met one menopausal neurodivergent person, you’ve met one menopausal neurodivergent person.My own menopause story is uniquely bleak, and I want us all to know about other ways our neurokin are surviving this often challenging life phase. My goals are always to share experiences and build community around neurodivergent menopause.I am now relaunching the Q&A series under the name The Divergent Menopause Q&A, and am opening it up to all people who identify as neurodivergent with lived experience of the menopause transition!Completed Q&As will be published here and, emailed out to my subscribers. Respondents can be anonymised when it goes online, although I will need an email address to contact you and make sure you are happy with the final edit.Your email address will not be shared in the post, nor shared with any third parties. Without a contact email address to reach out to you, I will be unable to publish your Q&A.I would LOVE to share your neurodivergent menopause story! It doesn’t need to be remarkable or dramatic.We already know from research that the rate of suicide is higher for neurodivergent midlife people transitioning through menopause compared to the neurotypical population.We have no time to waste in sharing our experiences, and getting the message across that perimenopause and hormonal fluctuations can affect neurodivergent people in a more extreme and potentially harmful way than the neurotypical population. Whilst also showing that this isn’t the case for all neurodivergent people.I want this feature to be inclusive of all races and genders of people who experience the menopausal transition. White cisgender women dominate the narrative, so if you or someone you know from a minority demographic group would like to participate in The Divergent Menopause Q&A Series, please reach out to me.I aim to diversify the message and be representative of all neurodivergent peri/menopausal people.Below is the information you will find directly on The Divergent Menopause Q&A when you click this link, followed by the 12 questions, so you know what to expect.Thank you for being here.This Q&A is part of a series sharing the lived experiences of neurodivergent people going through menopause and perimenopause. You may already be familiar with my previous interview series, The Auti Peri Q&A.Neurodivergent perimenopause is a highly individual, dynamic and sometimes prolonged life stage represented by fluctuations in physical, psychological and cognitive symptoms that can be different for everyone.None of us should have to feel alone at this time of our lives.By sharing your story, you are helping to:💕 Raise self-advocacy as a community effort, not just an individualised responsibility💕 Contribute meaningfully and anecdotally to the growing body of work and research into neurodivergent menopause💕 Empower our unified voiceWe have no time to waste in sharing our lived experiences, and getting the message across that perimenopause and hormonal fluctuations can affect neurodivergent people in a more extreme and potentially harmful way than the neurotypical population. Whilst hopefully also showing that this isn’t the case for all neurodivergent people.On the next page I will explain my Q&A process.Thank you for trusting me with your story.How to Q&ABy sharing your experience, you are helping to build understanding, challenge silence, and make this transition more visible for others.On the next page you will be asked to provide some information about yourself, and to upload a photo that you would like to accompany your published Q&A post.On the following pages there are twelve open ended questions and prompts where you are invited to share your neurodivergent menopause experience in your own words. There is no right way to answer these questions. You can write as much or as little as feels manageable.But please do provide as much detail as possible because this is not a survey. The more information you share, the richer your published Q&A post will be, and the more other people can learn from your lived experience.Your responses will be treated with care and respect. I may lightly edit for clarity and flow, while keeping your voice and meaning intact. Nobody else has access to your responses, and I will be notified when you submit the completed Q&A. I will then go through a formatting process to prepare your post on Substack, invite you to be a guest writer, and send you the draft link for your approval.When we are both happy with it we will decide when to schedule its release. On that day, your Q&A post will be emailed to my subscriber list, and published on Divergent Menopause as part of an ongoing series.If answering the questions all feels like too much, please stop. You are under no obligation to complete the Q&A once you start, and I will totally understand if you change your mind.There is no time limit, so you can return to it in the future if now is not a good time for you.Please prioritise your own mental wellbeing at all times.Any questions, insights or feedback? You are welcome to contact me via Substack DMs or email me at: [email protected]’s go!The Questions:Q1. Your perspectiveWhat does “neurodivergent menopause” mean to you?Take your time, there’s no need to summarise.Q2. When things changedWhen did your neurodivergent menopause symptoms start and what were/are they? You can include physical, emotional, sensory, cognitive, social, and/or sexual changes.Q3. Menopause healthcareWhat happened if/when you presented with neurodivergent menopause to a healthcare professional?Q4. Treatment and symptom managementWhat has your treatment protocol been in managing your neurodivergent menopause?You can include medical, alternative, herbal, therapeutic, surgical, spiritual, diet, exercise etc.Q5. Daily impactHow has your everyday life and sense of self been impacted by neurodivergent menopause? You can include your caring/employment responsibilities, hobbies, relationships etc.Q6. ChallengesAre there things that make or have made your menopause transition especially difficult for you as a neurodivergent person? If so, what kinds of things?Q7. What has helpedWhat kinds of services, treatments, resources or supports have you found most helpful?Q8. Treatment and symptom managementAre there things that could make or could have made your menopause transition easier for you as a neurodivergent person? If so, what kinds of things?Q9. What’s been hardestWhat has felt most difficult or overwhelming?Q10. Support where you liveWhat support, services or resources exist where you are?How accessible are they?Q11. What you want people to understandWhat do you wish more people understood about neurodivergent menopause?Q12. Anything elseIs there anything else you’d like to share? Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

There is a common menopause-related condition that can cause tearing, burning, recurrent urinary tract infections(UTIs), loss of sexual function and many other symptoms. And it does not improve with time.Yet most people have never heard of it. Even our doctors!If you’ve ever been told it’s “just thrush,” “just dryness,” or “just part of getting older”, then this is for you.Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.I am Sam Galloway (she/her), an autistic ADHDer (AuDHDer), and a surgical menopause survivor. I write Divergent Menopause to share what many of us are never told until we have to find out the hard way.Thanks for joining me on this wild midlife ride! 🎢TL;DR:Genitourinary Syndrome of Menopause (GSM) is a common but underdiagnosed condition that can cause tearing, burning, recurrent UTIs, and loss of sexual function. And it does not improve with time.Many people (including doctors) mistake it for infections or “normal ageing.”Effective treatment exists but most of us are never told.2025 changed everything for meFor me personally, it was the year of my life saving gynaecological operation that immediately put me into surgical menopause, aged 44. If you have been here a while you may already know that I had a total hysterectomy with bilaterel salpingo-oopherectomy i.e. my uterus, cervix, fallopian tubes and ovaries were removed. YAY!! This was for several reasons including thickening of my endometrium (lining of the womb), progesterone intolerance, premenstrual dysphoric disorder (PMDD), chronic pelvic pain, and prolonged mental health issues caused by the hormonal flux of perimenopause. After the initial recovery time, which was blissful bedrest on Codeine, building LEGO and binge watching Taskmaster for a couple of months, I am glad to report that my mood is finally stable. And now with the use of systemic add-back hormone replacement therapy (HRT)/menopause hormone therapy (MHT), my life is back on track, and my hormonal flux has been eliminated.But my surgery was just the beginning of my menopause. It surgically ended my horrendous perimenopause, but I have sadly not been spared the full post-menopausal array of hormonally depleted horrors.Yes, I am 44. No, I am not too young to have Genitourinary Syndrome of Menopause (GSM).Genitourinary syndrome of menopause isn’t all about dryness, and “dryness” isn’t even what we think it is. It isn’t wiping after using the toilet, and shredding the paper on your sandpaper-like skin. Dryness is more like labial tears that don’t heal, burning that can’t be soothed, and an itch that isn’t thrush. And that is only for starters…I am not judging anyone for thinking that dryness only means that your vulva feels parched and sex hurts. Lubricating might offer temporary relief but it is no cure. This is a lot and it has all been a steep learning curve for me. There is so much I didn’t know. I didn’t know even after I had shown to my own labial tear to my usual doctor when I was 39 or so, and he had prescribed an antifungal and antibacterial cream that I diligently applied. Even after I then went back because it hadn’t healed, and showed it to yet another doctor at the surgery, and she described the skin as “friable” (which I learned meant extremely fragile skin), and prescribed the same medication, on the wrong assumption that it must have been a particularly stubborn fungal infection. I was still none the wiser about GSM.And neither were the doctors treating me.Has anything like this ever happened to you?I would genuinely like to know how many of us were persistently treated for infections that never existed.It wasn’t until I first saw my menopause specialist doctor months, perhaps even a couple of years, later that I began to learn what was really happening to my body. As we live in distant parts of Aotearoa New Zealand, appointments with my menopause doctor are usually remote via telemedicine video or phone calls, and graphic anatomical photos are sent over a secure medical online portal to inform assessments. So when my tear wasn’t healing I eventually sent a photo of it to my menopause doctor. She reported that the tissues looked pale and inflamed. Immediately I was prescribed the correct treatment (and I hurriedly deleted the photos from my phone before anyone else saw them..!)Although my doctor didn’t call it “genitourinary syndrome of menopause”, it didn’t take me long to bolt down the dry, pale and friable rabbit hole of doom. 🕳️And what was the miracle cream that I still use twice a week, and will need to be prised from my cold dry dead hands? Vaginal oestrogen cream! Here is a post from the Divergent Menopause (formerly The Autistic Perimenopause: A Temporary Regression) archives way back in 2024 when GSM was a agonisingly brand new and thrilling concept to me:What else happened in 2025?On a much more significant scale than my hysterectomy, a groundbreaking step was made by the United States medical authorities. Yet this news completely went under my radar until a few weeks ago, when I listened to a podcast episode from April 2025, where urologists Kelly Casperson, MD and Rachel Rubin excitedly announced the new guidelines on genitourinary syndrome of menopause. I learn more from this discussion with every listen. Feeding off their energy, I went straight into hyper ADHD mode and developed an intense interest in this little known, painfully taboo, yet extremely common syndrome that has been affecting me - and possibly you too? - for years. Last year, the American Urology Association (AUA), Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) and American Urogynecologic Society (AUGS) jointly published the Genitourinary Syndrome of Menopause: AUA/SUFU/AUGS Guideline (2025). Six years in the making, this guideline was written to provide clinicians with the necessary information to identify, diagnose, counsel and treat GSM.So what symptoms count as GSM? Probably not what you think, and you may already have some of them. Brace yourself…Vulvovaginal symptoms* Dryness* Burning * IrritationUrinary symptoms* Urgency* Frequency* Dysuria (pain, discomfort or burning whilst urinating)* Recurrent urinary tract infections (UTIs)Vulvovaginal and urinary effects of menopause combined cause the sexual symptoms:* Dyspareunia (painful intercourse)* Bleeding during intercourse* Broader impacts on sexual function: reduced libido, reduced arousal and reduced orgasmPhysical changes of GSM:* Labial atrophy* Reduced moisture* Introital stenosis (narrowing/shortening/closing/loss of flexibility of vagina and vaginal opening due to scar tissue) leads to pain in sex, discomfort during pelvic exams and difficulty using tampons* Clitoral atrophy. CLITORAL ATROPHY!!??Vaginal surface may be:* Friable (tissue that is easily irritated and more prone to inflammation, bleeding and tearing)* Hypopigmented (pale skin)* Petechiae (pinprick sized red or purple spots on the skin from fragile capillaries bursting)* Ulcerations * Tears in the skin (from personal experience, I can report that this burns like a biatch, and doesn’t heal without vaginal oestrogen)Urethral (the hole you pee from) findings:* Caruncles (benign vascular growth on outside of the urethra)* Prolapse (a pelvic organ loses it’s support and falls down into the urethra)* Polyps This list is not comprehensive, there are other symptoms that I don’t know about yet. Please share in the comments if you know of others that I have missed. Did you know that the term “Genitourinary Syndrome of Menopause” doesn’t even cover the entirety of this issue, nor the time in your lifespan when these GSM symptoms can occur?Genitourinary symptoms occur during other life stages of hormonal flux including pregnancy, postpartum, when taking hormonal contraceptives, and whilst breastfeeding. I am still quaking from this news. I breastfed both my boys until they were four years old because, before my perimenopause tried to kill me and I needed a medical treatment pathway to preserve my life, I was a super crunchy, all natural, hippie Mama. Now in hindsight I think that my fellow woke lefty greeny attachment parenting Mama and baby community were all undiagnosed neurodivergents too. I wouldn’t have wanted it any other way! And before I 100% wanted babies I 100% didn’t want babies, and so I spent decades on the contraceptive pill, contraceptive injections and contraceptive implants. Is it any wonder that my poor vag is now utterly wrecked due to a lack of oestrogen through so many years of my life? Yet we get told that the stitches, tears and birth injuries are the worst issues of early motherhood and that, whatever happens, we are lucky as long as we have birthed a “healthy” baby. If only I knew then what I know now… Someone should have handed me a prescription for vaginal oestrogen there and then! Imagine if the midwives handed it out immediately after birth? It would have soothed my tattered vagina stitches, I reckon.This is our time to get informed. When we know better, we can take better care of ourselves.During the ‘You Are Not Broken’ podcast episode, recorded on the day of release of the new (at the time) GSM guidelines in 2025, Dr Rachel Rubin said:“… it is bold, it is simple, it is unapologetic, it is evidence-based, and it is very, very clear that vaginal hormones are absolutely preventative of urinary… tract infections, help with pain with intercourse, help with overactive bladder and urinary urgency. They are safe to take if you have breast cancer history, family history of breast cancer, history of blood clots.“They are safe, and they are… lifelong therapies. They are chronic therapies that should be used…“… This is urinary frequency and urgency, recurrent urinary tract infections which kill people. It is pain with sex, dryness, muted orgasms, absent arousal. It is, it is, and it doesn’t get better with time.“Sometimes hot flashes get better. But as your audience knows, the genitourinary symptoms do not get better for most people.”From You Are Not Broken: 315. BONUS - Genitourinary Syndrome of Menopause Guidelines released today!, 29 Apr 2025If you aren’t already using vaginal oestrogen, then why not? There is so much to be gained. It is so much better to prevent GSM than to have to suffer with insidious symptoms unnecessarily.If you recognise yourself in this, you are not broken, you are underinformed. And you deserved to know all this sooner. This is the kind of information I wish I had had years earlier!If this post helped you understand something about your body that no one has explained before, you can support this work becoming a patron as a paid subscriber.Cheers,Paid subscribers make it possible for me to keep researching, writing, and sharing the information many of us are missing. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

If you’ve ever felt like your brain stopped working in neurodivergent midlife, this discussion may explain why.Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.I am Sam Galloway (she/her), an autistic ADHDer (AuDHDer), 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! 🎢Thank you to Marie-Christine Oliver for this is fascinating and enriching chat!So many brilliant people joined us live and we are so grateful for your contributions in the chat, as well as having you all there with us. It was intense so people dipped in and out.For accessibility, the video has closed captions, the transcript is available within this post, and you can listen to an audio only version if preferred.It was a long one (we went 40 minutes over our scheduled hour - ADHD much?), but we covered all the things. Well, we tried to!We even completed the Meno-D rating scale to detect depression in menopause together which is one of my favourite supports in my menopausal transition, along with my cats, and my vaginal oestrogen cream. And yes, I mentioned clitoral atrophy because we should know about these things!⚠️ Content warning for talk of suicidality, disordered eating, mental health hospital stays, early menopause, IVF, medical gaslighting, misdiagnosis, loss of career/function/sense of self, involuntary unmasking, and clitoral atrophy.TL;DRead/Watch/Listen (AI generated)Perimenopause can act as a burnout accelerant for neurodivergent women—especially those with ADHD and autism—because hormonal changes destabilise already overworked nervous systems.This often leads to:* Sudden loss of masking ability* Cognitive decline and emotional dysregulation* Misdiagnosis and medical gaslighting* Identity collapse and increased suicidality riskThe conversation highlights a critical gap: research, language, and clinical understanding are lagging far behind lived experience.⏱️⏱️ Full Timestamped Summary (AI generated)00:00 – Intro (chaotic, human start) Live recording begins; Sam introduces the topic and guest Marie-Christine Oliver.02:00 – Core concept Perimenopause as a burnout accelerant for neurodivergent nervous systems.03:30 – Lived experience IVF, early perimenopause, nervous system collapse, career loss, suicidality, late diagnosis.06:30 – The biology Estrogen supports dopamine + serotonin → drop creates a double neurological hit.07:00 – Masking collapse Sudden loss of ability to cope → meltdowns, shutdowns, dysregulation.08:00 – Cognitive decline Brain fog, memory loss, speech issues → often mistaken for dementia.10:00 – HRT explained A buffer, not a cure; reduces extremes but doesn’t fully restore capacity.13:00 – Mental health risks High rates of suicidality; symptoms often misunderstood or misdiagnosed.15:00 – Research gaps Little to no research on ADHD + menopause or AuDHD.20:00 – Key insight Menopause = point where masking becomes impossible.22:00 – Quadruple empathy problem Breakdown between patient + doctor + neurotype + menopause context.26:00 – Medical gaslighting Symptoms dismissed or mislabelled → confusion + self-doubt.28:00 – Identity collapse Loss of career, function, and sense of self.31:00 – Compounding pressures Parenting, aging parents, chronic illness, hormones—all at once.33:00 – Diagnosis aftermath Labels accumulate; identity becomes deficit-based.36:00 – Menod tool introduced A scale for identifying menopausal depression.40:00 – Why the tool matters Captures real-life impact; useful for self-advocacy.42:00 – Energy depletion Extreme fatigue; even basic tasks feel impossible.43:00 – Paranoid thinking Workplace anxiety, social fear; blurred line between perception and reality.45:00 – Irritability / rage Outbursts, meltdowns → nervous system overload, not personality.47:00 – Self-esteem collapse Ranges from self-doubt to suicidality.49:00 – Hospitalisation Can help or harm; highlights systemic inequalities.50:00 – Social isolation Disconnection even when not alone.52:00 – “What is normal?” Tools often based on neurotypical assumptions.54:00 – Anxiety escalation Chronic nervous system dysregulation. 56:00 – Physical symptoms Pain, illness, unexplained issues tied to hormones + stress.58:00 – Sleep disruption Creates worsening feedback loops.60:00 – Body changes Weight, metabolism, physical identity shifts.62:00 – Libido changes Under-discussed but significant impact.64:00 – Memory + focus issues Deeply distressing; often misinterpreted as cognitive decline.66:00 – Symptom accumulation Multiple high scores = severe functional impact.68:00 – Whole-life impact Work, relationships, parenting all affected.70:00 – Why systems fail Healthcare treats symptoms separately, not holistically.72:00 – Forced self-advocacy Individuals must piece everything together themselves.74:00 – Grief Loss of self, identity, and capacity.76:00 – Burnout cycles Push → crash → partial recovery → repeat.78:00 – Lifelong overcapacity Perimenopause exposes unsustainable patterns.80:00 – Lack of prevention No warning, no preparation, no roadmap.82:00 – What could have helped Earlier diagnosis, awareness, and reduced pressure.84:00 – Systemic gaps Research, healthcare, and workplaces all lagging.86:00 – Community importance Peer conversations filling the gap.88:00 – Reframing Not failure → biological + neurological reality.90:00 – What’s needed next Research, integrated care, recognition.92:00 – Hope (with nuance) Improvement possible, but not full restoration.94:00 – Ongoing vulnerability Need for pacing, boundaries, nervous system care.96:00 – Final reflections This is widespread and under-recognised.98:00 – Closing Validation, connection, and shared understanding.100:00 – EndResources:Meno-D: A rating scale to detect depression in menopauseThe conversations we’re having here are filling a gap that research and healthcare still haven’t caught up with. If this work matters to you, consider becoming a paid subscriber to support it.Thank you to everyone who tuned into my live video! Join me for my next live video in the Substack app. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Episode TitleWhy So Many Women Don’t Know Their Own AnatomyEpisode DescriptionIn this conversation, Sam Galloway from Divergent Menopause speaks with Amber Horrox, creator of Warrior Within, about body literacy, menstrual shame and the long shadow of medical misogyny.Many women grow up knowing the names of internal reproductive organs — uterus, ovaries, fallopian tubes — yet struggle to name the external anatomy of their own bodies. Euphemisms, silence and shame mean that even describing symptoms to a doctor can be difficult.Sam and Amber explore:• Why women are rarely taught accurate anatomical language• How euphemisms create barriers in healthcare• The messaging around menstruation and “pushing through” pain• The impact of religious and fear-based sex education• Surgical menopause and chronic pelvic pain• Integrating medical, holistic and embodied approaches to healing• Reclaiming safety and agency in our bodiesA note on languageThis conversation uses the word "women" in places when discussing anatomy, menstruation and menopause. These experiences are not limited to one gender, and people of multiple genders may share them. The language here reflects the conversational nature of the discussion rather than an attempt to exclude anyone whose body or lived experience is part of this topic. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

The recent debate sparked by autism researcher Uta Frith has exposed a growing divide between traditional autism research and autistic lived experience.As more adults identify as autistic and the autism spectrum continues to expand, an increasingly urgent question emerges:Who gets to define autism?Researchers? Clinicians? Or autistic people ourselves?Read the full article on Substack: Divergent MenopauseDirect link to the essay postIn this episode, I unpack the controversy surrounding recent interviews with Professor Dame Uta Frith and reflect on what the debate reveals about the past, present, and future of autism research.Drawing on my own experiences as an autistic ADHDer (AuDHDer), parent of autistic children, and survivor of perimenopause, PMDD and surgical menopause, I explore why many autistic people feel triggered by this discussion, and why autistic voices must be central in conversations about autism.In this episode• The controversy surrounding recent interviews with autism researcher Uta Frith• Why some researchers believe the autism spectrum has become “too wide”• The growing divide between traditional autism research and autistic lived experience• Why masking, sensory needs, and late diagnosis are still debated• How generational views of disability shape autism discourse• The rise of autistic-led research and advocacy• Why many autistic people feel distrustful of traditional research models• The urgent need for research that improves autistic quality of life• Future research questions that could genuinely help autistic peopleTopics discussedAutism research, Neurodivergence, Late autism diagnosis, Masking and autistic burnout, Medical misogyny, Self-diagnosis, The social model of disability, The double empathy problem, Neurodivergent mental health, Autistic menopauseAbout the hostSam Galloway (she/her) is an autistic ADHDer (AuDHDer), writer, and creator of Divergent Menopause.Following her own experiences of neurodivergent perimenopause, PMDD, and surgical menopause, Sam writes and speaks about the intersections of autism, neurodivergence, hormones, and midlife mental health.Her work focuses on peer support, advocacy, and helping neurodivergent people navigate difficult transitions.Content noteThis episode includes discussion of:• medical gaslighting• medical misogyny• mental health services• suicide and suicidal ideationPlease take care while listening.Discussion questionsThis topic has sparked huge debate online, and I’d love to hear where listeners land:• What do you think the biggest gap is between autism research and autistic lived experience?• Have you ever encountered professionals who dismissed masking or sensory needs?• What areas of autism research do you think deserve more attention?Support the publicationIf this episode resonated with you, consider becoming a paid supporter of Divergent Menopause.This publication runs on a patron membership model, and paid subscribers help fund independent writing and advocacy centred on neurodivergent lived experience. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 orexperiences by imagining what it would be like to be in that person's situation.Empathythe ability to share someone else’s feelings or experiences by imagining what it would be like to be in that person’s situationSource: Cambridge DictionaryThis 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 ProblemMany 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 problemMisunderstandings 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 ProblemHave 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 ProblemWidespread 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 midlifeMedical 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. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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,andThanks for reading Divergent Menopause. Paid subscribers make this work possible. 💕🐈 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 Summary00:00 — Why this conversation matters02:31 — Progress made… then undone05:31 — Estrogen patch shortages & loss of choice (NZ)09:01 — Symptoms returning on the same dose12:01 — Collective patterns, individual gaslighting15:31 — Neurodivergent risk & mental health impacts18:31 — Estrogen as a brain hormone22:01 — Why “just switch to gel” isn’t simple25:31 — Sleep collapse as the red flag28:31 — Admin, advocacy & exhaustion32:57 — Suspected formulation change (mid-2025)34:31 — Medsafe reporting & deflection36:05 — User-error narratives & systemic gaslighting37:42 — Absorption differences & dosing reality39:58 — Brain fog, language loss & regression41:25 — Estrogen receptor saturation explained44:19 — Menopause is serious, not “just hot flushes”45:37 — Generational harm & WHI fallout47:03 — Surgical menopause & compounded harm48:37 — Aging with quality of life49:30 — Vaginal estrogen, bladder health & prolapse prevention52:35 — Prolapse, gatekeeping & specialist care54:38 — Medical training gaps (global)55:10 — Vaginal estrogen & cancer-risk reassurance56:07 — Solidarity over infighting56:56 — Closing reflections, access & hopeThank 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,SamThis work exists through collective care. A paid subscription is a meaningful way to support Divergent Menopause in 2026. Thank you! 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 Breakdown00:00 – 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 TakeawayIf 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,SamIf 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. 😊 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 planis 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 havinga toolkit you know to keep you regulated, regulate your nervoussystem and then that that’s also creative to meet your needs. You don’t alwayshave to be doing something.Sam Galloway Further reading and resourcesAllegra’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 MenopauseAuthor(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady, Rachel L. Moseley, Julie M. Gamble-TurnerPublication date (Electronic, pub): 27 June 2025This 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. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 ChapmanWhat natural treasures can you find where you live?🍁🐚🌸Further reading and resourcesAllegra’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 MenopauseAuthor(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady, Rachel L. Moseley, Julie M. Gamble-TurnerPublication date (Electronic, pub): 27 June 2025Next 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. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 readingAllegra’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 CreativesThe 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 awarenessA 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 MenopauseAuthor(s): Mx Rose Matthews , Christine A. Jenkins , Margaret Janse van Rensburg, Miranda J. Brady , Rachel L. Moseley , Julie M. Gamble-TurnerPublication date (Electronic, pub): 27 June 2025It 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. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 MonthAs 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.34There 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 thereYou 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 webinarsDivergent 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! Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 needs3) Special interests and “accidental” creativity and stuff that’s creative that you don’t think about4) How your creative practice changes as your needs change... or how creativity can help with unmaskingResources:https://www.scienceopen.com/hosted-document?doi=10.13169/intljofdissocjus.5.1.0004Allegra’s bookAllegra’s coursePrevious articles by Allegra? Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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 PittsIf 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 MenopauseA Conversation with Kim Pitts⏱️ 00:00 – 02:00 | IntroductionsSam (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 StoriesKim 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 IntoleranceSam 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 GatekeepingSam 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 & TrackingThey 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-GaslightingSam 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 & SurvivalContent 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 MythsKim 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 BarriersKim 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 CyclesSam 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 articlePlease 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! Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression.I am Sam Galloway (she/her) and I am an AuDHD woman seven weeks into surgical menopause (hysterectomy).If you are interested, you can read more on why I needed the surgery here.Thanks for joining me on this wild midlife ride! 🎢October 18th marks the annual event that is World Menopause Awareness Day! In this video and podcast episode, I take you through the advice (see the six posters below and here) provided by the World Menopause Society for 2025’s theme of Lifestyle Medicine in Menopausal Health!Closed captions and transcript available too.🎥 Prepare yourself for much brain fog, sarcasm and despair as I explore the multiply astonishing ways in which this mainstream advice is, at best, inaccessible and, at worst, detrimental to neurodivergent people going through this life transition. 🎧Here is last year’s World Menopause Day post from me.Some resources referenced in the video/podcast today:I wrote this article on Blue Zones earlier in the year, because I have always been obsessed with longevity research. However, I am now extremely scornful on the topic as you will find out if you read this, or listen to the podcast episode link in the following post:This is a great read on the narrow minded push for Mediterranean style diets:The six (!) International Menopause Society posters I share in the video, brimming with unreachable targets for so many of us who don’t and can’t conform to neuro-normative expectations:Below is my viral 2024 post, which shows that our way of being in the world is totally valid and important. Maybe we need anti-goals for menopause lifestyle advice. What would yours be? I would love to know in the comments.Take good care of yourself. 💐And be realistic about it, the above International Menopause Society goals were not written with neurodivergence, chronic illness and disability in mind.Cheers,Divergent Menopause is a labour of love. Each article takes hours to research, write and edit. If you have found my ongoing advocacy work valuable, please consider becoming a paid subscriber if you are able to. Thank you 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression. I am Sam Galloway (she/her) and I am an AuDHD woman four weeks into surgical menopause (hysterectomy). If you are interested, there is more on why I needed the surgery here. Thanks for joining me on this wild midlife ride! 🎢Hi All, Welcome to the final video of the mini series with Amanda Hanna from SomaPsych. I hope you have enjoyed it! Please let me know in the comments whether you like this format, and what topics you would to see covered in future mini series. This episode requires a content warning for suicidal ideation and actions, panic attacks, mental health crises and feelings of hopelessness. So many helpful techniques offered, and I would love to know which, if any, you find most effective. Please let us know in the poll, and feel free to expand in the comments. In case you missed the previous videos, the first offers techniques to use in the margins of our day to regulate our nervous systems and feel rested. In the second video Amanda suggests how to stop anxiety spiralling at night and (hopefully!) get back to sleep. The third video covers how to manage chronic pain flares and reduce recovery times.Why do we need S.O.S. techniques for de-escalating sudden panic, suicidal ideation and feelings of hopelessness?In my experience of pre-menstrual dysphoric disorder (PMDD), pregnancies, postpartum, puberty and perimenopause (not listed here in chronological order), states of hormonal flux trigger extremes of mood and personal safety concerns.Now that I am in a state of surgical post-menopause by hysterectomy, and in the fresh absence of my ovaries, my hormone production has now flatlined. That was the intention of my highly medicalised menopausal treatment plan, in order to eliminate all risk to myself from my own hormonal fluctuations.Some people may have lovely menstrual cycles and manage their perimenopause with minimal medical interventions. I am genuinely happy for those people, and wish we could all be like that. But we can’t. Some of us experience sudden moods that are so inextricably linked to our extreme hormonal highs and lows, that we cannot understand why we think we would be better off dead before we have had time to challenge that thought. For autistic women, our suicide risk is 13 times higher than that of neurotypicals during midlife. 1 in 4 ADHD women have attempted suicide. Perhaps, like me, you are an AuDHDer. I don’t have the stats on us, but I expect they are bleak. I don't tell you those statistics to shock or frighten you. My intention is to make you aware that you may be at increased risk, but that you have the ability to mitigate that risk by being aware of your emotional states throughout times of hormonal flux. We can be extremely impulsive, which may have been great when we were younger, but we have so much more at stake in midlife. If your highly sensitive brain tricks you into thinking your rage is shameful and your family would be better off without you, please know that that is a common thought. We just don't live in a society where it is acceptable to share these thoughts with someone else. I get DMs from people frequently who are feeling this way.Our thoughts are not facts, they can’t objectively dictate to us. Thoughts come, and then they go, and new ones take their place. Please share with others if you are experiencing thoughts of suicide, self-harm or causing harm to others. Ruminating on these thoughts isn’t unusual, and just because certain thoughts persist and/or recur doesn’t make them any more substantial or credible. You matter to me, to this community and to all the people who love you. Sometimes it doesn't feel like this, I know. During perimenopause I too experienced intrusive thoughts that put my family and I at risk. Thoughts that I should stop my car on the train tracks and wait for a freight train to stop my pain and functioning regressions. My kids were in the back of the car! And it was a recurrent thought.Often I wasn’t even experiencing suicidal ideation until I reached a railway crossing, and that would trigger the thought. I would hum, stim, flap all whilst driving; trying to hush and force away the thought, consciously accelerating across the tracks and willing myself to stay in motion on the road. It took all of my limited energy to just get my kids and I home safely, at which point I would need to crash (excuse the pun) out on the sofa. Often autistic inertia followed. It would take me 24 hours to process the thoughts, which had come and gone in the fraction of a second, and to tell my husband and/or my doctor what had happened. I don't wish that pain on you. It can be common in neurodivergent menopause, but please, let’s not normalise it. It is a signal that you need more support, more rest, more mental health interventions - and those aren’t bad things. As late diagnosed neurodivergent, we have stuffed down our feelings for decades. This is the time to unmask, to reach out, to prioritise yourself. For me, this looked like surgical intervention to stop the problem at its root cause - by cutting out my ovaries the surgeons have stopped my hormonal flux. Yes, it is drastic, but not as drastic as the potential headline “Local woman, 44, and two sons killed on impact by freight train”. Please, take your thoughts to someone else if and when they are bothering you. I am not saying a hysterectomy is the answer for you, but I know for sure that suicide definitely isn’t. Please don't underestimate the power of a safety plan! Contrary to popular belief, talking about suicide does not lead to suicide. If you are experiencing suicidal ideation, self-injurious thoughts or behaviours, and/or fear for your own or someone else’s safety, please tell someone you trust. Although overwhelmingly intense, these feelings do pass. Get help now to protect your future self. Zoom AI has provided the following summary of the conversation:SummaryManaging Panic and Suicidal IdeationSam and Amanda discussed techniques for managing panic, anxiety, and suicidal ideation, particularly in the context of neurodivergence and hormonal fluctuations. Amanda emphasized the importance of recognising patterns and creating a "rescue kit" with soothing objects and practical items like water and medication to help manage overwhelming moments. They also highlighted the need to remember that these experiences are temporary and to practice self-compassion during difficult times.Safety Planning for Panic ManagementAmanda and Sam discussed strategies for managing panic attacks and creating safety plans. Amanda shared her methods of using post-it notes and voice recordings as reminders during overwhelming moments. Sam mentioned a video she created on writing autism-adapted suicide safety plans, emphasising the importance of considering professionals' availability and boundaries. They both stressed the value of evolving safety plans and having prearranged signals with supportive contacts for distraction or reassurance.Mindfulness Tools for OverwhelmAmanda discussed the challenges of managing overwhelming situations without proper safety resources, explaining how the brain can become hyper vigilant or fixated on past or future concerns. She described various personal tools people use to ground themselves in the present moment, such as physical sensations or specific activities, and emphasised that finding an effective tool requires personal discovery. Amanda concluded that these tools serve as circuit breakers to help individuals regain focus and presence.Neurodivergent Emotional Management StrategiesAmanda and Sam discussed strategies for managing intense emotional states, particularly focusing on post-panic attacks and suicidal ideation. Sam shared her experience of having suicidal thoughts while driving, particularly during hormonal fluctuations, and emphasised the importance of having a plan for dealing with such moments. They agreed that it's crucial to recognise these feelings as part of their neurodivergent experiences and to consider the impact on loved ones, rather than acting impulsively. Amanda highlighted the need for more open conversations about these experiences, especially in neurodivergent and hormonal contexts.Emotional Regulation Techniques DiscussionAmanda and Sam discussed tools for managing discomfort and panic attacks, with Amanda introducing "riding the wave" as a technique for observing and navigating emotional states without immediate action. Sam shared personal experiences with ADHD and autism, highlighting how pattern recognition can both help and hinder understanding of emotional responses. They agreed that building nervous system regulation capacity through regular practice, even when feeling well, is crucial for better managing challenging moments.* Toolkit: Warning Signs of Suicide for Autistic People: An autism-specific resource based on research findings and expert consensusPlease take good care of yourself. Cheers, If you find my work valuable, why not become a paid subscriber to The Autistic Perimenopause: A Temporary Regression? (This is not a rhetorical question.) Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi Team Auti Peri, Welcome to the third video in the series with Amanda Hanna from SomaPsych. In this episode we explore how to:* identify our individual patterns of current or recurrent pain flares* be present at times of reduced pain or “good moments”* encourage the nervous system to imprint soothing and regulating patterns in our bodies.How does the nervous system get to know what is painful? What is uncomfortable? What’s tension versus tightness? Please share in the poll which techniques discussed in this video that you have tried. I suspect this work needs to be done consistently and regularly to see longer term benefits. The poll has been set to stay open “Forever” (which feels like more time than we need), so feel free to come back to this episode in the future and let us know in the poll and the comments what benefits you have noticed over time. In case you missed the previous videos, the first offers techniques to use in the margins of our day to regulate our nervous systems and feel rested. And in the second video Amanda suggests how to stop anxiety spiralling at night and (hopefully!) get back to sleep.Amanda discusses the work of Addie deHilster (she/her), Founder of Moved To Meditate. Addie is a Mindful Movement specialist who offers “Mindfulness practices for all the moving parts of your life”. To explore her work into meditating and moving with pain, you may like to listen to these podcast episodes:We'll cover:* the discomfort that is a normal part of the meditation process* meditating when the pain is more serious or ongoing* what the research says about mindfulness and pain* how the practice might need to be adjusted to accomodate painWhat you’ll hear about chronic pain and yoga:* defining chronic pain and what makes it so complex* how Yin Yoga practice can help you unwire habits and beliefs that perpetuate pain* using Somatic exercises and Yin poses to build back confidence in movement, and decrease fear* how Yin Yoga contributes to restoring your body image if it has been distorted by prolonged pain experiences.You’ll hear about:* addressing social anxiety and sensory issues that can come up for neurodiverse meditation students in a class setting* the importance of offering multiple ways to practice a technique like Mindfulness of Breathing or Loving-Kindness Meditation* stacking anchors to help students connect with the kinesthetic, visual, or auditory aspects of meditation, on their own terms* being aware of how different verbal instructions may (or may not) work for everyone* how Sue and Jan approach mindful movement or walking meditation for neurodiverse groups.In this video we are lucky enough to have a star cameo from Amanda’s puppy, Layla! ⭐️ 🎥 🐕‍🦺 Zoom AI has provided the following summary of the conversation:Conversational Discussion on Puppy FascinationSam and Amanda engaged in a casual conversation, discussing a puppy named Layla who was under the desk and seemed fascinated by a light. They briefly talked about taking notes and the appearance of a quill, before Sam prepared to record a video.Chronic Pain Management StrategiesSam and Amanda discussed strategies for managing chronic pain flares and reducing recovery times, particularly for neurodivergent individuals. Amanda shared insights from Addie deHilster's work on chronic pain management, including the concept of pendulating between neutral and painful sensations to help the nervous system reframe pain experiences. They explored techniques such as using opposite sensations (e.g., cold for hot pain) and planning ahead to mitigate predictable pain triggers. Sam emphasised the importance of explicit instruction for neurodivergent individuals, who may not naturally associate physical sensations with emotions.Shoulder Pain and Hypermobility JourneySam discussed her experience with shoulder pain and her journey to understand its root cause, which she suspects may be related to hypermobility and potentially Ehlers-Danlos syndrome. She explained that traditional medical approaches, like physiotherapy, might not address the underlying issue and highlighted her self-discovery process about "coat hanger pain," a term she learned that describes a specific pain region.Chronic Pain Management StrategiesSam and Amanda discussed strategies for managing chronic pain, focusing on balancing periods of pain and wellness. Amanda emphasised the importance of being present during "good" moments to help the nervous system better process and remember these feelings, which can help reduce the perception of pain over time. They also touched on how certain hormones and neurotransmitters, such as dopamine and serotonin, play a role in regulating pain and mood. I hope you have enjoyed this episode, and the series so far. The next episode concludes this mini series on nervous system regulation.Wishing you a regulated week!Cheers,The Autistic Perimenopause: A Temporary Regression is a reader-supported publication. Subscribe so you don’t miss a post, and please consider supporting the ongoing advocacy for neurodivergent menopause by becoming a paid subscriber. Thanks! Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

📣 Great news! The Autistic Perimenopause: A Temporary Regression has been renamed Divergent Menopause. Yay!! 💕It’s less of a mouthful, for sure. Only the name has changed, it is still me - Sam Galloway (she/her) and my faithful ragdoll cats Harry and Toby - steering the good ship Divergent Menopause. TL;DRWhy “Divergent”? Inclusivity.Why “Menopause”? Verb, not noun. To cover the entire menopause transition and beyond. Why the rename? For the sake of inclusivity for all our differently wired neurokin.Most autistic people have other co-occuring neurodivergent conditions, such as ADHD, sensory processing disorder, dyslexia, dyspraxia etc. Although we may not be aware of them all yet… Not all neurodivergent people will identify as autistic, but they may be having a scary old menopause transition, sharing most, if not all, of the same struggles and challenges. Let’s build each other up! We all know that the academic research is unable to keep up in real time with what we are uncovering daily about the ways our menopause experiences diverge from “the norm”. I believe that research will soon catch up and uncover that all of us differently wired legends share similar strengths, vulnerabilities, support needs, cognitive regressions and so on. I also believe that in time rigorous academic research will show that neurodivergent people are more likely than neurotypicals to have hormonally sensitive bodies and minds, and that we are collapsing under the weight of extreme hormonal flux.While they are piecing it all together, running research projects and publishing evidence that will take even longer to disseminate into supporting the everyday challenges faced by neurodivergent people, we are already gathering here. Our stories matter. Every time you leave a comment, reply to someone else or generously share your story in the Auti Peri Q&A (yet to be renamed…) feature, you are helping to compile the anecdotal evidence of what it means to move through the menopause transition neurodivergently. I could not do this work without you. We are trail blazers! This is urgent now. Autistic midlife women are 13 times more likely to attempt suicide than non-autistics. 1 in 4 ADHD women have attempted suicide. Compounding a lifetime of high masking neurodivergence with menopausal hormonal flux exacerbates our vulnerability. We already have lower than average life expectancy. The sooner we understand the risks our differences can present, the sooner we can engage appropriate support systems and maintain our safety. As neurodivergent people, I believe that we need to group together rather than being siloed by our different diagnoses. We have more in common than we have differences. Also, and I know I am not the only one, I am BOTH autistic AND have ADHD. An AuDHDer.Additionally, I have diagnosed anxiety, undiagnosed hypermobility/connective tissue disorder, dyspraxia, dyscalculia, and other neurodivergences that I can’t even recall right now thanks to my major menopausal and post-general anaesthetic brain fog…In my pre-peri life, I was likely gifted which is a yet another form of neurodivergence, but my cognitive regressions have raged on and on regardless of management of other symptoms. I hope it’s reversible as I age…Although my ADHD and autism have both been late diagnosed, when I look back over my life I can see eras where one reigned over the other. Often it was the ADHD that ramped up in times of pre-peri hormonal flux, such as during puberty. Then something about being a mother made me present more autistically overall. Yet I was multi-neurodivergent all along.Separating my neurodivergences is fruitless, I can no longer pretend to be more one than another. They all contribute to create the mess the person who is writing these words to you right now. It feels increasingly inauthentic to present my writing purely from an autistic perspective, when I am an AuDHDer, with astonishing levels of executive dysfunction to prove it. I don’t want to be down on my autism, my ADHD, or on any of the other complexities that make me me who I am. And so in renaming this community Divergent Menopause I hope that we continue growing in numbers, diversity and momentum. There are so many things I need to iron out, but I can’t right now because my brain is mush. Three weeks post-hysterectomy feels like an entire lifetime and a fleeting moment. I have been told by the surgeon and my primary care doctors that the recovery time is 6 to 8 weeks, and also that the general anaesthetic may take 3 months to wear off entirely. That means I am hopeful to be pain-free, fully mobile and have clarity of mind just in time for Christmas, which will be a gift. 🎄The reason I am calling this move a “rename” rather than a “rebrand” is because Canva looked at my efforts for a new logo and told me to stop wasting both our time. Here are some examples *cringe*And why have I changed the name from Perimenopause to Menopause?Simply because I have transitioned from a perimenopausal state to a surgically induced post-menopausal state in the slice of a scalpel (well, several, I have four incisions…).I am fully aware that the word ‘menopause’ is generally used as a noun, with the dictionary meaning of being the day that is exactly one year after a person’s final menstrual bleed. Yet menopause does not often fit into tidy little boxes. I haven’t had a menstrual cycle since I had a Mirena IUD inserted two years ago this month, and that was only advised because I was having a constant uncontrollable bleed that lasted months. I wouldn't call that a “period”, but we don’t have words for that either. The bleeds I have had since have been short, isolated emotional bodily trauma responses. One occured at my Dad’s deathbed, the other when my Mum’s visit to stay with my family in Aotearoa New Zealand ended and she went back to the UK. My GP advised me to anticipate another bleed in the event of any future little-t trauma. Hormones impact our emotions. Emotions impact our hormones. We are not as straightforward as medical science would like us to be, hence decades of gross negligence into avoiding research on women’s health. I am your classically annoying correct autistic pedant. I know that the language around the menopause transition is deliberately blurred. We descend from generations of women who were not supposed to talk about their menstrual bleeds, nor their cessation. We may never have heard from our sisters, cousins, aunties, mothers and grandmothers on the subject of hormones and menopause, and we were socialised to be “good girls” by not asking questions. The language of menopause, even our own anatomy, has been denied us. Our neurodivergent ways of communicating go chronically misunderstood and silenced. When we have questions in midlife, medical science does not yet offer answers to our predicaments. None of this is our fault though, and Divergent Menopause will continue to be a safe space for us to chat about our lived experiences. This remains a community that welcomes all forms of diversity. For all these reasons, my use of the latter word in the new name Divergent Menopause will be intended as a verb, rather than a noun. “Menopause” as an occurrence, a state of being, a transitional time in our lives. As for the Auti Peri Q&A, I still welcome people to please forward their responses to me if they would like to feature in the series! 🙏The Auti Peri Q&AI will soon be adapting the Q&A questions to open it up to all neurodivergent people who would like to share their experience of the menopause transition. I have other grand plans: to start a proper podcast, to rebrand Divergent Menopause with Autumnal tones, and perhaps to one day train as a menopause doula.But that is all going to have to wait until my brain is fully functioning again.🤞I thought I would have moved on from that stage in three weeks, but I suppose major surgery is major surgery… It is reminiscent of how I was feeling whilst still in hospital. ⬇️As I type this, my homemade hysterectomy pillow is lying across my tummy and under my arms giving me oodles of support, as I hoped it would. My laptop is balancing precariously on top of it. I have also been building this amazing LEGO set I was gifted to build whilst recovering from surgery. The wooden tray has also been balanced precariously on the pillow during the extensive build!I hope the name change isn’t too much of a shock. I hate surprises and change, and even I am cringing at the new name, despite it being a change I have been intending to make for many months now. It would be great if you could please share Divergent Menopause within your networks to help us get more visibility, have a wider reach, and, in so doing, support more people to feel less alone and lost in the haze of this challenging yet unavoidable life transition. I think it’s time for another nap…I hope you have a restful weekend ahead. Take good care of yourself.Cheers,Divergent Menopause (formerly known as The Autistic Perimenopause: A Temporary Regression) is a reader-supported publication. Paid subscriptions are on a patron model. If you find my work supportive and informative, and you value advocacy work, please consider becoming a paid subscriber. Thank you! 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello to you, Welcome to the second part of this four part video series with Amanda Hanna from SomaPsych. You can watch Part 1 here. In the first video we discussed techniques to use in the margins of our day to regulate our nervous systems and feel restedThis time we focus on sleep, which can be so elusive to neurodivergent people in times of hormonal flux. Let’s face it, sleep can be hard for us throughout our lifespan. As children, we may have formed negative associations with sleep depending on how gently - or not - our own times of sleeplessness were managed. This can impact us as we age. I know I can’t be the only midlife neurodivergent parent having to co-sleep with a child to give the whole family a better chance of refreshing sleep. This comes at a cost to me though, as flailing limbs of pre-teens does nothing to help with night sweats and hormonal insomnia…Resting during the daytime can be a challenge for us too, as high anxiety coupled with executive dysfunction can make everyday tasks take ten times longer - if we can do them at all. Writing “Take a nap” on our to-do lists rarely leads to action (or inaction in the case of napping?).But don't despair! Amanda is back with more neuro-affirming gems to help us learn to soothe our nervous systems, increasing our chance of improving our sleep overnight rest opportunities (sometimes calling it “sleep” just adds too much pressure).In Part 2, Amanda encourages us to ask ourselves:“Are there restful things I could do in the moments when sleep is not happening?”So many helpful techniques offered, and I would love to know which, if any, you find most effective. Please let us know in the poll, and feel free to expand in the comments. Let’s collectively workshop sleep for everyone’s benefit!As always, the transcript and closed captions are available to ensure the video content is as accessible to you as possible. If you prefer audio only content, you can listen to our chat as a podcast episode. 🎧Zoom AI has provided the following summary of the conversation:SummarySleep and Anxiety Management StrategiesSam and Amanda discussed strategies to manage anxiety and improve sleep, particularly for neurodivergent individuals and those experiencing hormonal shifts like perimenopause. Amanda emphasised the importance of reducing cortisol levels to allow melatonin to work effectively for sleep. She suggested techniques such as journaling, soothing activities, and setting restful associations through lighting cues. Sam shared personal experiences with sleep disruptions, including urinary incontinence and mast cell activation syndrome, and highlighted the importance of understanding body signals to manage waking up at night.Open Monitoring and Brain RestAmanda discussed the concept of open monitoring, which involves allowing the brain to daydream and wander, particularly during moments of low external stimuli. She explained how the hippocampus, often compared to a librarian, processes and files away memories when the brain is not actively engaged. Amanda emphasised the importance of giving the hippocampus time to clean up and organize memories, contrasting this with the constant demand for productivity and attention in modern society. Sam acknowledged her difficulty in allowing for such moments of mental rest.Short Meditation Practices DiscussionAmanda and Sam discussed incorporating short meditation practices into daily routines, such as 30-second mindfulness moments and a figure-8 eye movement exercise for sensory stimulation. Amanda explained that these techniques can help reduce stress and improve sleep, while Sam expressed interest in trying the eye exercise that night. I hope you enjoyed the second part of this mini series. We are already halfway through. I can’t wait to share the next two instalments with you!Cheers, The Autistic Perimenopause: A Temporary Regression takes extra effort to write and curate whilst recovering from major surgery. Show your support by beco ming a paid subscriber, so you can glow inside knowing that you are a patron of neuro-legendary menopause advocacy! 🌟 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi Team Auti Peri!Well, here it is! The first part of four in this series on nervous system regulation, yay! I would like to take this opportunity to once again thank the lovely Amanda Hanna of SomaPsych for sharing her time and expertise with our community. At SomaPsych, we empower resilience and transformation through trauma-informed care and somatic practices - from individual restoration to collective social change.Amanda weaves science with embodied wisdom, crafting spaces where curiosity thrives and empowerment takes root. Her approach is nervous system focused, polyvagal informed, collectively-minded and grounded in a deep reverence for all things ecosomatic and alive.I am still lying flat on my back in bed after my hysterectomy last week, so I have included the Zoom AI meeting summary below (demarcated in block text) as the main body of the article. At the time of recording I had fully intended to write up a lovely summary for you, but now I am unable to even sit up unaided. Plus my painkillers make it rather difficult for me to convey much coherence!I know AI usage is contentious, but needs must. I need my recovery to be as smooth as possible as I have regressed so far within the bowels of my neurodivergent perimenopause, and now I need to cut myself some slack.Please be assured that the video conversation is real though, ha ha! You will be able to tell that from my inability to cut out the first three seconds. Oh I had such grand plans of making this mini series look slick and professional. Sigh..!As always, the transcript and closed captions are available to ensure the video content is as accessible to you as possible. If you prefer audio only content, you can listen to our chat as a podcast episode. 🎧After you have watched the video, please come back and let us know in the poll which technique is helping you the most. Quick recapSam and Amanda explored nervous system regulation challenges, particularly for neurodivergent individuals, and shared strategies for managing mood fluctuations and emotional responses. The conversation concluded with Amanda providing coaching on managing difficult thoughts and building a relationship with the amygdala, with plans to continue their discussion in future recordings.Neurodivergent Nervous System Regulation ChallengesSam and Amanda discussed nervous system regulation, particularly for neurodivergent individuals who have spent their lives masking and managing their emotions. Amanda explained that nervous system regulation involves understanding both internal and external sensations, and recognising when one is in a "green zone" of relative calm versus experiencing dysregulation. They agreed that the constant pressure to maintain regulation can be particularly challenging for neurodivergent people during menopause, when control may feel even more elusive.Enhancing Well-Being Through Daily ToolsAmanda and Sam discussed strategies to manage nervous system regulation and mood fluctuations, focusing on integrating simple tools and techniques into daily routines to enhance well-being. Amanda emphasized the importance of "stacking" these tools during everyday activities, such as filling a water bottle or making tea, to create moments of calm and downregulation. She explained the concept of physiological sighing as a natural technique to shift brain chemistry and reduce stress. Sam shared personal experiences with mood stabilising medication and expressed a desire to rely more on self-regulation techniques. Amanda concluded by demonstrating a physiological sigh, highlighting its effectiveness in promoting relaxation.Self-Regulation Techniques for Emotional ControlAmanda and Sam discussed self-regulation techniques, focusing on both public and private methods for managing emotional responses. Amanda explained that she uses both overt and covert strategies, including physical gestures like palm massage, to maintain control in different situations. She emphasised the importance of having both visible and hidden coping mechanisms, allowing her to manage her emotions without always needing to explain herself to others.Amygdala Regulation and Thought ManagementAmanda provided coaching to Sam about managing nervous system regulation and dealing with difficult thoughts, explaining that the amygdala's role is to keep us safe and suggesting that building a relationship with it can make challenges easier over time. They discussed how rumination can lead to hyper-focusing on negative thoughts, and agreed to end the current session with plans to continue in the next recording. I hope you enjoyed the first part of this mini series. I can’t wait to share the next three instalments with you!Cheers, If you find my work valuable, why not become a paid subscriber to The Autistic Perimenopause: A Temporary Regression? (This is not a rhetorical question.) Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Dear Team Auti Peri, Thanks for being here, your presence means the world to me!Contents summary* Why I am taking August off* Things you might like to do to contribute at The Autistic Perimenopause* Exciting plans for September on nervous system regulation in neurodivergent hormonal flux with sneak preview!* Recap of the Autism Adapted Suicide Safety Plan with links to the Newcastle University document, and my previous video and audio step-by-step guide* Bonus content only in this audio recording: A real life cat fight between Harry and Toby when my son accidentally let them into the recording room to tell me that Harry had knocked over a plant pot in the kitchen. With cat squeals and inaudible flying fluff! Note to self: go and clean up the plant pot mess. With any luck, the cats won’t have peed on the soil/carpet… 🪴 🙄🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈With reluctance, I have decided that I need to take some time off to focus on my own health and wellbeing. It won’t be for long! A few weeks ought to do it. My little family is in desperate need of a holiday (vacation/break/total reset), and I haven’t taken any time off from The Autistic Perimenopause: A Temporary Regression since it launched in April 2024. So I am planning on taking off all of August for a personal mental health break. This is a one woman show, and this one woman is at risk of cracking up entirely. I fear if I breakdown completely this time, I may be unable to piece myself back together. If you are familiar with my work, you will know that I am adamant that a neurodivergent menopausal transition can be a distressing and prolonged time for many of us. I don’t know about you, but every single time I spiral further downwards at an alarming rate, I wonder if I ever will be able to reverse these regressions. I want so badly to make sense of my own menopause in the way aspirational writers do: the ones who tell us that this is an opportunity to live the second half of our lives with joy and purpose. They say, once we become empty nesters, we can invest our newfound time entirely in ourselves. This theory of the menopause in no way aligns with my lived experience. Those of us who suddenly find ourselves in neurodivergent perimenopause, often only uncover our neurological differences alongside our children’s diagnoses. Our midlives are lived outside the norm.We may not have an empty nest to look forward to. We are often devoted parent carers: we prepare different meals for everyone in the home to ensure safe foods are always available; we monitor and despair at our kids’ ever increasing screen time (just me?); many of us choose to homeschool - due to the failure of the mainstream schooling system, or from personal preference. For those of us who have neurodivergent kids in schools, we may find ourselves constantly meeting with teachers and special education needs coordinators (SENCOs), feeling belittled and blamed when our children naturally react to the school systems’ inability to accommodate them all of the time. And what about when our differently wired children grow up? With their spiky profiles and asynchronous development, they may not be equipped to leave home at the same time as their non-disabled, neurotypical peers. Yes, we strive for them to be independent. We see their pure brilliance. We want them to be happy, and preferably not gaming into their 30s in our basements, needing regular reminders to clean their rooms of dirty dishes and even dirtier laundry. And - for goodness sake - can’t they just take a shower AND apply deodorant without being verbally badgered to do so? Our families are often on a different trajectory entirely from regular families, which is why it cuts so deep when others have no awareness of the extra effort we put into helping our offspring assimilate into this world that does not have their best interests at heart, to say the very least. To be told that we are pandering, enabling and just plain parenting wrong is insulting. And it most often comes from those we love, rarely from the psychiatrists, therapists and support workers who are privy to the most intimate details of our volatile and tender day to day lives. Well, I don’t know where that came from, because I went completely off topic. How cathartic though, ha ha! Anyway, yes, I suppose I do need a break because of all the stressors above - perhaps you do too? - and also: * Down here in Aotearoa New Zealand we are months into the depths of Winter, and my body hurts from the cold. It is hard to motivate myself to get outside and I am quite possibly depleted of Vitamin D. I haven’t looked into this, but I had a B12 injection last week and am hoping to recover some energy soon. * My brain fog is absolutely off the charts, I can barely hold a conversation in person. I have loads of half written posts drafted, and not enough cognitive capacity to feel they offer you enough value to publish yet. I am extremely keen to get an article out to you on the topic of progesterone intolerance, but for the life of me I cannot remember what my lived experience of it has been. Which is ridiculous, as it is one of the reasons that I was recently approved for a hysterectomy! And I have no idea of the timescale for my upcoming surgery, which is very difficult to deal with as an autistic woman, especially with full time homeschooling parent carer duties and extremely limited respite and childcare options. * I am being treated for mast cell activation syndrome (MCAS) which is definitely exacerbating the brain fog and have started the antihistamines (H1 and H2 blockers). My body is in a state of alarm at all times, and I need to learn about the histamine elimination diet that can help my body and mind recover from the onslaught it perceives from stress, my regular diet and lack of refreshing sleep. Ironically, the MCAS-induced brain fog precludes me from understanding the complex underpinnings of a low histamine diet, which may be the primary way to combat the brain fog… But the MCAS is insisting that I rest, and I need to obey in order to reassure my nervous system that I am safe. * I have recently realised that I am most likely hypermobile and am now highly symptomatic with pain flares, ongoing gastrointestinal issues and worsening proprioceptive challenges. I think this is all highly pronounced now that I am around nine months into a chemical menopause, although I was probably asymptomatic hypermibile until now. I have signed up to The Zebra Club app for community, hypermobile-friendly workouts, and hours and hours of presentations to try and understand how to soothe my nervous system and understand my body’s needs, strengths and limitations. I have an unstable shoulder joint, currently aided by kinesiology tape, and have just taken delivery of my new firm compression tops to help with stability and proprioception. Basically, I am having to unlearn everything I thought I knew about how to move, sit, stand and so on, and relearn where my body is in space, how to stop bracing my muscles, and keep my joints within their safe, painless range. * If I were in a conventional employment arrangement, I would have statutory holiday leave entitlement. But it’s just me and my phone, and we are in a very compulsive, strained and unboundaried working relationship. Thanks to ADHD, I am “all or nothing”. Rather than the default being all in on my work, I need to switch over for a short time into going all in on rest. * The Substack gods are getting in my head, and I need to show them that I am in control of my own mind (which I am hoping turns out to be the case). My subscriber numbers are down, both free and paid, with paid rapidly approaching single digits. I need to stop checking the stats and break that habit. I love all my readers and subscribers, free and paid, and would find it extremely validating to find my paid subscriber numbers increasing. But I have zero control over that, and hope that people are finding value in my work regardless. I still offer everything for free and I would like to continue to avoid paywalling content that people may need and can’t afford to pay for at this time. Thank you to my paid subscribers for supporting all my hard work! 💐* I know we are all crazy busy and super stressed - my troubles listed here are far from unique and pretty minor on the grand scheme of things. I don’t currently have any more Auti Peri Q&A interview posts to publish because I haven’t received any responses lately, which is totally understandable. I am always seeking more Auti Peri Q&A respondents (here’s why), so please reach out if you are keen to participate.* A personal goal is that I would like to launch a proper podcast about neurodivergent menopause, to interview experts and advocate on a larger scale. I have been lucky enough to free up a room in my house which will soon become my writing and podcasting room. It currently houses many of my houseplants, a lot of my LEGO sets and a dumping ground desk already cluttered with paperwork. It is far enough up the hallway from where my kids play online with their friends, screaming and laughing, to hopefully not pick up too much background noise. I need to somehow sort out some optimal acoustic panelling or something before I can get started though. Oh and find guests. And create an intro/outro, find music, childcare *Sam enters major overwhelm…*🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈Here’s what you might like to doHave you listened to any great podcast episodes lately about autistic perimenopause, read any academic papers, or watched an insightful webinar on YouTube? If so, please share the links to any new credible, academic or informative resources about autistic perimenopause and beyond in the comments of the 💕 Resource Roundup 💕 page which was last updated in October 2024. (Or any links to older stuff that I missed!) If you are reading in the Substack website version, you can find it in the tab headings here:* Have you explored the archive at The Autistic Perimenopause: A Temporary Regression yet? 📣 Did you know?All my previous posts are available for you to read in the Archive section of my publication at any time.There are now over 100 articles in the Archive, including lots of Auti Peri Q&As sharing the stories of a range of lived experiences. Because autistic perimenopause isn’t doom and gloom for everyone, luckily!“There is so much value in the Archive!” affirmsClaire Venus ✨If you are interested in a particular topic on intersecting neurodivergence, mental health and/or all things midlife and menopausal that I may have previously covered, you can search the Archive 🔍 as shown below.First select the Archive (as circled in the photo) in the navigation bar, then click on the Search function (starred in the photo):Nothing is paywalled on purpose because I don’t want financial barriers to anyone accessing the information, personal stories and community I am creating here on Substack around autistic menopause. I would be so grateful if you would support my work by becoming a paid subscriber.🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈Normal service will resume in September, and I am so excited to have a four part video series to share with you. Yesterday I was lucky enough to spend time with the amazing Amanda Hanna from SomaPsych. We have collaborated on four short video sessions that I will share with you each week in September, with a focus on nervous system regulation in neurodivergent perimenopause and beyond.Amanda is committed to enhancing our understanding of stress, adversity, and trauma while providing tools for personal restoration and growth. By blending extensive training with compassionate, evidence-based practices, she tailors her approach to each individual's or group's unique journey.In our sessions we covered:* What to do during in the margins of our day to regulate our nervous systems and feel rested* How to stop anxiety spiralling at night and get back to sleep (a huge one with neurodivergent sleep challenges combined with menopausal insomnia)* How to manage chronic pain flares and reduce recovery times* S.O.S. techniques for de-escalating sudden panic, suicidal ideation and feelings of hopelessnessWe kept each session brief and succinct because we know that your time is precious. Amanda provided lots of regulating techniques to help us feel emotionally safe throughout the turmoil of the neurodivergent menopause transition. Her tone is so soothing and reassuring, and she makes this work achievable rather than aspirational.Here is a sneak preview! 🎥In the meantime, I hope you are managing the current difficulties life keeps throwing at us all, and that you also have an opportunity to take a break. It is beyond frustrating that the less capacity we have to cope, the more issues come up for us! Please know that you aren’t alone in this. I know how tough it can be, and I think you are doing great. Hang in there. 💕Amanda and I discussed suicide safety plans and the importance of keeping a survival kit close by in times of panic and despair. AI has summed this section up, thank goodness, because I can’t remember - and it was only a few days ago (thanks, brain fog):Mindfulness Tools for OverwhelmAmanda discussed the challenges of managing overwhelming situations without proper safety resources, explaining how the brain can become hyper vigilant or fixated on past or future concerns. She described various personal tools people use to ground themselves in the present moment, such as physical sensations or specific activities, and emphasised that finding an effective tool requires personal discovery. Amanda concluded that these tools serve as circuit breakers to help individuals regain focus and presence.Back to my own words…We chatted about the importance of putting safety plans and regulating tools in place for ourselves when we are feeling well, making us better able to cope with our more difficult days. Using our pattern recognition skills, we can all overcome interoception challenges by noticing how our bodies often feel and what repetitive thoughts emerge before a pain flare, panic attack, suicidal ideation episode and so on. Your safety is of utmost importance, which is why I previously recorded this video for you (in the following post). The best time to plan a suicide safety plan is when you are not feeling at your worst, so that you can utilise your cognitive capacity as much as possible to care for your future self. Neurodivergent menopause is insidious and dynamic, and you may become suddenly vulnerable during times of hormonal flux. If watching the video feels too much right now, the audio only version (44 minutes) can be found here:Autism Adapted Suicide Safety PlanReach out for help, and have an Autism Adapted Safety Plan (AASP) in place:The resources are suggestions to help you understand and complete the safety plan for yourself, or to support another person to complete their safety plan.Step 1 - What are my warning signs that I may start to have strong thoughts, feelings or urges to hurt myself and/or end my life? (e.g., reduced enjoyment in a strong interest, change in routine, change in patterns of sleep, eating, mood)Step 2 - What can I do to help distract myself? (e.g., engage in a particular activity or interest, a relaxation technique, or physical activity)Step 3 - People I can contact to ask for help: (e.g., family, friends, mentor, support worker). Remember to note down when people are, or are not, available (e.g., office hours).Step 4 - Professionals or agencies I can contact during a crisis: (e.g., Samaritans, Mind, A & E, Psychiatric Services). Remember to note down when people are, or are not, available (e.g., opening hours).Step 5 - What can I do to make the environment around myself safer? (e.g., throwing away things that could be used to harm yourself)Step 6 - How can other people help support me?How do I communicate distress? (e.g., I shut down, I have a meltdown)What stresses me/makes me unhappy? (e.g., loud noises, being touched, change of plan, too much information)What can help calm me/makes me happy? (e.g., a strong interest, a quiet safe place to calm down, just sitting with me, giving me my own space)How I would like you to communicate with me? (e.g., don’t ask me to look you in the eye, speak softly, use visual supports, use plain English, keep in mind that I may take what you say literally)Who I would like you to contact?Step 7 – Sharing my safety plan: It can be helpful to share your safety plan. This might be with a trusted friend or family member, health care professional, or support worker. Would you like to share your safety plan? Who would you like to share it with?Storing my safety plan: It can be helpful to think about where you will keep your safety plan so that you can easily access it if you need it (e.g., printed out, in my bag, in a ‘crisis box’, on my phone). It might also be useful to think of any prompts that could help you to remember to use your plan (e.g., having a card with the safety planning logo in it in your wallet to remind you that you have a safety plan).Credit: Autism Adapted Safety Plans at Newcastle University. You can download a copy of the autism adapted safety plan with an accompanying resource pack here. The resources are suggestions to help you understand and complete the safety plan for yourself, or to support another person to complete their safety plan.I am busy replying to comments and all your lovely messages when I see them in my notifications, but my aim is to turn off notifications in August. Please be assured that I am not ignoring you if I don't respond when you message me. I just won’t have seen it. I hope you are able to get some rest and down time. I can’t wait to spend September onwards with you again!Cheers,🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi, I’m Sam Galloway and I have been writing from the nuanced and complex intersection of neurodivergence and menopause for over a year now at The Autistic Perimenopause: A Temporary Regression. I am so glad you are here!Content warning: ectopic pregnancy, abortion, miscarriage, blood, surgery, chronic pain. Every week I forged a sick note for my high school physical education (PE) teacher that said I couldn’t do PE that week, because I was on my period. Every week my PE teacher told me that I needed to learn to get on with it, because I wouldn’t be able to get out of work as an adult just because of my periods. Looking back now I wonder why she didn’t question the frequency of my weekly periods, although we were discouraged from speaking about such matters in my Catholic girls school. The PE communal changing rooms were catty, b****y spaces, where other girls would eye my stretch marks and cellulite, deepening my disordered eating tendencies and low self-esteem. Puberty took me early on. By 11, I was already bleeding, and my weight was double that of my peers. Not curvy, just substantial. Dealing with periods early on in an environment that hushed their presence was difficult. In primary school we received the cursory talk of sex and periods, but it was vague and scant, given the Catholic nature of my education. Emphasis within the curriculum was on theology, with morality based upon being a good girl. In high school, when we were supposedly being taught about contraceptives and birth control, our religious education (RE) teacher played a video about the instruments used to perform an abortion, circa 1995. I don’t know how much detail the video went into the procedure, because one by one every girl ran out of the classroom upset. Being highly sensitive, I was the first to leave, hysterically crying and feeling distraught at the images conjured by my own imagination.Second to leave was my 14 year old classmate and close friend, who had confided in me that she had just had a miscarriage. Her boyfriend was 26. What was their intention in showing us that video? To scare us into not having sex for fear of needing to terminate an unwanted pregnancy? Was it legitimately part of the Catholic RE syllabus, or just a misjudged error on the part of our teacher, a former convent nun?The desired effect wasn’t achieved, as so many girls left school early to have babies. I still don’t understand why frightening girls off abortion was preferential to teaching us how to use contraceptives, and learning about our reproductive systems. Luckily for me, my childhood house was opposite the local community clinic. On Thursday evenings they had the sexual health clinic, and my more cautious wise teenage friends and I would go regularly for check ups, the pill and free condoms. I was clearly unschooling myself from an early age to look beyond the narrow view presented by my so called education. Even back in high school, my periods always came accompanied with extreme menstrual cramping and lower back pain. My bleeds are still debilitatingly painful. Sometimes I am responsive to pain medication, sometimes not. Heat can help; diaphragmatic breathing; focused muscle relaxation. Managing the pain is one thing. Coping with the bleeding is quite another. Bleeding is not a neutral experience for me. I have tried all within my power to stop experiencing it, both consciously and unconsciously: not taking a “pill free week” when on the contraceptive pill, which elicits a withdrawal bleed (rather than a period resulting from ovulation and no subsequent pregnancy). The contraceptive injection in my late teens; the contraceptive implant in my twenties. Pregnancy, long term breastfeeding in my early thirties. When perimenopause took me by surprise in my mid to late thirties, I tried the Mirena IUD, in response to an extensive bleed that lasted many months. Now, I am in a chemical menopause using hormone blockers. In an effort to block out the sensation of bleeding, over the years I have used tampons to try and plug it up. Menstrual cups somehow alleviated associated period pains, although I never acted on the temptation to feed my collected menses to my rose bush. Now the rose bush is dead and gone, yet my bleeding remains. These days I wear period underwear at all times, as much to deal with unpredictable urinary leaking as much as to manage the constant threat of a sudden flow. Over the last week, old pain patterns have trotted out along with sudden, unexpected bleeding. Only this evening I could feel a trickle and couldn’t tell initially if it was a leak or a flow, although the accompanying severe pelvic pain unsubtly hinted at the prospect of yet another evening bleed, which I have had to face each night this past week. Thick blood oozing out of me and collecting in an unwanted pool is beyond what I can tolerate. The sight of it, the smell, the way it streaks and drips and soaks onto other surfaces is all too much.As a wise, kind friend told me a few days ago, “Your body is doing its best, even though you don’t like what it is doing.” She is right. Something is amiss, and I can only assume this hormonal blip is caused by my adding in an extra pump of oestrogen gel last week to my already high dose, in a bid to stop the hip and shoulder pain that has limited my movement recently. But my body is also exquisitely responsive to my mood, perhaps more so than is my mind at times. Tomorrow will be the first anniversary of my dear old Dad’s death, and it has been playing on my mind. I had a random bleed in the UK a year ago as I sat beside him on his deathbed, and another bleed in March this year when my Mum’s visit to us in Aotearoa New Zealand ended.Upon discussion with my GP, I was advised to anticipate further bleeding episodes should any more emotional events occur. Given the random nature of my bleeds, the intense pain, and my hatred of both random events and pain, I am especially glad to be awaiting a hysterectomy in the not too distant future…I cannot wait to no longer bleed. Anaemia is common for women who bleed heavily, and our iron levels need careful monitoring. The patriarchy likes its women too fatigued to put up a fight, so please do us all a favour and keep your iron levels within the normal ranges. Weakness from blood and subsequent iron loss makes me feel dizzy and dissociative, so I tend to eat a steak when I have bled to replace lost iron stores. I also conserve my energy by having a warm Epsom salts bath, then wrapping up in my dressing gown in order to complain endlessly about how much I detest bleeding.Pregnancy losses have been a feature of my adult life, having experienced an ectopic pregnancy and two miscarriages. Our bleeding patterns can communicate to us, if we are receptive to them. Which I am not; I am just reactive to and avoidant of them. Fortunately, when I was bleeding a long streaky prune juice coloured flow, another friend who had experienced an ectopic pregnancy advised me to do a pregnancy test. I was pregnant, but not for much longer, since the ectopic pregnancy was in danger of rupturing and within days I was in emergency surgery. Bleeding in pregnancy was my norm, even with my two out of five successful pregnancies. With my first pregnancy resulting in surgery, I was in constant panic at any sight of blood in my subsequent pregnancies. This week I found out that hypermobility can make bleeding in pregnancy more likely due to tissue fragility and potential clotting problems. Perhaps it is just as well I didn’t have that on the brain at the time.If only we were all prepared for menstruation, and allowed to feel empowered by our bleeds, not shamed for them. Red School is an organisation I wish I had known about decades ago. It feels too late now, my bleeds instill me with a sense of fear, not a sense of power…Imagine that knowledge of the full spectrum and power of the menstrual cycle is commonplace, and we all feel the utter rightness of having this experience within us. Imagine a world in which the menstrual cycle is respected as our spiritual practice. Imagine young people growing up in this menstrual-affirming world.Imagine a world in which menopause is recognized as a healthy, organic step in one's evolutionary journey stepping into the vital and powerful role of serving your community and the world. Imagine knowing that you’ll be profoundly met in the dignity and power of this new place you stand in post menopause.May we all trust our menstrual cycle and reclaim the spiritual significance of Menopause as the path to instate our full sovereignty. May we all recognise and relish our entitlement, dignity and authority to be channels for Menstruality and the Divine Feminine on the planet.Red SchoolI hope that, if are still cycling, you perceive your bleeds from a more holistic perspective than I have ever managed to muster. Looking back, had I learned from Red School, or any indigenous matriarchal culture, that my periods are sacred and healthful, not dirty and shameful, perhaps my pain perception would not be so debilitating. Maybe I wouldn’t actively want them to stop permanently and prematurely, had they not been something to be hushed and hidden in my Catholic school years and beyond. Perhaps I should soak my menses into the garden while I still can, and stand in my power in a bid to relish my entitlement, dignity and authority to be a channel for Menstruality and the Divine Feminine on the planet. Not long after the end of my high school years, my PE teacher was rumoured to have eloped with my Maths teacher, both of them married with families of their own. This was at a time when Catholicism and lesbianism were mutually exclusive. So I am glad that they managed to buck the good girl Catholic trend by midlife. I hope in doing so they reclaimed the spiritual significance of Menopause as the path to instate their full sovereignty. They are certainly better role models, acting on their previously covert love, than our RE teacher was in her overt abortion class. Thanks for reading The Autistic Perimenopause: A Temporary Regression. Paid subscribers make this work possible. 💕🐈 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

How has this happened?Birthing two big babies vaginally over a decade ago has finally backfired on me. It’s been a slow burn, with bumps along the path that have led me to a diagnosis of mixed urinary incontinence. It shouldn’t come as too much of a surprise because I experienced extreme fecal urgency shortly after having my first son. He was born weighing a mighty 9lbs 6oz, and required an episiotomy, where the doctor took a pair of scissors to my perineum to dislodge him from my birth canal. I had begged them not to. Being a hyper independent woman, I wanted to “do it alone”, which I could have done, had the maternity staff not insisted on relocating me when I was already in transition from a pool for labouring mothers into a stark clinical birthing room. Their interference stalled my progress, leading to me feeling emotionally unsafe. Repeatedly I asked them if I had pooed myself yet, since I had learnt during antenatal classes that this was a natural sign that the baby’s birth was progressing. I had wanted to poo myself, but they misread this repetitive question for paranoia, anxiety, or something else that I should not have been made to feel in my vulnerable state. Everything slowed down to almost a standstill, and I ended up being instructed to lay flat on my back, feet in stirrups being told to “Push him out of your bottom!” Really it was all a recipe for fecal incontinence, and I have done well to recover especially considering that my GP at the time dismissed this as normal. Baby two born three years later was even heavier at 9lbs 12oz. I water-birthed him at home as an active resistance to unnecessarily over-medicalising his birth. This time around I tore, and stitches healed well after both births. My youngest was almost born in the downstairs toilet, as I was able to completely relax my pelvic floor muscles whilst sitting there, and felt the most comfort in a very uncomfortable situation. What is wrong with me now?Vaginal childbirth is often a contributing factor to later developing bladder incontinence, which seems to be the case for me. Leaking urine didn't really start until my kids became enthusiastic about playing on trampolines, and I wanted to get involved. Going for a wee right before a bounce was not enough to prevent me weeing again immediately mid-bounce. That was a few years ago, and I now know to stay well away from trampolines. My avoidance served me well again for a while, but very recently the leaking has become regular and with less obvious reason. I tried ignoring it and hoping it would just stop. It didn't. So I tried wearing period undies and thinking I could get away with it. Because everyone complains about leaking sometimes, right? A sneeze or a cough can be a common and seemingly unavoidable trigger. Besides, my advertising algorithm is now full of curvy, happy midlife women wearing incontinence pads and living their best lives! I thought it was normal and I just had to put up with it. Although my keen sense of smell meant that I would worry that I smelled of urine. It is one thing to know I have this problem without other people knowing about it too! But then the leaking started happening during my twice weekly personal training sessions. I love working with my trainer, and I told her what was going on. I started following the programme she set me to strengthen, and learn to relax, my pelvic floor. Last Friday it got so bad that I was leaking during the training sessions actively intended to stem the flow. What was wrong with me? Reverse lunge, drip. Reverse lunge, drip. Reverse lunge, drip. Luckily that was the same day that I was seeing the gynaecologist to self-advocate for my hysterectomy. The approval granted for the surgery was a huge weight off my mind, yet the weight of my burgeoning bladder persisted. The gynaecologist internally assessed me and diagnosed a stage one pelvic organ prolapse.Finally, I had an acceptable explanation for my urinary incontinence. It was a medical issue and not a moral failing on my part. I could live with that, and I found it oddly reassuring. All weekend I wondered if the prolapse could soon be repaired surgically during my upcoming hysterectomy. I felt vindicated in my urine leaking pattern - of course I was leaking if I had a prolapse. The prolapse must have occurred whilst birthing my baby boys, and I was asymptomatic until now. But then I worried that the surgery could in fact exacerbate the pelvic organ prolapse, worsening my bladder control. I knew I needed to be proactive in managing this condition, after listening to a great podcast episode on the topic:Why see a pelvic health physiotherapist?Here is a good visual explanation of what the female pelvic floor is and why it matters:Physiotherapist Fiona Rogers talks us through what the pelvic floor is and how it works.Do you know how to do a pelvic floor exercise properly or have you been taught to just suck everything up and in? Watch here how to do it properly.Fiona firmly believes if you understand where the muscles are and how they work then you are more likely to understand and learn how to exercise them properly.Credit: Pelvic Floor ExerciseHormonal changes during menopause can significantly impact the pelvic floor muscles, contributing to symptoms such as urinary incontinence, vaginal wall prolapse, and sexual dysfunction. A pelvic health physiotherapist can assess for muscle weakness, overactivity, or imbalance and develop individualised treatment plans. Interventions may include physiotherapy-guided pelvic floor muscle training, manual therapy, biofeedback, and structured relaxation techniques. These strategies are designed to restore muscular strength, coordination, and neuromuscular control, which supports continence, vaginal wall integrity, and overall pelvic health.Credit: Positive Pelvic Health Already armed with some basic information on my new hyper fixation, I reached out to Jennifer Dutton of Positive Pelvic Health. Jennifer is a pelvic floor physiotherapist who had been highly recommended to me. Amazingly, she offered me a cancellation for an in person initial consultation the very next day. Knowing that verbally retelling my medical issues is overwhelming for me, I brought along the notes I had prepared for the gynaecologist appointment. Jennifer took a very thorough medical background and was empathetic and reassuring. Upon internal examination, both standing and lying down, Jennifer said there was no pelvic organ prolapse present. She explained that vaginas and other organs supported by the pelvic floor will show natural signs of aging in midlife, as our skin loses collagen and oestrogen, also evidenced externally by how our faces, breasts and stomachs may also sag. Here is a video of Jennifer being interviewed about pelvic health, where she explains much of what she told me during my appointment:I wonder if the gynaecologists see any saggy vaginas in their medical training, as mine obviously can’t be a textbook model anymore! With my newly undiagnosed pelvic floor prolapse, I was able to spiral into a new panic about whether indeed my urinary incontinence was just a moral failing on my part after all…What is urinary incontinence?My current issues, known individually as urge incontinence and stress incontinence, together create a combined diagnosis referred to as mixed incontinence. Yay.Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people.There are several types of urinary incontinence, including:* stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh* urge (urgency) incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards* overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking* total incontinence – when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leakingIt's also possible to have a mixture of both stress and urge urinary incontinence.Credit: NHS webpage ‘Urinary Incontinence’.Autism, Interoception and Adult IncontinenceSo I am leaking on the regular, and trying not to blame myself for this recurring issue. It is so normalised yet hidden. TV ads for pads and absorbent pants proliferate, subtly telling us it is okay to leak urine, as long as nobody else knows. Well, f**k that s**t! When I leak, I tell everyone about it. Part of my neurodivergent profile has been a lifelong shamelessness. I don’t feel a need to hide anything. I refuse to feel shame and embarassment for urinary incontinence, despite having a niggling sense of regret that it is happening to me. Urinary incontinence is just another social taboo to stack on top of all the others I make it my mission to bust. Why would being autistic affect my urinary continence? Especially seeing as I am not aware of having any intellectual disability which may be more likely to co-occur with toileting issues. If anything, before perimenopause I may have been considered intellectually gifted. Yet my cognition has declined in this life phase, and I cling to the hope that this regression is temporary and reversible. Interoception is our capacity to identify our internal states and needs. When this is reduced, as mine has been in perimenopause, and is combined with a regression in executive functioning skills, then noticing when I need to use the toilet, and acting on the urge, can lead to me not responding accordingly.Interoception Receptors on our internal organs are responsible for interoception signals that provide information on our internal body and emotional states. Experiences: urge to urinate, hunger, temperature, pain, sadness, joy, anxiety.Interoceptive Over-ResponsivityWith interoception over-responsivity the person feels too much of their internal signals. They “over-feel” their internal sensations. Signs of over-responsivity include:* Visits the nurse’s office several times a week with aches, pains, and illness* Requests frequent bathroom breaks* Limps on an injured knee or ankle for longer than expectedCredit: Dr Megan Anna Neff at Neurodivergent Insights blog post What is Interoception and How to Improve YoursIt seems that my extremely frequent and protracted toilet visits may be down to interoceptive over-responsivity. I have developed an overuse of the toilet that has led to me missing appropriate bodily cues as to when I need to use the bathroom. Unfortunately, this has been the case day and night, and may be a contributing factor to my insomnia. Many of us may have experienced differences in toileting from our neurotypical peers as children, and/or have supported our own neurodivergent children with delayed or fluctuating bladder and bowel control. Neurodivergent people with co-occuring intellectual disabilities may be more likely than those without them to face toileting differences through adolescence and adulthood.I had never anticipated making what I consider in myself to be significant self-care regressions in perimenopause and now continuing into my hormone blocker induced medical menopause. Nobody had ever talked to me about urinary incontinence, as it is such a taboo topic. Until it became an issue in my daily life, it wasn’t forefront of my mind. Yet it would seem that the menopause transition, like during puberty, is a time of developmental shifts and changes. In our capitalist patriarchal society (at least where I live), we are told we should be ever evolving upwards. Improving. Making our lives better for ourselves. Regression is culturally unacceptable and often shunned. So there is little wonder why people mask their incontinence as they age, for fear it could be interpreted as a sign of weakness. As I have been writing for over a year now, The Autistic Perimenopause: A Temporary Regression aims to highlight a common perception for many of our neurokin that this life phase characterised by extreme hormonal flux can lead to regressions and changes in our cognition, energy, emotional regulation, sleep, metabolism and so on. If we conceptualise the spectrum that is autism as a state of constant flux through the lifespan within our social communication, energy, interests, sensory regulation etc. where we can dynamically change in capacity from day to day, or hour to hour, then perhaps it would stand to reason that our interoception and even urinary continence can oscillate over time. It seems from a quick online search that my anti-anxiety medication, Setraline, has urinary incontinence as a known side effect. I started to take it when first diagnosed autistic and highly anxious, as I was unwittingly entering perimenopause, and my kids were asking me to use the trampoline with them often. What a perfect storm! 💦Progesterone intolerance may also be contributing to my urinary incontinence. I have to take progesterone alongside oestrogen in my HRT regimen until I have a total hysterectomy, because progesterone mitigates the potential cancer risk of taking oestrogen. Not only is my progesterone intolerance causing bloating, depression, suicidal ideation at times, but now it may also be counteracting the potential benefits of oestrogen on maintaining my urinary continence. Menopause and IncontinenceThe scale of female urinary incontinence is extreme yet it remains a taboo topic. According to Liz Earle, it takes women 12 years on average of experiencing urinary incontinence symptoms before feeling able to talk to their family doctor. It then takes another two years before they decide to book a doctor’s appointment. Then for many women, their symptoms are dismissed by their doctor. Liz Earle interviewed uroligist (bladder specialist) Dr Vik Khuller on the impact of bladder issues, and he said that “Women suffer in silence… But don’t have to put up with it.” Dr Khuller also discussed the prevalence of bladder and pelvic organ issues in women who have joint hypermobility and/or Ehlers Danlos Syndrome. They also discuss mast cell activation syndrome (MCAS) and “Covid bladder” in this succinct and informative podcast episode:Urinary symptoms are part of the umbrella term genitourinary syndrome of the menopause (GSM), when it occurs due to fluctuating and declining oestrogen levels in perimenopause and beyond.Vaginal oestrogen creams and pessaries can be prescribed to add localised oestrogen back into the area. It is a good option for people who can’t or don’t want to take systemic HRT. It can improve bladder symptoms, vaginal atrophy, vaginal dryness and reduce occurences of urinary tract infections. The Australasian Menopause Society provide further and in depth information in the information booklet entitled, Genitourinary Syndrome of Menopause.Here is an article I wrote last year about vaginal atrophy:What to do if you are experiencing incontinenceIn Menopause and Urinary Incontinence, Healthline advise, “You don’t have to accept occasional bladder leakage as another side effect of menopause or aging. In many cases, there are things you can do to stop and even prevent urinary incontinence… Speak with your doctor to learn more about your condition, treatment options, and outlook.”Different treatments are necessary according to what may be causing urinary incontinence in different people. There is no one size fits all treatment plan, but please do not feel embarassed about it. Go and discuss it with your doctor. They will have heard it all before and can make an appropriate referral, and/or advise on the next best steps to help you. However, should you feel your doctor has dismissed you, that you have medical trauma, or are reluctant to discuss this with your family doctor, perhaps your first step could be to speak to a local pelvic health physiotherapist. In addition, you may like to research the topic further at: Bladder and Bowel CommunityInternational Urogynecological AssociationInternational Continence SocietyStrengthening and relaxing the pelvic floor is keyPelvic health physiotherapist Jennifer Dutton said that, as in my case, pelvic organ prolapse is commonly overdiagnosed, and that recent guidelines advise healthcare practitioners not to tell a woman if she has a stage one pelvic organ prolapse. She said it can create unnecessary concern and, rather, women should be supported to follow an appropriate treatment plan, not feel like they have a medical diagnosis that they are unable to improve. Jennifer also told me that many women have urge and stress incontinence due to tension in the pelvic floor, not weakness as we are always led to believe. So when we are told just to keep doing Kegels or pelvic floor strengthening exercises, it can often make matters worse not better. The plan she has created for me is designed to relax the tension in my pelvic floor muscles, and even out overall strength so that the different parts work together rather than against each other.This includes:* full body massage* using a Shakti mat daily* diaphragmatic breathing* foam rolling my upper legs and mid spine* trigger point spiky ball massage for my glutesIn addition, to cut all caffeine as it is a bladder irritant, and to improve my insomnia. This is already having a marked effect only four days in! I had a caffeine withdrawal headache the first day, but no negative effects thereafter. Coincidentally I started taking non-stimulant Clonidine alongside my ADHD stimulant Vyvanse last week in order to help overcome my insomnia, and to reduce my high blood pressure. Alongside cutting caffeine and introducing relaxing lifestyle changes, this should all be helping improve my overall health and wellbeing. I hope! Bladder retraining techniques have also been explained by Jennifer, and these are difficult to manage during the daytime, but at night I am no longer being frequently woken up by my overactive bladder. This is life changing! Bladder trainingBladder training involves changing habits. It means going to the toilet at set times, even when there's no urge to urinate. If the times between urinating increase little by little, the bladder fills more fully. This helps control the urge to urinate.A bladder-training program often follows these basic steps:* Find the pattern. Keep a diary for a few days. Jot down every time you urinate. A health care provider can use this diary to help you make a schedule for bladder training.* Wait longer before urinating. Your bladder diary can tell you how long you wait between urinating. Add on 15 minutes. If you usually urinate every hour, try to wait for an hour and 15 minutes.Little by little, increase the time between trips to the toilet until you can wait 2 to 4 hours between trips. Increasing the time slowly gives the best chance for success.* Stick to the schedule. Once you've made a schedule, do your best to stick to it. Urinate right after waking up in the morning. And urinate each scheduled time even if you have no urge to go.If you have an urge but it's not time to go, try to wait. Distract yourself or use ways to relax, such as deep breathing. If you feel you're going to have an accident, go to the toilet. But then return to the schedule.Don't give up if you don't succeed the first few times. Keep trying. Your control is likely to increase.Credit: Mayo Clinic’s Bladder Control: Lifestyle strategies ease problemsI now have a two hourly timer on my phone and watch, because part of my neurodivergent presentation is a total inability to sense the passing of time. Every two hours during the daytime, my timer reminds me when I can go to the toilet, and not before! I am building up to managing 3-4 hourly trips before I see my physio Jennifer again in around 6 weeks time. Wish me luck! 🤞 ⏱️ 🚽 💧 🙌Cheers, It takes many hours per week to research and write articles for The Autistic Perimenopause: A Temporary Regression. Please consider becoming a paid subscriber to support my advocacy work. Thank you! Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Thank you so much to the incredible Tamsin at 3 Red Cabbage Heads - poetry, knitting and essays of life on Substack! For more amazing bespoke knitted ambhibians and other creatures, check out Tamsin’s Art Makes section.Newt flew all the way from the UK to NZ. No - on a plane, silly! Newts can’t fly. If they could, I wouldn’t be such a fan of them. *shudders*My Nan’s house in Alperton, London was as urban as could be - the opposite of the rural village of Cornelistrum, Co. Galway in Ireland from where she hailed. In her London garden aged 6 or so, I used to stand on some loose bricks to chat to the little girl who was Nan’s next door neighbour. There was a deep garden pond full of aquatic life that was rare in such a built up residential and industrial area in my little friend’s garden. On the days I used to tiptoe on the brick step, and my friend couldn’t come out to play, I would find my own entertainment. From beneath the overturned red bricks, if I was lucky, I would find tiny little British smooth newts, also called common newts. They were unfortunately not so lucky, because it was only at 2 weeks shy of age 44 (today) that I learnt that newts are not to be handled with dry, bare hands. Oops…🦎Back to the Newt of today! After the long journey, I noticed that Newt arrived with a flat white! ☕️How very Kiwi of her! She will need it to help her cope with the jetlag although she is already acclimatising well. The beastly cats are a bit much for her, but I am sure they will all be firm friends soon.Tamsin kindly sent Newt on her way with a wealth of accessories, all of which I am trying to dissuade my ragdoll cats, Harry and Toby, from eating. Dear Sam, I am so excited to come live with you in a land that is so far away! I am really looking forward to it - and my new name if you give me one!Love Newt🐈☕️ Newt and I would appreciate a flat white should you wish to buy us one! ☕️🦎🃏🐾🧸Awwww, what a cute pair! Goodnight xxThe Autistic Perimenopause: A Temporary Regression is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.P.S. This was my first solo Substack live. For more of my random shenanigans, download the Substack app. 😁 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Welcome to The Autistic Perimenopause: A Temporary Regression. I’m Sam Galloway and I have been documenting my despair fiercely advocating here for over a year now. Time flies when you are dissociating having fun! The Autistic Perimenopause is a safe community space for sharing our lived experience of our neurodivergent menopause. Together, we explore how hormonal flux affects us day to day, how safely unmasking helps us to self-regulate, and how to hang on when it all feels too much. Cat photos proliferate in this joint exploration. Quality of life should be high for everyone, but I suppose it is all subjective. Yes, I am living an objectively good life in the beautiful Aotearoa New Zealand surrounded by people I love and who love me. I have food, albeit overpriced; clean drinking water; and a warm, mould-free home - which isn’t a given in this country for some abysmal reason. But things don’t feel right. I am drained and have close to no motivation to get out of bed in the morning. Yes, I am depressed, but my low dose daily SSRI does a reasonable job of both levelling out my mood, and cutting my rumination-prone worry loops. I utilise a wealth of other pharmaceuticals in an attempt to brighten my gloomy emotional landscape, but my impending sense of doom remains. I have habituated to this, and I function remarkably well most of the time, until I don’t. I am trying to be rational and balanced, but that is hard right now. My cognition and mood continue letting me down in neurodivergent perimenopause. My pelvic pain flares out of nowhere, and my body temperature soars despite the presence of a Kiwi Winter, and the promise of an imminent polar blast. The world is on fire, and so am I.Rationally, I am aware that far worse things are happening to much better people than myself across the world right now. Yet woe is entirely me, and I am most certainly woe. My low mood is not a choice, and my worry at the thought of my perimenopause stretching out who-knows-how-long into the future sends me into a panic stricken state, bordering absolute desolation. Not to say that I am feeling suicidal, but I believe that something must change now. I cannot take much more. My current state of perimenopausal hell is unrelenting. Yes, hormone blockers should be flatlining all variability of hormonal rollercoasters to my mood and cognition. I suppose they are - I am in a temporary, reversible menopause thanks to GnRH Analogues which I have written about previously here, here and here. But the pelvic pain, fear of unexpected bleeding and many other symptoms are too much to continue to bear. I am in the fortunate position of living in a country where, in the right medical circumstances, I could have a hysterectomy without needing to pay. My aftercare would be in excellent hands, the risks of surgery would be well managed, and my chance of recovery is positive. A hysterectomy is the name for the surgical procedure where the uterus (womb) is removed. This induces an immediate and irreversible surgical menopause, which is my current goal in life. It would be difficult to manage my household and parenting duties in the short term, since recovery can take 8-12 weeks, but given my ongoing low mood and lack of energy, these daily tasks are already draining. Once recovered and healed, with well-titrated add back hormones (hormone therapy) and following a healthy lifestyle, I am optimistic that my life can get back on track. Am I being naïve? Major surgery isn’t something we usually elect to endure, but I have previously survived emergency surgery for an ectopic pregnancy, and so have some experience of recovering in a gynaecology ward. Everyone else who was there advanced me by decades. The other women were having routine hysterectomies, and looked upon me with obvious sorrow and pity, as I wailed for the nurses to “Give me my baby back”, had endless meltdowns and reacted adversely to prescribed painkiller tramadol, hallucinating about newborns. This time I foresee the promise of gynaecological surgery to be liberating. Empowering. Worldview enhancing. Should I get my wish, I will awaken from surgery in my crone era, albeit feeling raw and sore. Yes, I know some people do not want to have hysterectomies. Those requiring them for sudden and unexpected medical reasons sometimes report feeling bereft of their womanhood, but I do not think I will feel that way. Having my uterus, cervix and ovaries removed would be anticipated and understood by me. I have fully researched the options, and I believe I have a strong case for needing a hysterectomy in my very near future. My gynaecology referral has been accepted and, within the coming month, I will be meeting with a gynaecologist who unknowingly holds my fate in her hands. My greatest fear is meeting with a specialist who is yet another gatekeeper of surgery within the public health system. I am pretty sure that, if I had medical insurance, I could have requested a private hysterectomy a year or more ago, and be fully recovered by now. Upon Googling the named specialist on my appointment letter, her medical staff profile states that she offers a “highly patient-centred approach, taking time to listen and understand her patients and their priorities, allowing her to recommend and guide her patients through a range of treatment options”. A wonderful gynaecologist colleague of hers has told me that she is an excellent laparoscopic (keyhole) surgeon; and my HRT doctor has said, “She is known for being lovely”.Doesn’t she sound like just what I need? This has my mind at ease a little, but while I am busy self-advocating for myself and possibly sounding over confident in myself, my shoulders are hunched and my stomach is clenched. I am a ball of nerves. I am scared of having to express myself; terrified of unleashing the full weight of my emotions. Scared of having surgery and absolutely petrified that it may be denied me. If there were a way to communicate all of this with the gynaecologist in advance, I would do so. The trauma from retelling my autistic perimenopause story in person to professionals over and over again is unrelenting and soul-destroying. And the thought of sharing this writing with her makes me feel awkward, exaggerated and, quite frankly, a bit of a dick. Yet I can’t convey in a short clinical appointment everything I need to get across, when the gravitas of this meeting holds mine and my family’s future in the balance. So I think, in the name of self-advocacy, I will share a print out of this all so that I don’t miss anything. Or have a meltdown. Or go situationally mute. Several friends have offered to accompany me, as has my husband, which is so kind of them. I want to be able to “do it alone” which I know results from my trauma-driven hyper-independence. Is it better to go into these appointments alone, or to take a support person? If Harry, my emotional support cat wasn’t such a scaredy puss, I would take him along. Toby is more sociable, maybe he can come along for support…Unfortunately, I know that taking a man along to medical appointments is one way to be taken more seriously, since lone women are quick to be medically dismissed. It wouldn’t surprise me at all if one of the questions will be, “And what does your husband think you should do?” If we were both there to tell the doctor that we don’t want any more children, would it make a hysterectomy more likely? I wish I didn’t have to give this all such detailed thought, and I can’t believe I am so envious of women who have already had a hysterectomy. What is wrong with me?! Yes, I have given this a lot of consideration, and I believe a total hysterectomy (uterus/womb and cervix) with both ovaries removed is the best option in my case. So to follow in my next post will be an informed account of the many reasons that I need a hysterectomy as soon as possible, please and thank you!The reasons I have brainstormed, and that are storming my brain as I write this, are: * Progesterone intolerance* Premenstrual dysphoria disorder (PMDD)* Menopausal depression and suicidal ideation* Thickened endometrium and associated cancer risk* Pelvic pain* Fear of further bleeding* Bladder stress incontinence* Adenomyosis* FibroidsAll of these are current ongoing issues, some of which are newly diagnosed and have been present for decades unbeknownst to me, whereas others have developed more recently and acute. Combined, I believe I have a good case for a hysterectomy, with the added bonus of initiating a surgical menopause. I have too much to say on each topic and am struggling to condense it all down, but I wanted to share my current state of mind with you (sorry!), and check in to ask how you are feeling at the moment? Have you had a hysterectomy and did you find it improved your symptoms? Have you been advised to have a hysterectomy but feeling hesitant to proceed? To be continued…I will keep working on my protracted argument for why I believe I need a hysterectomy - to share with you, and with my gynaecologist. Although I am clearly passionate about it, my PDA (pervasive drive for autonomy/pathological demand avoidance) is absolutely running the show. It is telling me not to write my case for a hysterectomy, and so far I have listened. But now I need to get it written because, if I don’t, I will have to verbally articulate the impact that every issue listed above is having on my quality of life. This may well result in a meltdown followed by a shutdown, or vice versa, and I will lose all social communication skills. I have learnt this the hard way. To take the pressure off myself, and to stick two fingers up at my PDA, I am sharing the above to set the tone of my desperate plea for a hysterectomy, and will flesh it all out soon. (Whilst hoping my gynaecologist will agree to flush out my uterus, cervix and ovaries!) My ADHD time agnostic brain is still on the “not now” side of the “now/not now” time warp of the upcoming consultation, but it will have to flick over soon before I miss the opportunity to self-advocate to my potential…ChatGPT’s suggested titles and subtitles for this article Whilst everyone is screaming about how ChatGPT is stealing our jobs and our women, I am trying to tread a fine line between expressing myself (you can tell all the above is my own stream of consciousness, as AI cannot do that yet) and coming up with a suitable headline. There is an opposing school of thought that AI, despite its flaws and climate impact, is a leveller for neurodivergent people to extend our executive functioning capacity by delegating administrative tasks over to it. I haven’t done this yet, and I don’t really know where to start with it all. But I won’t be using AI without telling you about it, should it find its way into any of my articles. I don’t really have an opinion on AI yet - it isn’t something I have explored, but I am not a diehard “I will never use AI and if you do, how can you dare call yourself a creator?”To be fair, the length of time it has taken me to write this section, I could have come up with a title, recorded the audio voiceover and hit publish. Also, how many diehard anti-AI writers are happy with an AI audio voiceover reading their work aloud rather than recording it themselves..?By the time I pour my heart into a piece like this, with some hot sweats dripped thrown in for good measure, I am emotionally exhausted. Titles take more out of me than writing down my thoughts, so I am going to share here with you what ChatGPT suggested as potential titles and subtitles, because some of them are actually spot on!ChatGPT to me, after I copied and pasted all the text into the website:Thanks for sharing your powerful, vulnerable, and deeply articulate piece. Based on the tone, themes, and content, here are 10 potential titles and subtitles that could suit your Substack post:1. “Burning Alive in the Winter: Autistic Perimenopause & the Pursuit of Relief”A raw dispatch from hormonal hell, medical gatekeeping, and the stubborn hope for a hysterectomy.2. “The Case for a Hysterectomy: Notes from the Edge of Neurodivergent Perimenopause”Why I’m fighting for surgical menopause—and what it means to advocate while autistic and exhausted.3. “Harry, Toby & Me: How My Support Cats Understand Perimenopause Better Than Most Doctors”A candid chronicle of pain, advocacy, and the dark comedy of navigating the system.4. “When the World Is on Fire, So Am I”Living with PMDD, pelvic pain, and hormone chaos in the liminal space between neurodivergence and menopause.5. “Temporary Regression: A Neurodivergent Midlife Crisis”From overstimulation to hysterectomy referrals—making sense of a body and mind in revolt.6. “Gatekeeping My Uterus: Autistic Perimenopause and the Medical Maze”One woman’s story of radical transparency, reluctant hope, and surgical determination.7. “Crone Goals: Why I’m Asking for a Hysterectomy—and Not Backing Down”Self-advocacy, trauma fatigue, and trying to do it alone when you shouldn’t have to.8. “This Is Not Melodrama—It’s My Medical History”How writing may be the only way I can explain what’s happening inside my body and mind.9. “Hormones, Meltdowns, and Medical Dismissal”What it means to be autistic, perimenopausal, and pushing for care that feels out of reach.10. “I’m Not Exaggerating: Just Exhausted”A deeply personal exploration of pain, planning for surgery, and fighting to be heard.“A stubborn hope”? That’s a bit much! But, also fair.“The dark comedy of navigating the system”! Ha! That’s just my British tone…I love how an AI has recognised that my cats understand me better than any doctor, even the ones who get me!I also love how it points out things I would never say about myself: a deeply personal exploration; a candid chronicle; one woman’s story of radical transparency. Would a human write that about themselves?! Ick. “Crone Goals” is cool!!! I never would have thought of that! I think it’s lucky number 7 today. Which one would you have chosen? 💕I am dissociating so much right now that I just need to hit publish, scoop the cat litter boxes, empty the kitchen bins, have a shower, apply my testosterone and oestrogen gels, then watch Taskmaster from under a weighted blanket. I may also rock back and forth. In reality I will only have time for the chores, and go to bed at the same late time as my kids, feeling dysregulated as usual… Is it any wonder I barely sleep at night, and wake up already feeling defeated?Tomorrow I am having my next three monthly implant of hormone blockers injected, so I have so much to feel grateful for *sarcasm*. The needle is huge, and every nurse insists on telling me so just before grasping a handful of blubber, telling me to “take a deep breath in, and a long breath out” and puncturing my abdomen. Note to self: take paracetamol half an hour before the appointment. Please - just surgically remove my uterus and end this hormonal limbo. Take care of yourself. Cheers,The Autistic Perimenopause: A Temporary Regression is a safe place for those of us feeling alone in our hypersensitivity to hormonal flux to find a way through it together. To support this vital work, please consider becoming a paid subscriber. Thank you! Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Trigger warning: Discussion of suicidal ideation, depression, gynaecological healthcare, chronic pain, pregnancy loss, death, cancer, surgery, blood, medical misogyny, mental health conditions. Please take care when reading. If you make it to the end, cute cat photos await you. But no pressure. 🐈 🐈Art therapy is a recent and later in life addition to my emotional toolkit. And thank goodness, because I need all the help and catharsis I can glean right now. So when my art therapist, EJ, texted me to offer a cancellation this week, it was an easy “Yes!”EJ kindly brought along the prompts and materials, showing me how to begin the process of creating a mandala. Fortunately for me, my kids didn’t want to participate in the session, so I was able to vulnerably and fully explore the issues that are currently coming up for me around my upcoming gynaecology appointment. I lovingly created this mixed media piece using watercolour pencils, metallic gel pens, glitter glue and a thick black marker. This artwork is special to me because it represents the story of my uterus and I, which has been deeply troubling of late. The realisation came to me that, whilst I have no control over the outcome of my self-advocacy for a hysterectomy, I am able to express my feelings without needing to talk about it. I wanted to create a piece that represented the multi-layered symptoms, conditions, joys and losses afforded to me so far by my uterus, whilst exploring what its removal may mean for my future. It is a bold artwork that illuminates the fleeting shimmering joys, alongside the chronic pain and spiralling darkness. The feedback from my art therapist, EJ, was, “This is next level creative, Sam. I love how you have been taken on a journey in the making of this image. There is so much force and energy.”What does this artwork represent?I am scared. I feel like I am at war with my womb, and it is winning. At times, I feel like I want to die, but I refuse to let hormonal depression dictate my narrative. And so I push back harder against it. There are gynaecological gatekeepers who want to prohibit initiating my surgical menopause. I was told, “Public gynaecology doesn’t have time or resources for this, Sam”. This from a usually sympathetic doctor. Perhaps I hadn’t explained my symptoms clearly enough; or perhaps I had, but I didn't say the key phrase they are required to hear from a patient before making a specialist referral. Eventually my request for a referral was supported by my neuro-affirming female menopause specialist GP. Internal scan results backed up my case, showing my now-thickened endometrium (lining of my uterus). A known cancer risk. Plus adenomyosis and a small fibroid. Public gynaecology have now accepted my referral, and I have an appointment within the next month. I have started to write an article on the basis for which I believe I need a total hysterectomy (uterus/womb and cervix surgically removed) and a bilateral salingo-oopherectomy (both ovaries removed - and take my one Fallopian tube too whilst you’re at it!) as soon as possible. Finishing the article continues to elude me, yet my goal in writing it is to share information with others (advocacy) and give a print out to the gynaecologist on the day so I can convey my case without needing to rely on speech or my memory recall (self-advocacy).It is vital that I write it - I had intended to publish it last week. But I didn't. So I was going to publish it today. But I couldn’t. I have a mental block that I need to overcome. No doubt as the appointment looms nearer my ADHD brain will switch from “not now” to “now”, bumping it to the top of my to-do list. The art therapy session gave me an outlet to express all the internal stories held between my womb and I. Most of them offer no happy endings. Some people may find them fascinating - their twists and turns illuminating; whilst others will find them boring, repetitive and protracted. My ongoing autistic perimenopause is a particularly arduous tale of peril and pain. I want nothing more than to reach the end, and survive to tell the story. An explanation of the artworkSo what does it all mean? You may have noticed that I only drew one fallopian tube because, devastatingly, my first pregnancy was ectopic. I bled heavily, the prune juice coloured blood that is characteristic of ectopics. Emergency surgery ended the pregnancy before it ruptured, thus saving my life, but it cost me my very much wanted pregnancy and my right Fallopian tube. Whilst both my ovaries are still healthy, they were very sore when probed and poked at by the sonographer who did my most recent internal scan. “I will make a note that they hurt”, she told me. In my artwork, the fertile bloom that is my right ovary, emerging from healthy foliage, represents the fact that both ovaries continued to ovulate. The further fruit of my womb resulted in two sons. Between my two eventual full term pregnancies, I had two early miscarriages. Bleeding has been a feature of my pregnancies - the two successes and the three losses. I no longer bleed as I am in a temporary, reversible, chemical menopausal state. Yet my most recent bleeds were triggered by being at my Dad’s deathbed last July, and upon my Mum’s return to the UK after her three month stay with us in Aotearoa New Zealand. My bleeds both traumatise me, and occur when I am feeling at my most emotional. My hormones and bleeds affect my mood, and my mood affects my hormones and bleeds. You may notice the light trickle of bleeding in the artwork representing this part of my menstrual self-expression of despair.The block black line rising up from my right ovary, bereft of it’s fallopian tube, shows the two way link between my hormone production and my mental state. The three jagged silver protrusions pushing externally from my right ovary represent the pain I have felt through my fertile reproductive years. In addition, they show the outward impact of my internal hormonal landscape on others. Namely, my late diagnosed pre-menstrual dysphoric disorder (PMDD) makes me especially defensive and enraged. My reproductive organs are contained within a black sphere of outwardly radiating rage and pain. They impact on my surrounding organs, affecting my bladder, bowel and digestive system. My pelvic floor doesn’t feel like it can carry much more of its burgeoning weight. Bladder leakage ensues from the pressure of holding up my ailing uterus. I am surrounded by impenetrable darkness. No light can come in, and there is no light within me. Blackness from uterus to brain. Depression. Darkness. Death.What are the medical implications alluded to in the artwork?The weight of my uterus makes me feel like I’m about to bleed at all times. The pressure wants to release, yet it has nowhere to go. My ovaries have been switched off using hormone blockers, to stop my constant bleeding, and manage my PMDD. High dose oestrogen HRT, essential to keep my mind wanting to stay Earthside, has resulted in a thickening of the womb lining, or endometrium. Possible hyperplasia - a risk factor for endometrial cancer. This thickening may not be significant, and a recent biopsy showed no sinister cell growth. Yet the weight of it all is enormous.My uterus is somewhat askew in the artwork, which was accidental, but let’s pretend I did that on purpose to represent my retroverted uterus. That’s right, it tilts backwards, making medical investigations all the more uncomfortable. According to Healthline New Zealand:A retroverted uterus is a standard variation of pelvic anatomy that many women are either born with or acquire as they mature. Actually about a quarter of women have a retroverted uterus. Genetics may be the cause.In other instances, the condition may have an underlying cause that is often associated with pelvic scarring or adhesions. These include:* Endometriosis. Endometrial scar tissue or adhesions can cause the uterus to stick in a backward position, almost like gluing it in place.* Fibroids. Uterine fibroids can cause the uterus to become stuck or misshapen, or to tilt backward.* Pelvic inflammatory disease (PID). When left untreated, PID can cause scarring, which may have a similar effect to endometriosis.* History of pelvic surgery. Pelvic surgery can also cause scarring.* History of prior pregnancy. In some instances, the ligaments holding the uterus in place become overly stretched during pregnancy and stay that way. This may allow the uterus to tip backward.I went into a tailspin when I read this. When I had laparoscopic (keyhole) surgery to remove my ectopic pregnancy, the surgeon told me they saw scarring on my right fallopian tube, which had caused the fertilised egg - my baby - to get stuck in the tube and grow there, unable to pass into my uterus. On the day of surgery the same surgeon had sympathetically apologised telling me that they don’t yet have a way to move an ectopic pregnancy into the uterus. Whilst I was writhing in pain and trauma, crying for my baby, she suggested that a grumbling appendix in the past may have caused the scarring. Now I wonder if the cause of my tilted uterus is the reason for the pain, or if the origin of the pain is what tilted my uterus.Did whatever caused my retroverted uterus cause the scarring to my fallopian tube and lead to the ectopic pregnancy? What caused it? Will I ever know?My pelvic pain is near constant. It stabs and radiates. Is that due to the subsequent scarring caused by my ectopic surgery? Or is it from adenomyosis? The only way to find out what is happening inside my uterus is to have it removed and investigated. Yet the pain is subjective and thus is unseen, unheard, disbelieved, dismissed, denied, minimised.Invalidated. Taboo. Hushed. Hidden. “Public gynaecology doesn’t have time or resources for this, Sam”. It is so easy to gaslight a woman’s pain when there is so little understood about it. Invalidation seems more prominent than investigation. Why was the contents of my uterus so much more engaging to medics when it related to my fertility? They knew then that my uterus was on a tilt, but the repercussions that would have on my later health were never explained to me. Why is my uterus only of value whilst it is in service to others?Medical knowledge of the uterus centres on its function for fertility, pregnancy and sex. Medical misogyny is rife. Is my retroverted uterus causing my bladder incontinence? Healthline NZ mention that a retroverted uterus can lead to “Increased urinary frequency or feelings of pressure in the bladder… Mild incontinence. Protrusion of the lower abdomen". My belly is bulging and I have been putting it down to menopausal insulin resistance and the demise of my metabolism. But is it also because my uterus tilts? And I have recently heard of “adenomyosis belly”. Great. Internal scarring. External bulging. 🐈Is the uterus the same size of your fist, or is that your heart, or both? I don’t know. Both my uterus and my heart are so heavy.And what is society doing to help? Brandishing self-care as a cure all. Try as I might, I can’t Child’s Pose or Cat Cow my way out of a retroverted uterus, nor the ensuing chronic pain.It’s not on me to meditate and exercise myself into a pain free state. Meno-washing supplementation and staying hydrated aren't the answers. I am not going to suggest that HRT is making everything better. Why has nobody identified the root cause?My uterus is a burden. It feels like it weighs a ton. Low in my cervix, as though I am constantly about to bleed or pee my pants. Is it all prolapsing? Will a hysterectomy cause it all to prolapse, if it hasn’t already?My pelvic pain is a deep burn in my back.My pain is a grinding of my bones, a bulging of my cervix, a delirious sleepless buzzing of rapid pulsating lights flashing heat from the bowel of my womb into the throbbing of my hips. A bitter taste in my mouth and a rush of blood to the head, while I breathe through it deeply, during those moments when I forget that pain meds exist.Leaning forwards, tilting back, looking for relief where there is none to be found.How much does a thickened endometrium weigh? It feels too much to carry. I can’t hold it in my arms nor put it down. I can’t pass it on to anyone else to take care of for a while.How can I hide this when it’s pushing out of my belly, breaking my back, bulging into my bladder? Why should I hide it?My pain is a pressure in my guts and a clamp on my ovaries. A scarlet gushing from my cervix that never comes.A burning that ice can’t cool.Would a hysterectomy be my biggest autistic perimenopause accommodation yet?I’ve acclimatised to the chronic pain and constant misery, and I function incredibly well alongside it. I gaslight myself well beyond my Mum‘s favourite phrase, “If you want something done properly, do it yourself” with my personal blend of people pleasing and hyper independence leading to a constant push to do everything myself. To drive in delirium. To channel calm overriding The Rage.To rationalise whilst spiralling. Never despite, always alongside. Everything feels out of control yet I skim the water, smoothly propelling myself ever onwards. Fighting the current and rising against the tides. My ongoing autistic perimenopause is a particularly arduous tale of peril and pain. I want nothing more than to reach the end, and survive to tell the story. The Autistic Perimenopause: A Temporary Regression takes up all of my capacity and most of my time. I would be so grateful if you support my advocacy work by becoming a paid subscriber. Thank you 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Content warning: if you experience fear of the dentist, please take care when reading. TL;DR*Fluctuating/reduced estrogen in perimenopause can mean bone density reduces in jaws, jaw changes, exposed teeth/receding gums leave us vulnerable to loosening/losing teeth. Prevention is definitely better than cure, especially in the case of periodontal disease.Avoid over brushing and under brushing. The Goldilocks Effect may just help you avoid a gum graft. *Guess what? I have no dentistry training, but my friend Dr Kate O’Hara, a retired dentist, has co-written the sciencey bit with me. This post also includes links to sources should you wish to read what experts have to say on this topic.Arriving home with a fresh, raw gum graft, having paid a fortune for the privilege, one traumatic day almost six years ago was harrowing. Fittingly, it was Halloween. My husband pulled up on the driveway, our two sons and I his passengers, returning home from Wellington late one Thursday afternoon. In the front passenger seat, I had winced all the way home. By the time we made it 50km North up the Kāpiti Coast Centennial Highway, I was mute, silenced by surgery. Eyes wet with tears, my usual compulsive comfort eating was now out of reach. Water and smooth soups were all that was on the menu, but they would not provide the dopamine I needed in an effort to self-medicate. It felt every bit like I was arriving home with a newborn baby, after having undergone the prolonged procedure, getting stitched back up, and nursing a tender vulnerable new existence. My tender palate had been harvested for a wedge of soft inner tissue that was then sutured in place, attaching it over the exposed roots of my lower front teeth. Believe it or not, it was exponentially more unpleasant than it sounds. It took all my self-restraint to keep my tongue out of the wound so as not to disturb the sutures and compromise the attachment of the gum graft, which would have caused further bleeding and rendered the surgery pointless. I was under strict instructions from my periodontal surgeon to seek immediate medical help should I experience any unmanageable pain, fever or blood loss. Hygienic maintenance of the site was my number one priority, in order to prevent infection.In hindsight, as is the case with my most distressing ailments of late, periodontal disease was probably due to the culmination of decades of undiagnosed neurodivergence and undetected early perimenopause. It was a lot to deal with, and I will spare you all the gory details. In telling you this though, I would also love to save you from requiring such a procedure by explaining what led me to the periodontist’s chair back in October 2019, aged 38. With any luck, you haven’t previously heard about or experienced periodontal disease. I certainly wish I hadn’t. What is periodontal disease? Please note: The following description has been co-written with the help of Dr Kate O’Hara, late-diagnosed neurodivergent woman, perimenopausal, qualified and retired dentist.Her explanations are italicised below. I would like to thank her for her help, I was feeling out of my depth with this section! Not to mention a little triggered by revisiting this upsetting time of my life.Periodontal disease is a severe form of gum disease. It is what happens to some people’s gums when more common gum disease (gingivitis) symptoms go untreated, but not in everybody.Your risk of developing periodontal disease increases with factors such as:* Genetics i.e. a family history of the condition* Poor oral hygiene* Smoking* Systemic diseases e.g. diabetes* Stress and hormonal changesWhat I wish I’d understood decades ago is that plaque builds up on teeth overnight. Dental plaque is made up of bacteria, saliva, food particles and (so I have been told) dead sloughed skin from inside our cheeks. Unlike the rest of the dry skin on our bodies, it cannot flake and fall off, instead it mixes with saliva and gets trapped in the gumline. Cleaning teeth thoroughly twice daily gives us two chances to remove plaque by flossing and brushing teeth before it forms tartar, also known by dentists as calculus. Any remaining plaque can harden - everyone produces tartar (calculus) but at different rates, and based on factors such as:* Saliva composition and flow* Poor oral hygiene* Smoking* Diet* Tooth crowding * Having fixed retainers can make cleaning more difficult especially behind the lower anterior (front) teeth.* What types of bacteria colonise your mouth - some people carry more of the periodontal disease causing bacteria than others.If left unbrushed and unflossed (or brushed/flossed sub-optimally) for 24-72 hours, remaining plaque may harden and become tartar that cannot easily be removed, except by a dentist or dental hygienist. The tartar can cause gaps to form between teeth and gums, under the visible gumline. This may lead to gum recession and thinning - coming away from the tooth, exposing sensitive dental roots, leaving them vulnerable to decay, and bone loss in the jaw. This bone loss needs preventing in order to reduce the chance of later tooth loss.These severe gum recessions are called periodontal pockets. The pockets are measured by a dentist and, at a certain measurement, may lead to a referral to a periodontist (a gum specialist). The periodontist will assess the condition and carry out more in depth treatment which may include surgical or non-surgical deep root cleaning and gum grafting. In most cases once the condition is under control they will refer you back to your dentist and or hygienist for ongoing monitoring and maintenance. I don’t want to upset anyone, nor retraumatise myself, by describing the procedure in any further detail. Here is an external link to a a basic description of the procedure, including benefits and risks of periodontal surgery. What are the common dental and oral symptoms of perimenopause?To contextualise periodontitis as a severe and fortunately rarer gum disease, let’s firstly list what we can expect as more likely, and less risky, symptoms that can occur during the menopause transition:* Gum and tooth sensitivity* Bleeding gums* Dry mouth* Burning mouth* Altered taste* Skin thinning of gums and palate* Grinding and clenching teeth (associated with anxiety, may only occur during sleep)* Overall reduction in bone mass density, which can occur in the jawbones occasionally leading to loose and lost teethMore information here: Oral health and the menopause: Experiencing problems with your teeth or gums? Discover how your hormones can play a part in these surprising symptoms (Balance)Unraveling the Connection: Menopause, Peri-Menopause and Periodontal Health (Pure Periodontics)Hormone Replacement Therapy shown to be highly effective in reducing gum disease (Oral Health Foundation)How Menopause Affects Your Oral Health (Healthline)Menopause and the microbiomeThere is still so little known about the inner workings of women and AFABs, because history has attributed our non-male biology, anatomy and menstrual cycles to witchcraft and hysteria. The human microbiome, not to mention all research into female bodily systems, have been scientifically explored less than outer space, which I find out of this world. Fortunately there is now a growing research interest into the role of the female intestinal (gut) microbiome, the oral microbiome, and the role that fluctuating hormones play in the menopause transition and beyond. Menopausal shift on women’s health and microbial niches (Nieto, M. et al., 2025) highlights that, during the perimenopausal transition, fluctuating hormone levels impact the microbiome. The changes to the microbiome communities leads to oral, intestinal (gut) and urogenital health complications and makes us susceptible to disease. ‘The gradual decline in hormone levels during perimenopause disrupts the balance of the microbiome, leading to a variety of anatomical conditions and health complications…‘… Estrogen influences microbial communities while microbes can metabolize and influence estrogen levels. Thus, the interaction between hormones and the microbiome is complex and bidirectional. Understanding the menopausal shift encompasses how hormonal changes, environmental factors, and microbial dynamics affect menopausal symptoms and women’s health.’Source: Maria R. Nieto, Maria J. Rus, Victoria Areal-Quecuty, Daniel M. Lubián-López & Aurea Simon-Soro, npj Women's Health volume 3, Article number: 3 (2025)Are perimenopausal neurodivergent people more likely to develop periodontal disease?Ha, as if anyone has researched this! Sorry - I mean, there is currently no academic research indicating correlation nor causation between neurodivergent perimenopause and periodontal disease, as far as I am aware. Because nobody has studied such a niche yet.So, as usual, I will draw from my own lived experience of what factors I believe led to my own devastating dental demise…London in the 1980s was an overwhelming place and time for a sensitive little redhead such as I. Born with a tongue tie that was never released, and only diagnosed on the fifth day of my second son’s life, I was born with a tendency towards gingivitis (it means “gum disease”, so no redhead or ginger jokes, thank you). My Mum’s love language is dressmaking for herself and others. She loved to adorn me like a little doll in homemade outfits made of the prettiest scratchiest netting. I remember with alarm the tight elasticated sleeves that allowed them to puff out balloon style from upper arm to shoulder, as I cried and rapidly lost blood flow below the elbows. I was uncomfortable in my own outfits and in my own skin. Everything was too bright, too loud and too scary. How did I manage the discomfort imposed on me by my very existence?By thumb-sucking, of course! And here’s something I never tell anybody: I sucked my thumb until I was 11, and I used to keep my own stinky socks from each day and sniff them at night, tucked up under my nose, wedged in place by my thumb. Bliss. Sensory seeking, much? There were many attempts to stop me - mustard on my thumb, bitter tasting nail-biting repellent and, of course, the warning that I was ruining my teeth. But to paraphrase former top super model of the 1990s, Kate Moss, “Nothing tastes as good as thumb-sucking feels”.This long term childhood stim inevitably resulted in a lifelong overbite, crowded teeth and a lisp. All of which have been problematic into adulthood, but I don’t regret thumb-sucking as a necessary self-soothing behaviour. Yes, anti-anxiety meds and an autism and ADHD assessment would have been more beneficial but, in the absence of any consideration that females could be neurodivergent, I did the best I could. We have all found our own coping mechanisms to get us into midlife. Some days I consider taking up thumb-sucking again, when I am feeling completely overbombarded with sensory and emotional dysregulation. Sigh. Now I know that crowded teeth are little plaque traps, and my long term “sweet tooth”self-medicating habit also made me prone to dental decay and resulting fillings. During my childhood I developed sub-optimal toothbrushing habits, fuelled by my ritualistic undiagnosed OCD behaviours. I brushed too hard (interoception differences), for too long (no sense of time) and too often (compulsive, repetitive actions made things feel “safer”). Maintaining my dental health in my early twenties felt like a waste of my low salary, as I was teaching and studying full time. I didn’t visit a dentist for many years, and carried on with my usual brushing technique. Flossing was a non-starter. I didn’t have time for that!My lagging executive functioning skills made it virtually impossible to book dental appointments. Conversely, I visited the GP frequently through adolescence and into my mid-thirties, until I was diagnosed highly anxious and autistic, and realised that my constant “cancer” scares and other issues were in fact due to health anxiety, formerly known as being a hyperchondriac. (Low dose Sertraline has eased that and my multitude of other OCD and anxiety issues.)It wasn’t until I was newly married in my late twenties that I felt compelled to initiate having my wonky teeth correctly aligned with orthodontic braces. Privately, and at great expense. My orthodontist was very empathetic, and both she and her assistant spoke with lisps and had been childhood thumb-suckers! I had found my people. The braces were tight, awkward and painful, which I oddly enjoyed. They were endlessly difficult to floss and brush though, and they led to developing near constant sores in my mouth. The overcrowding of my front lower teeth was slow yet staggering, as they all were moved back into alignment. It was a long process. But my eventual straightened teeth felt like a hard won battle that I wouldn’t let anything ruin! So, to come back to the earlier question I put to myself: Are perimenopausal neurodivergent people more likely to develop periodontal disease?I think I was susceptible to developing it due to my repetitive yet inefficient brushing behaviours. My childhood thumb-sucking stim led to the misalignment of my teeth, making it harder to eliminate plaque, thus encouraging the formation of tartar. Thanks to self-medicating my undiagnosed teenage ADHD, I was a smoker for a short while in the 90s. My periodontist agreed that dramatic orthodontic realignment (braces for my extra wonky teeth) may also have contributed to the periodontal pockets at my two front lower teeth that were the site of the gum graft.Certainly my chronic sugar habit may have disrupted my oral microbiome, and that was exacerbated by perimenopausal hormonal flux, before many other more stereotypical symptoms (i.e. hot flushes and The Rage) had shown up.I wonder if there may have been a genetic element at play? I don’t know for sure, and I probably never will…I don’t know what it is like not to be a neurodivergent person, but I think there are elements of my way of being in the world that contibuted to my long term gum health, or lack thereof. Perimenopause was effecting me at this time in ways I had not known possible. Perhaps future research will show that this is an epigenetic issue. Epigenetics means that behaviours and environmental factors affect how your genes work. In this case, where a genetic (or family history) of gum disease, alongside insufficient dental treatment and the adverse environmental factors align at perimenopause, resulting in development of periodontitis for some people. Maybe?I posed the same question to my retired dentist friend Kate, and here is her response:Me: In your professional opinion, are perimenopausal neurodivergent people more likely to develop periodontal disease? Kate: That’s a really interesting question. As a qualified, now-retired dentist — and someone who is both late-diagnosed neurodivergent and currently navigating perimenopause — it’s not something I specifically tracked in clinical practice, but I also wasn’t looking for it at the time.There isn’t yet a robust body of research directly linking neurodivergence and perimenopause to increased periodontal disease risk. But based on what we do know, my professional opinion is that the answer is indirectly, yes.Neurodivergent individuals often experience factors that can negatively impact oral health, including:• Executive dysfunction or burnout that interferes with consistent oral hygiene routines.• Sensory sensitivities that make brushing or flossing physically unpleasant.• Increased rates of anxiety or depression, which can reduce motivation or energy for self-care.• Medication side effects (e.g., from stimulants or antidepressants), especially dry mouth — a known risk factor for periodontal issues.• More intense or irregular hormonal fluctuations during perimenopause, which can heighten the inflammatory response in the gums.• Genetic links — both neurodivergence and periodontal disease susceptibility tend to run in families.• Childhood oral habits, such as thumb-sucking (more common among neurodivergent populations), that can lead to crowded teeth and make effective cleaning harder long-term.So while we don’t yet have conclusive studies to point to, it’s reasonable to suggest that the behavioural, hormonal, and genetic factors often seen in perimenopausal neurodivergent individuals could increase periodontal risk. Awareness, early intervention, and individualised support are key.— Dr Kate O’Hara, late-diagnosed neurodivergent woman, perimenopausal, qualified and retired dentist.So it wasn’t inevitable, but it seems the odds were stacked against me all along. The shame and deep despair I felt in needing the gum graft, and what I had done to let myself get into that situation were as extreme as the procedure itself. I feel like Dr. Kate has absolved me of my guilt!Post-Periodontal Disease CareFollowing my gum graft, I had several check ups with the periodontist. “It felt like I was looking after a newborn baby”, I told him. “Well, you have looked after it very well”, he replied. Post-surgical care was intense. The graft was a success and remains well attached to my gumline. I was relieved to soon be discharged back to my regular dentist and oral hygienist. I am on a frequent appointment schedule with the hygienist, around four thorough professional cleans each year. It is expensive, but I would rather invest in preventative dental care now, than have to shell out a fortune on reactive dental surgery again in the future. Either way, it will cost me money.Hypervigilance around my oral health is time consuming and emotionally draining as I would never wish to go through the procedure again. I worry endlessly about the health and stability of my gum graft as though it were my third child.Maintenance consists of twice daily interdental brushing of the gaps between all but my top front teeth, water flossing and using a pressure sensor electric toothbrush with a built-in timer with a fluoride toothpaste. The water flosser is practically a tiny water blaster for your gumline. You can’t help but feel clean after using it - as long as you are using it properly! It features in my previous post as one of The Unsexy Gadgets That Help Me Survive Perimenopause.I would love to know your thoughts on this topic! 💕 What changes have you noticed with your teeth and gums in perimenopause?💕 Do you think your neurodivergence affects your oral health and dental hygiene routine?Please let me know in the comments.Cheers,Writing this article has been a weekend’s work, and I look forward to spending more time chatting in the comments. Your donation makes it possible for me to advocate and support our autistic perimenopause community every day. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Wowee, this post I released in the perineum festive break between Christmas and New Year 2024 has now had 10k+ views, 800+ likes, 100+ comments, and 100+ restacks:I am delighted it has resonated with so many people! I am still receiving comments on the post - although annoyingly not receiving notifications for them all…Thanks to demand avoidance, I have held out months before finally recording and releasing the audio voiceover. How apt!There are loads of comments in the original post if you would like to explore this topic further, and delve into what others have already said about it! Here is a quick recap of the intro to the post:Anti-Goals are:* Intentions that we actively avoid achieving.* A tool for demand avoidant neurodivergent adults to channel their precious and limited time, energy, focus and connections away from the tasks, people and responsibilities that drain us.* Anti-establishment, anti-capitalism and anti-productivity; thus aligning with many neurodivergent people’s mindset.New Year = New You? Just Say “No”!We have time - anti-goals are definitely best set mid year! 😜Cheers,It is an honour to host this community space for people in neurodivergent menopause. I dedicate many hours each week to respond to comments from all of my fantastic readers. Paid subscriptions make my advocacy work possible. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi Team Auti Peri, My autistic perimenopause is an absolute shitshow right now. How is yours treating you? This week I have had bodily aches and last night I convinced myself to do the five minute evening yoga flow that used to be habitual. I don’t know if my body was aching because I hadn’t been doing it but, just as I was gently finishing triangle pose a muscle below my left hip absolutely wrenched itself! I couldn't breathe, whilst *trying* to breathe into it (those hypnobirthing sessions I took ten years ago are still paying off, baby! Ha ha, “baby”! Geddit?)Wincing, I hobbled all the way to the kitchen (where, alas, no soothing birthing pool and kind doula was awaiting me), grabbed the ice pack from the freezer and double dropped paracetamol. Inserted two Utrogestan (progesterone capsules) you know where, slapped my night time pump of oestrogen gel onto my arm and hoped it would soon stop hurting. Thanks to extreme HRT-defying levels of insomnia, I woke up several times in agony, struggling out of one awkward sleeping position into another. Nothing would stop it hurting, and 24 hours later it still hurts. Yes, I must have pulled a muscle, and normal injuries will occur in midlife. But I’ll be damned to believe that this agonising muscle pain isn’t distinctly down to perimenopause. Do I have evidence of this? Nope - you and I know I have no medical training whatsoever, apart from that one day first aid refresher course I took a decade ago. But, I know this is perimenopause! And I don’t know why I am still symptomatic when I am in a chemical menopausal state (it’s temporary, and reversible, much to my ongoing distress) caused by hormone blockers to alleviate my very late diagnosed premenstrual dysphoric disorder (PMDD). Alongside this treatment I am on carefully titrated hormone therapy (HRT/MHT) and things should be settled. I have never felt any less settled in my life!Fortunately I have doctors who are validating my lived experience of autistic perimenopause, and are empathising with my ongoing onslaught symptoms. I am waiting to see a public gynaecologist to have EVERYTHING removed by hysterectomy ASAP before I go completely out of my own mind. But what is it like when our doctors don’t believe us? When they dismiss our symptoms, and struggle to engage with our autistic communication? What is it like to be told by medical “experts” that, not only are you not autistic (“Or you wouldn’t be here and giving me eye contact”), but that you are “too young to be perimenopausal”. If you have heard either or both of these statements, welcome to the club. Just because they dismiss you, doesn’t mean you are wrong. Only you know what is happening in your body and mind for you at any given time. If they don’t understand that, I would recommend getting a second opinion. If that isn’t possible, you can take notes using a symptom tracker as supporting evidence. You may also wish to take along a trusted person who can advocate alongside you. Surely it’s harder for them to dispute you both? I would like to think so, anyway. Okay, so I am going to make some bold claims here. I have little to no supporting research, because there isn’t enough research into perimenopause, and the experts are still arguing amongst themselves and invalidating perimenopausal people everywhere. But I read all the time about seemingly random symptoms that occur in midlife that may be perimenopause related. Some of them may seem obscure. Perhaps they are, but those of us with interoception differences (either having heightened or reduced sensitivities in our internal states) are easily dismissed by healthcare practitioners. Speaking to you as an advocate in a peer support role, not from a medical background, I want to remind you - again - that if a doctor minimises your lived experience, it doesn't mean you are imagining these symptoms. For example, a common symptom is for menopausal people to experience brain fog. Often to the extent where we believe we are losing our minds, or in early stage dementia. This feels terrifying and shameful. We may feel like a burden to others and that our loved ones are better off without us. Please believe me when I tell you that lots of people feel this way, and I receive many comments and messages about this. It is not an uncommon experience, and it may be more widely experienced in the neurodivergent community, since many of us have been living with brain fog all our lives. At perimenopausal onset, our cognition may feel like it has dropped off a cliff. That is the inspiration for the latter part of my publication’s title: A Temporary Regression. I want to normalise this phenomenon. Oddly though, there are still doctors who say there is no empirical evidence that brain fog exists as a phenomena in perimenopause, which I frankly find ludicrous. There are many other symptoms that are more commonly experienced, but are kept on the down low due to societal taboos. Namely: low/no libido, and dry and/or atrophied vaginas and vulvas. Atrophy isn’t what it sounds like. Your skin may be sore or raw, you may have recurrent urinary tract infections (UTIs), but if you are waiting for your cervix to prolapse via your vag and descend out of your labia before you will eventually see your doctor, you are in for a horrendous time. I wrote about this a long time ago, so am re-sharing my post on vaginal atrophy in case you are interested (no OnlyFans content, I promise): We all know what the regular symptoms of peri/menopause are, right? Here is a quick refresher, with thanks to the Australasian Menopause Society (factsheet and infographic):* Changes in menstrual periods is an early symptom* Hot flushes* Night sweats* Problems sleeping* Pain in your joints* Tiredness* Anxiety or mood changes* Dry vagina* Overactive bladder or discomfortBut these stereotypical symptoms are just the tip of the iceberg. Well, maybe a better analogy would be a cliff face, with the main symptoms at the top, and the lesser known ones near the middle and bottom. If you get any or all to an extreme degree, you too may feel like you have been drop kicked off the top of the cliff, spiralling as you helplessly descend, hitting the ground hard, and feeling left for dead. I will spare you an infographic accompaniment to that gory metaphor…Delving deeper into the research 👓 we will find that around 34 symptoms are commonly stated:I haven’t found an extensive symptom checker, but more comprehensive lists are available. It is strange and unhelpful that menopause organisations list many possible symptoms, yet produce woefully short charts and trackers. Don't they know that we need thorough and comprehensive information?! Haven’t they heard of autistic perimenopause??!! No and no. So let’s keep pushing through. I hope you are still with me. Please don’t give up hope. I know of many excellent academic researchers pushing for our recognition and validation, but that is a long drawn out public dissemination process. Not to mention getting that information into policies, medical schools and primary care/GP practices. Whilst we wait for them to catch up with what we already know, we need to keep educating ourselves and staying in community. ***Hours of Googling later… If the academics don’t know this stuff, let’s not expect AI to have a clue!***The Join the dots: A-Z symptoms list is useful as the list includes a description of each of the symptoms listed. Please open the link for all the list items. There are other symptoms that are less taboo and more obscure. They crop up in midlife and we don’t realise they may be due to extreme hormonal flux. Here they are:Cold flushesScalp tinglingMetallic taste in mouthTennis elbowFrozen shoulderDry eyesBloatingBlood sugar dysregulationPhantom smellsHair loss/thinning/receding hairlineIncreased facial and bodily hair growthTinnitusBreast painBleeding gumsDental problemsBurning mouth syndromeElectric shocksBrittle nailsDizzinessHormonal acneOsteoporosisRoasaceaBody odourMelasma (darker patches of skin, usually on the face)Heart palpitationsSudden onset of phobias (e.g. driving)Body temperature dysregulationFormication (sensation of insects crawling on the skin)Weight gainHeadaches/migrainesDigestive issuesSkin tinglingSources of obscure symptoms: Uncommon Signs & Symptoms Of MenopauseWhat Are the Most Surprising Menopause Symptoms?10 surprising menopause symptomsI feel like the dyspraxic NDers amongst us 🙋‍♀️ will be all too familiar with this one already:Changes in spatial awarenessDuring the menopause, changes in the perception of depth of vision can occur, which can affect your awareness of surroundings. Your concentration can sometimes dip during this time, and your eyes can become drier. This can lead to clumsiness or being more accident prone.Source: HCA Healthcare UK 18 signs of the menopause that you might have missedNot to mention those of us who are self-identified or formally diagnosed as ADHD: Other Psychological and Behavioral ChangesConditions like obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD) have been shown to appear or worsen at menopause. Hormonal fluctuations change how your brain functions, and some women may experience:When it happens: Changes in mood and behavior can start in perimenopause.Possible symptoms include:* Impulsivity or risk-taking behavior* Heightened sense of caution or anxiety bordering on paranoia* Compulsive or repetitive behaviors (e.g., checking or cleaning)Source: Midi The Complete List of Menopause SymptomsYes, Midi, and the rest! 📋 🧠 🛑A lot of these symptoms may already be part of our neurodivergent experience of being in the world. But they may become more acute, frequent and even unbearable when our hormone levels are in extreme flux. That is one of the reasons I think we may find perimenopause absolutely horrendous. We have struggled with these symptoms throughout our lives, often with co-occuring chronic illnesses and anxiety disorders. Perimenopause depletes our resources and pushes us well beyond our limits. It may completely floor us. Urgh.Please do see your doctor if you have any of these symptoms because, although they may *just* (ha!) be due to perimenopause, it is important to primarily have other health conditions screened and eliminated. Even my husband wants you to check with your doctor if you have these symptoms, rather than just take my word for it! (Me: “Today I am writing about surprising symptoms of perimenopause.” Him: “Your readers know you aren’t a doctor, right? They should get checked over in case it is something more serious than perimenopause.”) I do take his point. And also, I take perimenopause seriously too. Plus, don’t feed our health anxiety, man! 😜As I was compiling the list above I remembered that, before we left the UK to live in Aotearoa New Zealand, I had an MRI to check the cause of constant scalp tingling. It was all clear thankfully, but five minutes ago I just turned to my husband and said that I just realised that was an early perimenopause symptom! He dismissively shook his head in despair about my ongoing obsession hyperfocus special interest passion in neurodivergent menopause and tried telling me that was a long time ago and unrelated. Thank goodness I know better, ha ha! Don’t let people dismiss you - but also please know that they will try and dismiss you. Because they are sick of hearing about it. So come and tell us all here about your strangest symptoms that may or may not be attributed to perimenopause. I know that you know that the neurodivergent version of perimenopause can really mess with our heads (scalp tingling aside). Unfortunately so many emotional and mental health issues are more likely to occur within our vulnerable community. Here is a not-fun list of anecdotal perimenopause symptoms that I would like to add from a neurodivergent perspective, based on my own experiences and those discussed within our community:* An impending sense of doom, which has been a fluctuating symptom in midlife for me. * Cognitive decline is something my readers often message me about, and is difficult to work around in late-stage capitalism.* Involuntary unmasking is often reported by autistics, since our energy and capacity are depleted in perimenopause. * Extreme brain fog, to the point of self-reported cognitive decline. * Constant. Sensory. Overload. * New onset chronic illnesses. Yay.* Emotional dysregulation to the max!* Self-care regressions (unable to cook meals, take showers, keep up with the laundry, can’t book medical appointments etc.).* Executive functioning goes to 💩* Loss of sense of self. * An inability to cope. * Intrusive thoughts, OCD flare ups.* Trauma and complex Post Traumatic Stress Disorder (CPTSD) becomes unmanageable.* A general sense of confusion and lack of previous clarity. * Vulnerable to medical dismissal. * Lonely and socially isolated. * Regression in social communication and/or “feeling more autistic”.* We can expect increased intensity and regularity of meltdowns/shutdowns. Expect the worst, hope for the best…* The Rage is all too common. * Suicidal ideation is unfortunately prevalent in autistic midlife. * Previous eating disorders may recur, or new ones begin. * Menopausal depression can be extreme, and is more likely if you have previously experienced hormonal depression. For example, during puberty, pregnancy, postpartum, following pregnancy or baby loss, premenstrual dysphoria disorder (PMDD). If you are affected by menopausal depression, this post from the archives may be of interest to you:If you are currently at risk of suicide, or of harming yourself or others, please seek immediate help. If you would like support to write an Autism Adapted Suicide Safety Plan, I will walk you through writing one in this video post:Oh look! We have reached the end. That took me ages and it was super depressing… Well folks, that’s autistic perimenopause for you! Intense AF, and we wouldn’t want it any other way! 💕It has sickened surprised me that whilst compiling this article, I still find myself piecing together all the symptoms I have had over the last few years. I hope I can have that hysterectomy soon because I can not take much more of this. When will it end? (A question for my gynaecologist.)Let me know in the comments if you have had any symptoms that I have missed off? Which of your symptoms are most surprising? I vaguely remember we started to compile a list together a while ago but no idea what I did with it, sorry…I think it may be in the Baby Koala post in the archives..? 🐨 😶‍🌫️ 🤷‍♀️Right, I have been writing this from dawn to dusk and need to go brush my poor peri teeth before my jawbones lose their density, my gums recede rapidly, and I am left here clasping a handful of my own fallen teeth. Apologies for the gross visuals I have conjured. ChatGPT would never do that to you, but I am sick of AI today so it’s all on me…I need to go to bed soon so that soon I can wake up, drink coffee, and do it all again tomorrow. Urgh, isn’t adulting just the worst?Take care of yourself. Hang in there. Surely things will start turning around for us all soon..? 🤞Cheers,It has taken me many, many painful years to experience the symptoms of perimenopause so that I can tell you all about them. Paid subscribers make it possible for me to keep writing, recording and co-regulating at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Thank you to Kristi Keller 🇨🇦, Tamu Thomas and many others for joining my live video with Allegra Chapman!Bonus! Scroll to the end of post for a gratuitous cute cat photo... 🐈 ⬇️Let's talk about creativity, rest, and why you are doing better than you think — even on the hard days.TL;DR: Rest, Creativity, and Self-Compassion* Creativity looks different for everyone, especially if you're neurodivergent, disabled, menopausal or raising kids.* You don't need to create every day. Rest is part of the creative process.* Depression, ADHD, and PDA (Pathological Demand Avoidance/Pervasive Drive for Autonomy) can make creativity feel impossible — and that's okay.* Tiny goals (like opening a document) and body doubling (working alongside someone virtually) can help.* There are seven types of rest (physical, mental, emotional, social, sensory, creative, spiritual) — and we all need different kinds at different times.* Crafting, knitting, Lego building, journaling — all of these are real creativity and real rest.* Self-care is not selfish. You are worthy of it, even when you're not producing anything.* Build a creative practice that fits your energy, your mind, and your real life — not following somebody else's rules.💕 Start where you are. Go gently. You are doing enough.So much generous advice from Allegra about the balancing act of creating and resting, whilst managing motherhood and midlife adulting in general.You can subscribe to Allegra’s Substack at The Gathering. If you would like to work with Allegra she is running her Divergent Creatives course in June 2025 and is offering a time limited discount here. 💕Notes on accessibility: Apologies again for my numerous audio and visual tech issues, I hope the video is accessible to you. Closed captions are available in video playback. There is a verbatim transcript within this post. Audio alone may be triggering to those with auditory processing sensitivities from the second half onwards, hence why I had to stick my fingers in my ears whilst talking towards the end of the conversation. I sounded like I was in a cave! I don’t like caves…Note to my husband AKA Life Admin Time: Wayne Galloway, I need a new phone! 😭 ☎️Notes on AI as an accessibility tool in this post:Our discussion was full of self-compassion to inspire you and support our creative endeavours with as little energy and capacity that may be available to us at any given time. To this end, I have asked ChatGPT to summarise the video transcripts for you, because it is beyond my limited capacity. I use AI as an accessibility tool in some of my posts to ensure I can provide information as succinctly as possible, and I always disclose this to you. I have checked that the summaries (TL;DR above, and timestamped summary below, both in block text) provided make sense and reflect the vibe of our discussion. Even using AI to summarise I have spent two hours hyperfocused on drafting this post, argh! Clear and succinct communication is not a personal strength of mine, so here AI is providing the job of a virtual assistant: The longer summary…Timestamped Summary of "Rest and Creativity" Conversation00:00 – 00:16 | Introduction* The conversation opens about the need to talk about rest and creativity.* Sam shares personal struggles with depression and physical exhaustion in neurodivergent perimenopause.00:16 – 01:00 | Self-Care When You’re Exhausted* Basic self-care (eating, meds, water) was all Sam could manage during a recent depressive episode.* Hormonal issues made it harder; could barely leave the house for two weeks.* Creativity felt impossible when functioning at the bare minimum.01:00 – 02:10 | The Difficulty of Creativity in Depression* They discuss how masking struggles — like pretending to function while struggling inside — drains energy.* Parenting makes it even harder because there's no real option to retreat fully for self-care.02:10 – 04:00 | Redefining Creativity for Neurodivergent and Disabled People* Introduction to Allegra’s Substack mission: supporting creatives who are neurodivergent, disabled, chronically ill, or raising kids.* Breaking myths: You don’t need to create every day to be a “real creative.”* Allegra advises banning the word "should." Creative practices must fit individual needs.04:00 – 06:00 | Fighting the Myth of Daily Consistency* Allegra’s personal experience: writing two books without daily word counts.* Encouragement to ignore rigid advice and find what works for you.06:00 – 08:00 | Coping with Depression in Creative Life* Depression often blocks access to all the helpful activities (nature, creativity, movement).* When depressed, just surviving is enough.* Recommend creating a "self-care toolkit" in advance (like coloring books, prompts, knitting).08:00 – 10:00 | Creative Rest and Chronic Conditions* Case study: a participant in a creative program who could only manage 15 minutes a day.* Even tiny creative actions are valuable.* Rest can be creative.10:00 – 14:00 | PDA, ADHD, and Demand Avoidance* Discussion of PDA (Pathological Demand Avoidance) and its neuro-affirming term Pervasive Drive for Autonomy.* How PDA complicates creative work, even when it's something you want to do.* Challenges with ADHD, PDA, and creative resistance.14:00 – 18:00 | Crafting, Knitting, and Self-Compassion* Knitting discussed as a low-pressure creative outlet.* Tips: start simple (e.g., knit a scarf, not socks!).* Crafting seen as valid creativity and a form of therapeutic rest.18:00 – 22:00 | The Seven Types of Rest* Based on Dr. Saundra Dalton-Smith’s work (TEDx talk), explained through a book by Tamu Thomas:* Physical Rest* Mental Rest* Emotional Rest* Social Rest* Sensory Rest* Creative Rest* Spiritual Rest* Understanding these helps tailor rest for neurodivergent and busy lives.22:00 – 26:00 | Rest as Resistance* Rest is crucial for caregivers and neurodivergent people.* Respite can be as simple as headphones in the same room.* Recognising the emotional toll of caregiving and demanding lives.26:00 – 31:00 | Accountability, Body Doubling, and Tiny Goals* Accountability is a major motivator for creative people.* Body doubling (working alongside someone else) helps maintain focus.* Set very tiny goals ("open the Word document" — that's enough!) to overcome inertia.31:00 – 36:00 | Different Tools for Different Brains* Visual cues like leaving projects lying around and visible help ADHD minds.* Flexible habits ("rituals," not rigid routines) work better for many neurodivergent creatives.* Understand yourself first — then build systems around your real needs.36:00 – 42:00 | Nonlinear Creative Processes* Bullet points, mind maps, recording yourself — all valid first steps.* Finished creative work never starts polished — allow messy beginnings.42:00 – End | Closing Thoughts* Let go of the idea there’s only one "right" creative method.* Adapt creativity around fluctuating mental health and energy.* Self-care is a right, not just a means to be more productive for others.* Discussion ends with warmth and encouragement to honor your own rhythm.If you have read this far, thank you. Here is a photo of Harry as tax, overseeing the post-editing process. Here is social proof that I am indeed putting the ADHD into “But you don’t look neurodivergent!” (By the way, nobody has ever told me I don’t look autistic or ADHD, ha ha!):Wish me luck, I am relocating my dumping ground DOOM pile writing desk to another room in the house later today! 🤞Fun fact! Did you know the “DOOM” in “DOOM pile” stands for “didn’t organise, only moved”?Look at that basket on the floor, it has my proper mic in it. Regrets, I have a few…Two coffee mugs to be found in the photo! 🦊 🦊 If you would like to buy me a coffee, I would be very grateful!Until next time! I deep dive daily into neurodivergent perimenopause and report back here to help you stay above the water. Your donations help me to keep this community afloat. 🛟 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello! I just found out that today, April 24th, is World Hormone Day! It is already getting late into the evening here in Aotearoa NZ. But better late than never. I recorded a last minute video to share with you, where I talk about my hormone replacement therapy (HRT) regimen. There is no attempt to persuade you to try it (although vaginal Ovestin cream is the best!), but more of a run through of my regimen, and I share tips I have picked up to make application and absorption as unmessy and icky as possible. My professional background is in teaching/education and not medicine, so please don’t take anything I say as medical advice. I see my role as peer support and advocacy. Please see your doctor about HRT and midlife healthcare. This video isn’t scripted so I hope it all makes sense. It was getting late here, and I am in a depressive spiral for some reason. Therefore I copied and pasted the video transcript into Claude.ai to create an easy read timestamped description for accessibility. It was so dull that I asked Claude to make it fun. It didn’t disappoint! I am sharing it below (in the block text) if the video/audio aren’t your preferred way of accessing/processing information. There are closed captions on the video and also a verbatim transcript. Please forgive the “ums” and “ahs”, my ADHD meds were wearing off and I was staving off a medication rebound. Isn’t neurodivergent midlife fun?! *sarcasm*Fun & Quirky Video Guide: Sam's Hormone Adventure! 🎢The Opening Act 🎭0:00-0:14 - Meet our hero Sam Galloway from "The Autistic Perimenopause: A Temporary Regression" 0:15-0:24 - It's World Hormone Day! 🎉 (April 24th) Cue the confetti!The Estrogel Experience 💪0:25-0:54 - Say hello to Estrogel, Sam's estradiol buddy! 0:55-1:18 - Cool trick alert! 🧙‍♀️ Pumping onto the lid for sensory-friendly application 1:19-2:04 - The arm dance! 💃 Shoulder-to-wrist application technique 2:05-2:28 - Don't rub it all in! And keep it away from co-sleeping kiddos (no accidental hormone sharing!)Testosterone Time ⚡2:29-3:06 - Meet Testogel: possibly a neurodivergent's best friend! 3:07-3:37 - The quarter pump challenge 🎯 (precision matters!) 3:38-3:57 - Outer thigh gets the goods (buttocks are also an option!) 3:58-4:25 - The 5-minute waiting game before pants come into playPatch Party 🎪4:26-4:48 - Introducing the lifesaving patches! (Literally - "better than suicidal ideation") 4:49-5:32 - Math time! 25 + 75 = 100 (because 100s aren't available anymore) 5:33-6:16 - What's in the mystery packet? A much smaller patch than you'd expect! 6:17-7:16 - The Great Patch Direction Debate 🧭 Length-wise wins to prevent splitting! 7:17-8:12 - Warm it up! Press it down! Air bubbles are the enemy!Progesterone Parade 🎪8:13-9:56 - Utrogestan enters the chat (AKA: the one Sam struggles with) 9:57-10:55 - For some lucky folks: sleep, calm, and happiness! (Not for Sam though 😅) 10:56-12:04 - Tiny capsules with options! Oral, vaginal, or... elsewhere? 🤫 12:05-12:48 - Cancer prevention > side effects (but removal is the dream!)Cream Dream Team 🌈12:49-13:22 - The grand finale: Ovestin cream! ("You need this, guys!") 13:23-14:01 - Topical means local! Less problems in places it doesn't need to be 14:02-14:46 - The schedule: nightly for a few weeks, then twice-weekly maintenance 14:47-15:19 - Surprise family interruptions! 😂 Quick goodbye as real life happens!Bonus Round 🏆Throughout - Random husband and child cameos! Keeping it real! Entire Video - Zero filter, 100% authentic hormone talk!Claude.ai has hyped me right up, ha ha! ChatGPT, eat your heart out. Right, I’d better go. I need to shower and apply all the gels, patches and pop all the pills. I hope your hormones are being kind to you today! Cheers, This week I have shared all my hard won HRT geekery and enthusiasm. Your support helps me raise awareness of autistic perimenopause and advocate for us all. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello!If you are new here, welcome to The Autistic Perimenopause: A Temporary Regression!I am Sam - a late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause.Today I am deep in the midst of neurodivergent perimenopausal misery, so let’s see if I can put words in an order that conveys anything of interest and/or that makes sense… 🤞This week I have spent one million hours researching, writing and editing this and other upcoming posts. Your support allows me to keep this community thriving. April is Premenstrual Dysphoric Disorder (PMDD) Awareness Month, as well as Autism Awareness Month. Yippee! 🎉Geopolitically, the awareness drive doesn’t seem to be hitting the mark, with those in power denying us any sort of respect or rights. But let’s pop that aside for now and imagine we are receiving the support and respect we deserve for being the differently wired legends that we know we are. 💕What is PMDD?Premenstrual dysphoric disorder is a cyclical, hormone-based disorder that impacts approximately 1 in 20 reproductive-age women who were assigned female at birth. The condition is often underdiagnosed, misdiagnosed or dismissed entirely by medical professionals, despite patient reports of debilitating anxiety, hopelessness and a variety of physical symptoms in the two weeks before menses.UIC Today: Suicidal thoughts, behaviors linked to hormone-sensitive brain disorderI know, I am sorry. As it was for me, so may it be for you: yet another co-occurring condition we can enjoy adding to the alphabet soup of diagnoses we are gaining in neurodivergent midlife. PMDD can be another great too-late explainer of why everything has been so s**t for those of us being destroyed by our menstrual cycles for decades. Yay. But contextualising past (and, in my case, current) hell is a winner, right? So, yes, PMDD is an actual “mental health disorder” and validates why many of us have felt beyond awful on a cyclical basis. Yet with no perception of time and as a lifelong time agnostic (thanks, ADHD!), it is unfortunate that tracking symptoms and noticing patterns over time is not a strength of mine. Whilst I can think back to the overflowing catalogue of times when former friends and ex partners have told me I am a “crazy b***h”, I wouldn’t pick up on that being, for example, the third week of every four week cycle. PMDD is not a hormonal imbalance. The hormone levels are not the issue, rather those of us with PMDD are neurobiologically sensitive to the fluctuations of oestrogen and progesterone levels through a normal and natural menstrual cycle. NB: I am so exhausted by PMDD and all the other midlife BS right now that I am not coping with, that I am struggling to figure out when to use the words “period”, “cycle” and “episode” in the correct context. And all this whilst my teen is sitting beside me as I write telling me about Fortnite…Here is a very short podcast episode from The International Association for Premenstrual Disorders and provides a succinct explanation of PMDD: In order for me not to provide you with the wrong information, let’s hand this over to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.I don’t know about you, but I cannot process that text right now. Therefore, full disclosure, I have asked ChatGPT to summarise this for an autistic audience in an easy-read style: ⬇️✅ To have PMDD, these things must happen:🌸 What is Premenstrual Dysphoric Disorder (PMDD)?PMDD is a serious health condition that affects some people before their period (menstrual cycle). It causes strong feelings and body changes.✅ To have PMDD, these things must happen:1. Timing of Symptoms* You must have at least 5 symptoms in the week before your period starts.* The symptoms:* Start before your period,* Get better a few days after your period starts,* Are mostly gone in the week after your period ends.2. At Least 1 Strong Feeling Symptom (Pick from this list):You must have one or more of these:* Mood swings (feeling very happy then very sad quickly)* Feeling angry or annoyed easily* Feeling very sad or hopeless* Feeling nervous, worried, or on edge3. Other Symptoms (To make a total of 5 symptoms)You also need more symptoms from this list:* Not enjoying things you usually like (e.g. friends, hobbies)* Trouble focusing or thinking* Feeling very tired or no energy* Eating a lot, or craving certain foods* Sleeping too much or not enough* Feeling overwhelmed or out of control* Body problems like:* Breast pain or swelling* Muscle or joint pain* Feeling bloated* Gaining weight4. How it Affects Your Life* The symptoms make it hard to do normal things like:* Going to school or work* Being with friends or family5. Other Health Conditions* PMDD symptoms should not just be part of another condition (like depression or anxiety), but PMDD can happen at the same time as other conditions.6. Keeping Track* Doctors should look at your symptoms for at least 2 periods in a row to be sure.7. Not Caused by Something Else* The symptoms are not caused by:* Drugs or alcohol* Medication* Another illness (like a thyroid problem)(Sam) Then I asked ChatGPT for a diagram to support the visual processors amongst us 🙋‍♀️⬇️⬇️Sam to ChatGPT:⬇️(Sam) ChatGPT could not fulfil this request, so let’s not get too worried about AI coming over here and taking our jobs and our women just yet.*** END OF CHATGPT AND AI USE IN THIS POST *** (apart from the transcript from my audio voiceover that Substack tech will hopefully write up for me later) 💕Why do I need to know if I have PMDD?Increased risk of suicidality is associated with PMDD, and that is why I want you to know about it. It is also more prevalent in the neurodivergent population, which I doubt will shock you.It is tricky, as it can take decades before we realise this chronic mental health condition affects us. I was diagnosed with it retrospectively after unwittingly undergoing the third line treatment for this little known debilitating mental health condition. Before I knew I had PMDD, I heavily masked my cyclical breakdowns, took a lot of time off work (I was a teacher in my 20s), binge ate chocolate, then manically exercised to compensate for it. I lost close friendships, stormed out of the house with no plan where to go and not knowing why I had put myself in that vulnerable position. I drove dangerously, and leaned into impulsivity. I raged and had intense meltdowns, smashing things a la Fern Brady in her autistic memoir, ‘Strong Female Character’. Whilst it is helpful to know now that I was a PMDD sufferer, I would have found greater benefit in that diagnosis decades ago. I could have planned my life accordingly. I masked to an exhausting extent, and made up for my self-destructive PMDD one-week-in-four episodes by pushing myself beyond my limits my three “good” weeks per menstrual cycle. Putting all my energy into hiding and excusing this “mental disorder” each month left me exhausted and susceptible to cyclical undiagnosed autistic burnout. So now I know that understanding myself sets me up to be more aware of potential challenges, and kinder to myself when they are genuinely insurmountable. People diagnosed with PMDD these days are able to request reasonable accommodations at school, at home and at work. In the laughably entitled podcast The Happy Menopause, interviewee and PMDD survivor, lecturer and researcher, Dr. Lynsay Matthews, states that PMDD sufferers may describe their episodes as: * spiralling* unravelling* out of control.And they may identify these patterns in line with the luteal phase (post-ovulation to your bleed, average days 14-28 of the menstrual cycle): * cyclical relationship crises (splitting up with your partner every month, losing friendships etc.)* cyclical addiction crises (patterns of alcohol or drug misuse, associated driving under the influence offences etc.)* cyclical psychosis crises (I don’t have examples of this but I am wondering about the misdiagnoses of Bipolar Disorder and/or Borderline Personality Disorder that so many menstruating autistics and ADHDers receive..?)💕Australia-based UK-trained GP with an interest in women’s hormonal health, who was interviewed on the Sexy Ageing podcast, Dr. Ceri Cashell, says:“Life’s short. You don’t know what’s around the corner, so to lose half or a quarter of your life due to these (PMDD) symptoms is horrific.”How do I know if I have PMDD?IAPMD provides an online self-screening tool that is not intended to be diagnostic, but may support you in knowing whether or not to pursue an assessment. The purpose of the self-screening tool is to help you identify whether you may have PMDD or Premenstrual Exacerbation (PME). PME, is a condition that is a worsening of symptoms of another disorder, such as generalised anxiety or major depressive disorder. It is a different condition to PMDD, but the two can be difficult to distinguish between. What a mindfuck.If you, like me, have used the oral contraceptive pill over the years, your PMDD may have been masked treated by this during that time. That can make it harder for us to know in hindsight that we have been struggling with this condition. Therefore, symptom tracking is required for an assessment and diagnosis.HOW IS PMDD DIAGNOSED?Premenstrual Dysphoric Disorder cannot currently be detected or diagnosed via a blood or saliva test. However, a blood test can rule out other conditions which would need to be managed differently to PMDD. The only way to definitively diagnose PMDD is to track the severity of your symptoms over two or more menstrual cycles.Download the IAPMD premenstrual tracking guide to identify a possible link between any symptoms you have been experiencing and your ovulation cycle.The trackable symptoms:* Felt depressed, sad, “down,”, or “blue” or felt hopeless; or felt worthless or guilty* Felt anxious, tense, “keyed up” or “on edge”* Had mood swings (i.e., suddenly feeling sad or tearful) or was sensitive to rejection or feelings were easily hurt* Felt angry, or irritable* Had less interest in usual activities (work, school, friends, hobbies)* Had difficulty concentrating* Felt lethargic, tired, or fatigued; or had lack of energy* Had increased appetite or overate; or had cravings for specific foods* Slept more, took naps, found it hard to get up when intended; or had trouble getting to sleep or staying asleep* Felt overwhelmed or unable to cope or felt out of control* Had breast tenderness, breast swelling, bloated sensation, weight gain, headache, joint or muscle pain, or other physical symptomsAt work, school, home, or in daily routine, at least one of the problems noted above caused reduction of production of efficiency At least one of the problems noted above caused avoidance of or less participation in hobbies or social activitiesAt least one of the problems noted above interfered with relationships with othersSource: IAPMD website💕PMDD and NeurodivergenceWhen I look at the lists of symptoms above I can see how they have characterised and dominated extensive periods phases of my life so far. It is hard to unpick those symptoms when they can be an unfortunate way that our co-occurring autism, ADHD, anxiety and/or depression present in our lives. But I do recall that in an earlier stage of my perimenopause, I was having multiple bad weeks on the trot, would hold out for my unpredictable period that would arrive within two or six weeks, and rejoice in that one week of bliss where my mind and body felt rejuvenated. Waiting for my period was torturous, the menstrual cramps and back pain were hideous, and the unpredictability was just cruel. Eventually my periods morphed into one long bleed that lasted months with no reprieve, and my sensory overload was unbearable. My suicidal ideation ramped up, and I was given a Mirena coil to stop the bleeding. The cessation of my bleed was an enormous relief on my depleted energy levels and my overwrought nervous system, but within a short time it became clear that I was not tolerating the constant low level progesterone release of the Mirena. Anecdotal evidence suggests that there may be a subgroup of PMDD sufferers who are progesterone sensitive, but of course the research evidence is lagging on this topic. As highly sensitive individuals, we must tread our treatment paths tentatively and reflexively. Our doctors may be highly skilled (or sometimes not), but our feedback is vital in our own healthcare. Interoceptive differences in our bodies and minds complicates this all further, in that we may feel highly sensitised or desensitised to the effects of our hormones, hormone therapy and other treatment options. It is essential that we are aware and educated on this because suicidality is rife in our community. We can just reach a point where it all gets too much, and we don’t feel we can take anymore. I know what that feels like. But I try to remind myself that, as much as I love statistics, I don’t want to become one. Perhaps that is due to my demand avoidant profile..? I often think that is the case, and it makes me more determined and impassioned to share what I can with you, for both our benefit. Recently I recorded this video to walk you through the straightforward yet emotive process of writing an autism adapted suicide safety plan:Whilst researching this topic for you, I came across Jes Fleming on Instagram who shares information on PMDD and mood. In pursuit of balance, you might like to check out her resources as she has a naturopathic slant with the perspective of healing from rather than dealing with PMDD. I love an infographic and you might enjoy this one too: 💕PMDD TreatmentsLook, friends, it is too late for me. I ain’t healing from this. I am on a heavily medicalised path because I do not have the capacity to save myself from this autistic perimenopausal ADHD brain fog PMDD hell-spiral. Please don’t tell me I just need to think more positively. So what can be done for us in PMDD following a medical treatment plan? Depending on your own information processing capacity I have two sources for you.* If you have mental clarity right now, you might like to explore this IAPMD PDF resource that covers all current PMDD treatment options, with pros and cons and differing levels of efficacy and safety. It is presented in an informative table format. * Dr Lynsay Matthews (on The Happy Menopause podcast, surely that is an oxymoron?) summarises the evidence-based clinical four treatment categories for relieving PMDD. If you are short on time and/or capacity, listen from 22:30 ish for a treatment run through. I have summarised the treatments for you below, paraphrasing from the episode. Four categories of PMDD treatment:* Anti-depressants are effective in 60% of cases (SSRIs - Fluoxetine, Paroxetine, Sertraline etc.) and can be taken only in the luteal phase (post-ovulation until onset of bleeding). Known as onset dosing.* Hormonal treatments such as hormonal birth control/contraceptives. Less effective due to individual differences. May be life changing for some, but causes suicidality in others.* Chemical menopause is a medicine (GnRH Analogues e.g. Zoladex) used to pause your menstrual cycle. Alleviates PMDD symptoms for many people giving them a break, and validates that symptoms are menstrual cycle related. Useful for people intolerant of previous treatment options. Requires add-back HRT to maintain bone density and offset cardiovascular risk. A short term option, providing relief and giving time to make a long term plan. * Bilateral salpingo-oopherectomy and total hysterectomy (surgical removal of both ovaries and uterus). Removes the source of the menstrual cycle and fluctuating hormones. Requires add-back HRT to protect from dementia, cardiovascular disease, osteoporosis. Drastic treatment option, but may be required by people facing monthly suicide attempts, self-harm. 💕Shut this s**t downI have used the first three treatments and found some relief, but I am self-advocating for a surgical menopause. Personally I can no longer cope with the unpredictability of ongoing autistic perimenopause. This week I had my first bleed since I started on hormone blockers to cause my chemical menopause, and it completely freaked me out. I immediately emailed my long suffering doctor who reassured me that this bleed was hormonal (it was preceded by debilitating menstrual cramps and a week of moderate depression) rather than a symptom of endometrial cancer as I had feared. The thought of ever bleeding again is utterly sickening to me. It triggers sensory overload and reverts me into a state of unresolved pregnancy loss trauma. Friends and family who have had hysterectomies often speak of them improving their quality of life, even when they didn’t have PMDD. Several Auti Peri Q&A interviewees have shared that their surgical menopause gave them reprieve from their auti peri symptoms, even if they didn’t yet identify as neurodivergent. Perimenopause worsens PMDD because we no longer have predictable cycles, and don’t know when the next “good week” might be. This can leave us bereft of any symptom relief, unable to make plans, feeling hyper vigilant and unsafe at all times. It can destroy our relationships. Traumatise our children. Chronically dysregulate us. Make us feel bewildered and despairing. Toxic positivity menopause messaging around this life phase is exclusive of our neurodivergent lived experiences. Positing perimenopause as being an opportunity to reinvent ourselves dismisses the horrors many of us face. I was extremely reluctant to trial a chemical menopause. When I told my HRT doctor that I had read that some people say that if we lean into perimenopause and rest, then we can emerge post-menopausally ready for anything, she soon put me straight. “Sam, from what I have observed of other patients like you, if we don’t treat this now you may feel like a shell of your former self after menopause.”My HRT doctor is now my strongest advocate for my hysterectomy, but opinions can differ between professionals. Another doctor told me, when I described my symptoms and distress that:“Sam, public gynaecology does not have time and resources for your problems". Medical opinions can feel like polar opposites, and our suffering can all too easily be gaslit and dismissed. Self-advocacy is vital. Menopausal awareness is imperative. And seeking neuroaffirming clinicians for second and third opinions is soul destroying fundamental. Bonus tip: Yes, cats can help. Please accept this gallery of my pet floofs as a non-medical therapy option. Can you spot which photos I took through a tube for effect? 🧻What’s the good news?Post-menopause can liberate us from the hormonal fluctuations that trigger PMDD episodes due to our hormone levels decreasing and eventually flatlining. This means that we can hope for an improved quality of life in our later years. However, we may experience residual trauma and psychological symptoms may have become long term behaviours beyond the menopause transition…Are you dealing with PMDD at the moment, or have done in the past? I would love to know what you have found beneficial in the comments. P.S.: Harry and Toby send their love! 🐾 🐾 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi Team Auti Peri,How are things with you? Just a short video as I am too tired to write a long form post, but I wanted to let you know that I am thinking of you. In last weekend’s post I walked you through writing an Autism Adapted Suicide Safety Plan. I would love to know if you found it helpful?As you might expect, I am still on a low after that! This video post is a little lighter, in the metaphorical sense. The downlights in the room were blinding so I filmed it lying down to pretend I don’t have enormous under-eye bags. Which is a lie.My face in fact looks like this:💼 💼👃👄Sorry, I am in a weird mood…Anyway, the notes I was supposed to be referring to in this video read as per the following (is that even grammatically correct? I am so tired): * You are the expert on yourself.* You know your own needs better than any doctor or professional.* It can take us a while to decode our internal signals, but we have to trust our guts(?).* It has taken me two days to figure out that I am feeling (mildly) depressed. The cues were 1) not leaving the house in two days, and 2) eating cheesecake directly out of the non-Tupperware tub.* Functioning labels are often rejected by the autistic community because assigning a level to our (dis)abilities will never account for our fluctuations and regressions in functioning and support need levels. * Pre-autistic perimenopause I would have considered myself to have been a “gifted” thinker in terms of my processing speed, ability to articulate myself and to manipulate many directions of thought at once. * Mid-autistic perimenopause I have regressed significantly and am continuing to do so. * Autistic and neurodivergent people are dynamic beings in a world that wants to label us and put us in boxes. Which is ironic given that the “experts” tell us we are autistic if/when we label, categorise, line up and box all the things! If you take nothing else from this video, then please hear this: You should go and have a nice lie down alone for a bit. (But maybe turn off the downlights first.) 📝 Thank you for reading! 📝 🎧Thank you for listening! 🎧 📼 Thank you for watching! 📼 🐈 🐈 Please subscribe if you like! 🐈 🐈 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Trigger warning: this post is entirely written on the topic of preventing autistic suicidality and self-harm. If you are sensitive to these topics, please take extra care of yourself. 💕Hi Team Auti Peri! Sorry for the bleak post but some of us in the community are on a real low. Naturally, this has led to us sharing cat photos in The Autistic Perimenopause chat group. We need and deserve more than just autism awareness. We need a collective social movement to prolong our lives to the same life expectancy of our non-autistic peers.This morning I watched an Autistica webinar on the topic of suicide prevention for the autistic population. Did you know that autistic women are 13 times more likely than non-autistic women to die by suicide? I didn’t, but I learnt this in the second webinar I watched. And I had previously thought that the “3x more likely” statistic was most up to date... If you are feeling suicidal, or have strong feelings and urges to self-harm, please know that you are not alone. Many of us also feel that way, and we all need to support each other through this. Hiding these feelings doesn’t help anyone, but expressing them to others and following a safety plan can save our lives. Autistics deserve to live as long, happily and healthily as anyone else, so let’s work on suicide prevention together. In this video post I will take you through the seven steps of the Autism Adapted Suicide Safety Plan (AASP) using this document developed by Newcastle University in the UK. 🎥In the previous post shared below, I outlined 10 tips to support you, with the AASP being the tenth tip:Autism Adapted Suicide Safety PlanReach out for help, and have an Autism Adapted Safety Plan (AASP) in place:The resources are suggestions to help you understand and complete the safety plan for yourself, or to support another person to complete their safety plan.Step 1 - What are my warning signs that I may start to have strong thoughts, feelings or urges to hurt myself and/or end my life? (e.g., reduced enjoyment in a strong interest, change in routine, change in patterns of sleep, eating, mood)Step 2 - What can I do to help distract myself? (e.g., engage in a particular activity or interest, a relaxation technique, or physical activity)Step 3 - People I can contact to ask for help: (e.g., family, friends, mentor, support worker). Remember to note down when people are, or are not, available (e.g., office hours).Step 4 - Professionals or agencies I can contact during a crisis: (e.g., Samaritans, Mind, A & E, Psychiatric Services). Remember to note down when people are, or are not, available (e.g., opening hours).Step 5 - What can I do to make the environment around myself safer? (e.g., throwing away things that could be used to harm yourself)Step 6 - How can other people help support me?How do I communicate distress? (e.g., I shut down, I have a meltdown)What stresses me/makes me unhappy? (e.g., loud noises, being touched, change of plan, too much information)What can help calm me/makes me happy? (e.g., a strong interest, a quiet safe place to calm down, just sitting with me, giving me my own space)How I would like you to communicate with me? (e.g., don’t ask me to look you in the eye, speak softly, use visual supports, use plain English, keep in mind that I may take what you say literally)Who I would like you to contact?Step 7 – Sharing my safety plan: It can be helpful to share your safety plan. This might be with a trusted friend or family member, health care professional, or support worker. Would you like to share your safety plan? Who would you like to share it with?Storing my safety plan: It can be helpful to think about where you will keep your safety plan so that you can easily access it if you need it (e.g., printed out, in my bag, in a ‘crisis box’, on my phone). It might also be useful to think of any prompts that could help you to remember to use your plan (e.g., having a card with the safety planning logo in it in your wallet to remind you that you have a safety plan).I really hope this video is helpful to you! Please let me know what you think in the comments. To fulfil your accessibility preferences, you can listen to the podcast episode rather than watch the video, and/or read the video transcript within this post. 🎧Please take good care of yourself. 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

This direct message from a new friend on Substack this week has provoked self-reflection on my part, as well as being a reminder of how disempowered and uncertain we can feel during the neurodivergent menopause transition:“I have people around me on polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”Why are we so opposed and opinionated? I am guilty of pushing my own agenda on others, and I went too far via text message when recently advising another friend to drop the “withdrawal method” as contraception in a casual relationship. Like me, she is perimenopausal, and I was insistent that this contraceptive method cannot be reliably effective in our life stage, when our periods are unpredictable and our ovaries are forcefully making last ditch attempts at ovulation and conception. I was freaking out on her behalf, as the thought of me getting pregnant now is terrifying. I was so impassioned and preachy telling her my opinion, but it was an unwarranted projection of my own fears. I thought I was sparing her the risk of an unwanted pregnancy, and the avoidable trauma that can go along with that. My ADHD meds had worn off for the day and my interference filter was in the bin until the next day’s dose. I was letting my special interests of hormones, fertility and women’s bodily autonomy overcome my low capacity for listening to her views. Reading that back, I see how contradictory that is and how ridiculous I was being.I have since apologised to her profusely. Info dumping my special interests on others can feel so rewarding, and the dopamine that comes with it can overwhelm me. Missing my friend’s cues and discomfort - easily done over text message - only made it worse for both of us. Women and AFABs are socialised to be talked at and hold our tongue. Autistic women (me) once up on their soapbox are hard to quieten. Our friends may not tell us to STFU at the time, but they may b***h about us behind our back, which is worse. Do you have a friend like me who tells you their opinion without stopping to listen to yours?If so, I would like to apologise on both our behalf’s, and reframe our misguided interference as an offering of love and illumination. We are trying to show you that we understand your issue, and that we have the fix you need. That we have researched both sides and formed our conclusion, so that you don’t need to waste your time and energy on it. We’ve got your back!We are not looking for a fight, but we will often defend our opinion to the end, because it was hard won. I’ve said it before and I will say it again: info dumping is my love language. It is not an ideal love language… Most people would prefer to receive flowers over a barrage of texts telling them what to do for the best with their uterus.I know it is something I need to learn to control in myself, because it is pissing everyone else off. And I will come back to it when my cognition improves after this current regression. Or not. Anyway, back to the original point: “I have people around me on the polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”💕Bodily autonomyWomen and AFABs deserve impartiality when deciding on the best way to approach managing symptoms of perimenopause. The world is polarised in every way possible, more so now than ever. Can we say anything without receiving a barrage of comments, trolls and naysayers telling us we cannot do right for doing wrong?I want to take this opportunity to say that there are many different ways of living through the inevitable, natural and unavoidable menopause transition. Yes, I am heavily medicalised, monitored and hoping to end it all as soon as possible with a total hysterectomy for the sake of my mental health. But also yes, I did once consume my newborn baby’s placenta in a smoothie after a home hypnobirth in a birthing pool in my kitchen because I then identified as a “Crunchy Mama”. But we can change our minds at any point! In fact, immediately after mooing my baby out without pain relief, I insisted on using gas and air whilst having my perineum stitched back together because I had already been through enough. 🪡Boundaries are essential when making important decisions around our own health and wellbeing. Those boundaries include telling people that you have considered all options, and have decided what feels worthwhile trialling right here, right now. Many options in women’s health treatment are reversible and temporary anyway - perhaps apart from unmedicated births after the event, and surgical menopause. Feeling empowered to make your own choices, and having them supported by trained professionals overseeing your treatment plan, is vital. Your friends offering their support rather than judgement is a nice to have. It doesn’t need to determine what you do next.We don’t have to take sidesAll good teachers, child psychiatrists and similarly esteemed professionals will should tell us that we are the experts on our children, and that they will support us, backing us up with their expertise. We are pretty good at trusting our instincts when it comes to our children’s emotional safety and best interests. Rarely do we do the same for ourselves. Please know that you are the expert on yourself, and that the trained professionals you trust and work with on your perimenopause transition need to be experts in their field, and working alongside you as a partner. Optimising your quality of life and mental health at all times is what counts. We both know that your friends love you and want what’s best for you, but they might be misguided and biased on what you actually need right now. There are options for treatment that are medicalised and non-medicalised. The term “holistic” gets a bad rap these days. In its truest sense, holistic means our body, mind, spirit - and anything else I haven’t thought of - are interconnected. That we are one being. But “holistic medicine” is considered by some to be pretty woo-woo by comparison. What comes to my mind regarding “holistic medicine" is herbs, tinctures, compounds, sage bundles and other stuff I clearly haven’t researched for this article (sorry). Yet I consider my own menopause treatment plan to be fairly holistic - in the more holistic sense of the word - incorporating hormonal replacement therapy AKA HRT (micronised progesterone capsules, oestrogen gel and patches, vaginal estrogen cream, testosterone gel), hormone blockers, SSRI, strength training, plant based eating, protein powders, creatine, weighted blankets, artificial tears, yoga nidras, Ragdoll cats x2, podcasts, writing, and cathartically yelling at people who push me too far. 🧘‍♂️Yesterday I even tried to learn how to knit. Because I am desperate, and it seemed therapeutic, yet cheaper than most therapies.… 🧶Why Hormone Replacement Therapy (HRT) has bad PRHave you heard of the Women’s Health Initiative (WHI) study that wrongfully associated HRT with over-inflated risks of significant health issues? Because if you haven’t, I wouldn’t advise you read up on it. It’s since been disproven due to problems around research methodology, participants’ ages, and the outdated types of HRT that were offered at the time. Yet the repercussions of the WHI study still affects us all today. When we ask our doctors about being prescribed HRT, their computer will flash up a warning. ‘HRT prescribing guidelines have not been updated with the current evidence about HRT which means that when GPs prescribe they are warned by their computers that certain HRT products should not be prescribed.’Balance website, Dr Louise Newson: Understanding your GP – Four reasons why some women might not be able to obtain certain types of HRTGeneral practitioners are not trained in menopause during medical school to the extent that serves us, and nor are they required to undertake any further training on the topic once practicing. (Please correct me if I am wrong.)Medical misogyny fails women and AFABs every day, with the notion that menopausal people are subjects of hysteria continuing to prevail. You don’t have to sufferThe good news is that societal messaging on menopause is turning a corner. No longer a taboo, we are beginning to openly talk about it. Although I can only speak from own viewpoint in Aotearoa NZ as a middle class, native English speaking, white cis woman.We have a lot to learn from each other, but we all need to remain open minded. For the neurodivergents amongst us, and for anyone who has experienced previous bouts of hormonal depression and emotional/mood dysregulation (during puberty, pregnancy, using hormonal contraceptives, during IVF treatment, postpartum, PMDD and so on), we are especially vulnerable to recurrent depression due to the extreme fluctuations in perimenopause. These are potentially volatile times in our emotional lives. Menopause does not exist in a social vacuum. It affects entire families, workplaces, communities and societies. You are not being selfish by asking for more support in your day to day life, by seeking treatments, nor by having high standards of your healthcare providers. If you have seen beneficial results from ashwaganda, sprint interval training and sitting in circles with other women, I am very happy for you. Had I not sought neuro-affirming healthcare from a doctor who specialises in women’s health, with an interest in neurodivergence, perimenopause, and how the two intersect, I would have succumbed to menopausal suicidal ideation several years ago. When we say we need help, help is exactly what we need. We are not the “worried well”. Nor are we attention seeking. We are asserting our right to appropriate health care and medical advice. I don’t know about yours, but my friends can’t offer me impartial medical advice, or monitor my responses to different types of treatments that may or may not alleviate my psychiatric symptoms caused by fluctuating hormones. Nor can they refer me to specialists as and when necessary. HRT buffers hormonal fluctuations - it does not “replace” themThat’s why in many parts of the world, the term Menopause Hormone Therapy (MHT) is preferred over HRT. HRT/MHT provides a buffer to protect you against the effects of hormone fluctuations which may affect you in different ways: mood, sleep, libido, body pain, palpitations, brain fog/cognition, memory recall, focus, vaginal atrophy, metabolic regulation (I’m still holding out for this to work for me…), tolerance of your family, capacity to remain in employment etc. HRT is not a superficial “nice to have” pseudoscientific therapy. It won’t plump up your lips (neither facial nor vulval), nor remove your crow’s feet. But it might stop vaginal atrophy progressing whilst you use other treatments to alleviate symptoms, and it might support your sleep if insomnia is part of your peri symptom mix. It could also stop your hair falling out and support new growth (on your head, I am afraid it hasn’t reversed my balding mons pubis, nor reduced the thickening of midlife onset whiskers erupting from my chin, neck and right breast). HRT doesn’t come without risks to some people, but the delicate matter of balancing your individual risk versus potential health benefits is a matter for you to weigh up and decide with your trusted doctor, and not with Janet down the local pub over the second bottle of Prosecco. Australasian Menopause Society* What is HRT/MHT and is it safe? * Risks and Benefits of MHTHRT is but one tool in the toolbox of menopause survival aids, and it is unlikely to maximise your overall wellbeing without careful titration over time.There are other lifestyle changes that can potentially alleviate your symptoms in perimenopause, but some of us need HRT to buffer the fluctuations in order to have increased energy needed to later make those changes. Who wants to do a power-based heavy lifting weight session a la Dr Stacy Sims when they’ve had no sleep for three months? To try HRT or not?There are myriad treatments to support people experiencing adverse symptoms in perimenopause. Looking at our needs holistically (i.e. as a whole) can be more beneficial than assuming holistic support is “natural”, and that HRT is not. Then picking a side and fighting to the death. HRT/MHT uses bioidentical or body-identical hormones extracted in laboratories that are the closest match to those produced in our ovaries, adrenal glands, brains and perhaps in other places that I am too tired to fact check…‘Bioidentical or ‘body-identical’ hormone therapies are terms which can be applied to pharmaceutical-registered MHT products where the hormones have the same chemical structure as those produced in the human body.Australasian Menopause Society fact sheet: Bioidentical Hormone TherapyDr Jen Gunter offers an alternative take on the terms here, so I am sharing this article for balance:When you consider that hormonal symptoms of the menopause transition may respond best to hormonal treatments because they get to the root cause, they are worth looking into. Particularly when those symptoms are preventing you from functioning, relating to others, and you have tried other alternatives. If you try HRT and you don’t respond well to it or feel any symptom alleviation after careful titration overseen by your doctor, then you can simply stop using it (under medical guidance). Breast cancer and HRTIf you are a breast cancer survivor and are in perimenopause, you can discuss the use of HRT with your medical team including your oncologist, endocrinologist and so on. Hormone receptive-positive breast cancers may prevent you from being able to use HRT to reduce your risk of recurrence. But you should still be able to discuss alternatives, since you have already suffered enough and may be in a chemical menopausal state using hormone blockers. 💕When I recently asked a friend, who is both a practicing psychiatrist and a breast cancer survivor, she advised: It depends whether they have had hormone positive breast cancer. If hormone positive, HRT is a no. There could be dormant cancer cells in the body that start growing if fed by HRT. If hormone negative like triple negative breast cancer then HRT might be okay. Best they discuss with their GP or oncologist if they are still seeing one.I hope that this is researched more so that breast cancer survivors have more options to manage sudden onset menopausal symptoms. How best to decide?In summary, hormonal fluctuations affect different people in different ways. Whilst everyone is busy bickering over what is best, people in autistic perimenopause continue to be more likely to die from suicide than non-autistics . Your quality of life is paramount at all times; what do you need to do to optimise it right now? Everyone wants to help you, but nobody has all the information. Our symptoms will not be static during this prolonged transitional life phase.You do not have to suffer from unmanageable symptoms alone. Remember that, whilst menopause is not a disease, it can cause extreme and intolerable symptoms. Treatments are available and trialling something to target troublesome symptoms may make you feel more in control, which is important. Find a doctor you can trust to explore different options best suited for your symptom management. HRT health risks need to be discussed with your doctor because your medical history is what matters. Hormonal therapies may best target the root cause of your hormonal symptoms. And finally, this won’t last forever - TFFT. Thanks for reading The Autistic Perimenopause: A Temporary Regression. If you become a paid subscriber, you’re paying me because you value what I publish here and my work in general, benefit from my work, and you want to support me and my writing and research. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Have you heard of the Blue Zones? Before I was obsessed with autistic perimenopause (hard to believe there was such a time, I know), my special interest was longevity research findings and healthy lifestyle advice. National Geographic explorer and researcher, Dan Buettner, shares the optimal lifestyle principles believed to be responsible for extending the healthspans and lifespans of the oldest living human communities on Earth, in the idealistic Netflix documentary series: Live to 100: Secrets of the Blue Zones.Where on Earth are the Blue Zones?* Loma Linda, California, USA* The Nicoya Peninsula, Costa Rica* Nuoro Province, Sardinia* Icaria, Greece* Okinawa, JapanSome definitionsBlue Zones: regions of the world with the highest number of centenarians (people living to 100 and beyond) that Dan Buettner marked in blue on a world map, thus coining the term. With information galore to be gleaned and implemented from Dan’s New York Times bestselling books, countless podcast interviews, and now a Netflix series, we have no excuse to check out of this world early, right?Power 9: 9 commonalities found across the Blue Zones, that are thought to be lifestyle behaviours that can lead to a long lifespan, and healthspan.Lifespan: the length of time someone is alive. Healthspan: the length of time someone is free of dementia, chronic disease and/or disability, living with a good quality of life (which is highly subjective…)Mental health span: the length of time someone is free from significant mental health issues (including chronic stress, emotional dysregulation, depressive episodes), and able to function, cope and thrive despite life’s challenges. 🗺️I found Dan Buettner’s Blue Zones concept sexy long before it was well known in the mainstream. I even had a diagram of the Blue Zones Power 9 stuck to my fridge because knowledge is power sexy. But now that practically everyone is talking about the Blue Zones, I am no longer interested.Story of my life. The same thing happened when The Mighty Boosh got their third TV series onwards. The original BBC radio series was when it peaked!Not to mention when the now Taskmaster superstar Greg Davies’ incredible live sketch comedy trio, We Are Klang*, was scripted into a TV sitcom. Urgh, mainstream media. Yawn. They just lost all their appeal to me. I want to be the only person who knows something, and I want to be the one boring everyone else to death with it. If people then like it and quote it back at me, I’m out. But I know I shouldn’t be selfish with my longevity research special interest. We all want to grow old together beyond the midlife (ish) shitshow that is neurodivergent menopause. So many people rave about life improving for us post-menopause!Personally, I can not imagine feeling any worse than I currently do in autistic perimenopause, but I am trying to hang in there…A question I often ask myself is, if neurodivergent people could reverse engineer longevity to live in Blue Zones style conditions, could we all become centenarians?* You may find this YouTube clip highly offensive, in which case I can only apologise! It aligns with my vulgar British sense of humour… ☕️🗞️ This just in! 📰Blue Zones researchers report that…🙌 … Science Confirms: Coffee Can Add Years to Your Life 🙌☕️But what about us?Being late diagnosed neurodivergent can feel akin to being beaten up and left for dead. Yes, a diagnosis may feel validating and reassuring, putting our struggles to date into context. But rarely does it come with a plan or model to follow up with strategies intended to optimise our lives going forward. We may feel bereft of the person we could have become, had we benefited from the right accommodations and acceptance from others earlier in life, and from society at large. Where is the newly diagnosed neurodivergent’s manual we need to pick us up and guide us through midlife, and beyond? Sadly, academics are still at the research stage that tells us what we all already know: that The Lost Generation of Neurodivergent People (you and I) are at risk of poor mental health outcomes, chronic disabilities and untreated co-occuring conditions. Give it another twenty years, and we might know what to do about it. Research into the life expectancy of autistic people in the UKDr Judith Brown, Head of Evidence and Research at the National Autistic Society, said: “Autistic people continue to face unacceptable inequalities through a lack of understanding, barriers to vital services and inadequate care, which lead to poorer mental and physical health outcomes.“Without investment, improved understanding, inclusion and the correct level of support and care, autistic people will continue to see reduced life expectancy, with the most at-risk group in this study being autistic women with learning disabilities. This research should be a wake-up call for Government, the NHS, healthcare professionals and society as a whole that we must tackle the health inequality autistic people face.”University College London (UCL) News: ‘Premature death of autistic people in the UK investigated for the first time’, published online 24 November 2023It is bleak. Neurodivergent people often have a much shorter mental healthspan than the average population. I can’t think of a single year out of my 43 and counting that I haven’t grappled with mental health struggles that retrospectively co-occured alongside my undiagnosed neurodivergence. Fun fact: At birth, I weighed 8lb 7oz, and was already 9 months into a chronic existential crisis…What can really skew lifespan data is premature death by suicide. A shorter mental healthspan may cause the most vulnerable and least supported amongst us to have a preventably shortened lifespan. Risk factors for suicide in autistic peopleMental health challenges can increase the risk of someone taking their own life. About 8 in 10 autistic people will experience a mental health problem during their life. This compares to 1 in 4 people in the general population having a mental health problem at some point in their life.Some research suggests co-occurring ADHD can increase the risk of suicidality in autistic people. One study found possible explanations for this include increased depression, people feeling they are being perceived as a burden, and impulsivity (a key feature of ADHD) meaning people are more likely to be exposed to ‘painful and provocative’ life events.Gender diversity can increase the risk of suicidal acts. Autistic people are more likely to be gender diverse than non-autistic people.Autistica website, ‘Suicide and Autism’So, with all odds stacked against us, how can we reverse engineer longevity within the neurodivergent population? The Blue Zones Power 9! *mic drop**Picks mic back up* Don’t worry, guys! Dan and his Blue Zones have us covered! Let’s take each Blue Zones principle in turn and see how it fits into neurodivergent life. We need all the help we can get, afterall! But first, a message from Blue Zones’ own Dan Buettner (with all following italicised block quote text taken directly from the original research paper, Blue Zones Lessons From the World’s Longest Lived): “To make it to age 100, it seems that a person must have to win the genetic lottery. However, many individuals have the capacity to make it well into the early 90s and largely without chronic disease. Blue Zones uncovered 9 evidence-based common denominators among the world’s centenarians that are believed to slow this aging process.”1) Move naturallyThe world’s longest-lived people do not pump iron, run marathons, or join gyms. Instead, they live in environments that constantly nudge them into moving without thinking about it. They grow gardens and do not have mechanical conveniences for house and yard work.We are starting off with a banger, because I know that I move very unnaturally, and people have never hesitated to give me such feedback. As a child, I struggled with proximity to others. Observing what other people did with their hands was my mission as a teen, especially to figure out what they do with them when dancing… By midlife, I have had countless injuries from tripping up when running, smashing my hands and stubbing my toes when misjudging my motion through space. When autistics and ADHDers move naturally and stim, we are often discouraged from doing so. It looks weird, right? All that flapping, spinning, swinging and rocking makes the poor normies feel uncomfortable around us. Movement and exercise are sensitive topics for me, as I have a tendency to exercise compulsively, or not at all. No environment could nudge me into motion constantly without thinking about it. Nothing. As I was writing the introduction to this post yesterday we had a “light earthquake” with a local epicentre that measured 4.4 magnitude. Did I move? No. The fact that I live in a tsunami zone on the west coast of Aotearoa New Zealand is alarming (see what I did there?), because my reaction time to everything is exceptionally slow. Suggesting that I have my “mechanical conveniences” taken away so that I need to wash, rinse and wring my family’s laundry by hand is ludicrous. We would be forced to become naturists. And yes, I jumped on the kitchen garden bandwagon like many others during Covid lockdowns. But that’s all dead now, and, if I don’t start moving naturally soon, perhaps I will be too. 2) Know your purposeThe Okinawans call it Ikigai and the Nicoyans call it plan de vida; for both, it translates to “why I wake up in the morning.” Knowing your sense of purpose is worth up to 7 years of extra life expectancy.Ha ha, is this one a joke? I have only just discovered my own neurodivergence and everything I thought to be true is lies. I don’t know who I am, or why I am. And I am supposed to have it all figured out? I wake up in the morning because it’s what I do every day, not because I want to. But if I know why I wake up I get to do it for seven extra years? That sounds exhausting. Dan Buettner said on the Zoe podcast that those of us who don’t have a purpose in life are living “rudderless lives”, and I quite like the idea of that. Isn’t it poetic? Whilst everyone else is willingly in the ratrace, we often burnout and have to recover from utter exhaustion. Often whilst carefully titrating psychiatric pharmaceuticals to balance our differently wired brains, and sticking to our suicide safety plans. Meanwhile we have to keep providing snacks, plastering on a false smile and acting like we know our purpose. Anyone who isn’t trying to survive debilitating bouts of hormonal depression must have so much more time on their hands than I do!3) Down shiftEven people in the Blue Zones experience stress. Stress leads to chronic inflammation, associated with every major age-related disease. What the world’s longest-lived people have that others do not are routines to shed that stress. Okinawans take a few moments each day to remember their ancestors; Adventists pray; Ikarians take a nap; and Sardinians do happy hour.This is nice, isn’t it? Such a lovely idea. I don’t do many of those things and, as an PDAuDHDer (persistent drive for autonomous autistic with co-occuring attention deficit hyperactive disorder), I actively resist routines. I don’t like being told what to do, Dan. And in itself that is extremely stressful. The idea of a “Happy Hour” not being stressful is opposing to my reality. All those fake smiles, clinking glasses, trying to follow someone’s inane small talk with competing background noise? I think that would definitely become a daily “Unhappy Hour” for me, and I would be forced into social hangover mode shrivelled up in enforced isolation in a sensory deprivation tank for the following 23 hours before the next social onslaught Happy Hour. So I am wondering if autistic episodes of dissociation can count as a down shift? They are certainly a necessary relief from my alternative state of chronic hypervigilence. Sensory processing differences co-occur in many neurodivergent people. Feeling constantly under attack from every day sounds, smells, light levels, crowds, textures and clothes tags is overwhelming. A societal level down shift would be nice, where people could all just agree to stop talking and doing stuff near me regularly and for extended periods of time. Preferably forever. I think if I could be alone doing what I want to do at all times with no friction or conflict, I could significantly reduce my stress levels. How do I arrange this? 4) 80% rule"Hara hachi bu”—the Okinawan 2500-year old Confucian mantra said before meals reminds them to stop eating when their stomachs are 80% full. The 20% gap between not being hungry and feeling full could be the difference between losing weight or gaining it. People in the Blue Zones eat their smallest meal in the late afternoon or early evening, and then, they do not eat any more the rest of the day.This is like voodoo. How does anyone have a level of interoception so astute whereby they can determine the capacity of their stomach at any given time? Witchcraft. Don’t get me wrong, I would love to have this awareness. I can only tell if I am hungry retrospectively by getting snarky at people, then eating an emergency snack and apologising profusely. Three times a day. When I eat a meal, I eat until I feel like I may soon explode. Then eat a little lot more on top. Three times a day. Rather than, during the meal, contemplating what level of fullness my belly is at, after a meal, I contemplate what level of discomfort I am prepared to tolerate before taking reflux meds. 5) Plant slantBeans, including fava, black, soy, and lentils, are the cornerstone of most centenarian diets. Meat—mostly pork—is eaten on average only 5 times per month. Serving sizes are 3 to 4 oz, about the size of a deck of cards.Several things come to mind with Plant Slant. * The person who came up with the name of this principle was surely neurodivergent, and I love them for it. I like to imagine them cackling about it as they announced “Plant Slant!” too loudly in the research room, laughing until their stomach hurt (laughing alone, obviously, because this wouldn’t amuse a normie), then giving themselves the rest of the day off as a reward for such an epic contribution to science!* Blue Zones is often reduced down to recommending a Mediterranean style diet. If that is of interest to you, and you would appreciate an alternative perspective than this over hyped eating plan, I would recommend reading The Mediterranean Diet is a Whitewashed Fantasy, by Anjali Prasertong at Antiracist Dietitian (who wrote on Substack until February 2024). * Eating issues and disorders are common for neurodivergent people, including avoidant/restrictive food intake disorder (ARFID). Disordered and restricted eating patterns may start or flare up again for people during the menopause transition. * Additionally, many of us have co-occuring unresolved chronic gastrointestinal issues, and beans may not be friendly to our digestive systems. * For the many autistics who prefer a six pack of chicken nuggets over a five bean chilli, there can be so much guilt and shame around consuming our safe foods. So much so that we will eat them in secret. This is unfair on us. We should be able to freely enjoy the foods we love as much as anyone else. 6) Wine at 5People in all Blue Zones (except Adventists) drink alcohol moderately and regularly. Moderate drinkers outlive nondrinkers. The trick is to drink 1 to 2 glasses per day (preferably Sardinian Cannonau wine), with friends and/or with food. And no, you cannot save up all week and have 14 drinks on Saturday.This may turn into a therapy session for me but - actually I don’t even know where to begin…Alright, I grew up in London in the 1980s and 90s just as ladette culture was upwardly trending along with my teenage alcohol consumption. And I wasn’t drinking alone, we were all doing it. By 13 I was certainly a moderate drinker - and, seeing as I got started early, is that going to enhance my later life chances? By late teens and all through my twenties I was a heavy regular binge drinker. A very heavy drinker, but at least I had quit smoking by 15 and never took it up again. Watching my Dad die in an NHS respiratory ward last year will be enough to put me off ever restarting, and so I refuse to touch a vape. Thirties and now in my early-mid forties, I no longer drink alcohol (except the trace levels in kombucha, and consumed in fruit that has overripened to the point of fermentation in my fruit bowl). Honestly, I drank enough to never need nor want to drink again. I can not tolerate it anymore. Perimenopause has already ruined my cognition, I don’t want to impair it any further. Although I totally understand why others may enjoy reaching for a Wine at 5. Unfortunately around 5pm daily, my ADHD stimulant medications are wearing off, and it’s too late in the day for me to tolerate caffeine. So I get pretty grumpy and whiny. May I thus propose instead that the non-drinkers amongst us have a good old Whine at 5?7) Family firstSuccessful centenarians in the Blue Zones put their families first. This means keeping aging parents and grandparents nearby or in the home (it lowers disease and mortality rates of children in the home too.). They commit to a life partner (which can add up to 3 years of life expectancy) and invest in their children with time and love. (They’ll be more likely to care for aging parents when the time comes.)This is great, assuming they haven’t already disowned us for being the “weird” ones in the family! There is also the small issue of intergenerational trauma that runs through many neurodivergent families, including for those of who have consciously decided to break the shame cycle. There is still so much entrenched resentment, shame and rejection going back through our family lines that it can impact our day to day familial functioning. There are higher than average divorce rates for ADHDers, so many of us can kiss goodbye to those love-filled three additional years of life. And I wonder how that affects those people who were once adored and become widowed. Blue Zones puts a huge emphasis on intergenerational living arrangements, yet nuclear families are dominant in many of the places we live outside the Blue Zones. Thank you, late stage capitalism! 🫶Modern life perpetuates an enormous societal emphasis on hyper-independence as the goal for all, which is detrimental to many neurodivergent adults and children. As my hormone levels fluctuate catastrophically in autistic perimenopause, so too does my cognitive capacity, my energy levels, my tolerance for others, and my suicidality risk. I have been fortunate to rely upon family and friends when I have been at my most hormonally incapacitated, but not everyone feels safe enough to identify their support needs, nor to express them to others. If we can’t safely unmask around family, who can we unmask around?8) BelongAll but 5 of the 263 centenarians interviewed belonged to some faith-based community. Denomination does not seem to matter. Research shows that attending faith-based services 4 times per month will add 4 to 14 years of life expectancy.As a child raised London Irish Catholic, now vehemently rejecting that institution, I will need to be sensitive to others’ beliefs here (which isn’t my forte)…It is lovely for people who feel they belong to a faith group, regardless of what that faith may be. If it brings you joy, I am sincerely very happy for you. For those of us without religious faith, we can still congregate in groups. We have our conventions (Star Wars, gaming, board games etc.), music festivals (Glastonbury, I love you!), LEGO shows, model railway exhibitions and so on. I am trying so hard and failing to think beyond the autistic stereotypes here, but what I am trying to say is that our people are out there, if we know where to find them!9) Right tribeThe world’s longest lived people chose—or were born into—social circles that supported healthy behaviors, Okinawans created moais—groups of 5 friends that committed to each other for life. Research from the Framingham Studies shows that smoking, obesity, happiness, and even loneliness are contagious. So the social networks of long-lived people have favorably shaped their health behaviors.Shock horror! Neurodivergent people may not be born into social circles that support healthy behaviours! Some of us may spend decades developing complex post traumatic stress disorder (c-PTSD) alongside our missed neurodivergence, followed by decades spent unravelling our c-PTSD alongside processing our late identified neurodivergence. Yay!Megan Anna Neff writes here about the all too common intersection of trauma and autism.But we are not alone! The Lost Generation of Neurodivergents are finally getting our recognition, and we are thriving coping online together. Our NeuroTribes are where it’s at! (R.I.P. Steve Silberman.)If we can avoid catching smoking habits, obesity, happiness and loneliness from each other, we can maybe all suffer live to see 100! Although, 5 people in a Moai? At best, my maximum capacity when communicating effectively with others is on a one to one basis. Even then, I talk over them, or go silent; crack jokes they don’t get, then laugh alone hysterically for protracted periods; don’t know how to end a conversation; and can not infer when I have outstayed my welcome. I can not imagine being stuck in a group of 5 people until I am 100. So much social awkwardness and for so long? I’m out!Are you thinking what I’m thinking?Yes, Blue Zones is a sexy concept! The Netflix series is a great watch and Dan Buettner is doing great work in the world reverse engineering longevity in select communities. Oh to be in a Blue Zone. All those naps we could be taking, the plant slant *sniggers*, all the coffees… Sigh. Yet in reality this world is declining into climate catastrophe and political warfare, so the prospect of living to 100 outside of the idyllic Blue Zones is terrifying. But if the old good people of the Blue Zones are willing to adopt us all as refugees whilst our rights to disability state supports as neurodivergents are being removed in a worldwide domino effect, I am keen to sign up! 100 years though? That’s a long life and I am not sure I want to live forever in this dystopian moral drain. I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. I have spent a decade processing this information, and two days writing, editing, overcoming imposter syndrome and, eventually, publishing this particular article 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi, I’m Sam (she/her). A late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression AKA The Auti Peri.I am delighted to be the host of The Auti Peri Q&A Series! In this series, I host a Q&A interview with a fellow autistic person about their experience of the menopause transition.💕 Thank you for reading The Autistic Perimenopause! 💕If my work is valuable to you and you can afford to, please consider upgrading to a paid subscription.Annual paid subscriptions cost US $46.60/ NZ $80/UK £35.90 (ish) per year.Monthly paid subscriptions cost US $4.66/NZ $8/UK £3.59 (ish) per month. YAY! This is the tenth Auti Peri Q&A interview! 🎉Thanks so much to all my awesome previous guests! Here are their insightful Q&A interviews: Autistic Ang, Tamsin Chennell, Allegra Chapman, Julie M Green, Nicola Bal, Elly Marie, Jen deHaan and Patrice Riley.There are lots more fantastic Q&A guests to come! If you would like to be featured as part of this Q&A series, please message me. I’d love to share your story!Today I am putting myself in the hot seat and sharing my own responses to The Auti Peri Q&A - Sam Galloway - creator of The Autistic Perimenopause: A Temporary Regression. Originally from London in the UK, I currently live on the Kāpiti Coast of Aotearoa New Zealand with my husband, our two kids and two ragdoll cats. Harry is pictured with me below, the divine feline that he is! 😻Grab a cuppa, put your feet up and have a read. As you may expect, I have a lot to say on this subject! But I will try not to take up too much of your time… 🤞🎧What does “autistic perimenopause” mean to you?In my personal experience, symptoms of the menopause transition have been very extreme. They began at an earlier age (mid 30s) for me compared to the average, which isn’t uncommon for autistic people. I don’t know why some autistic people may start perimenopause younger than non-autistics. Some autistics are hypersensitive to internal changes, including the effects of hormonal fluctuations on our body and mind. We also may be aware of their effect sooner, before they become more frequent/severe. Changes can be unbearable and adversely affect my functioning and capacity to cope with everyday demands. Until I had a Mirena inserted, my sensory overload was increased in perimenopause with random menstrual and back pain, headaches, joint pain, skin dryness, dry eyes, spontaneous bleeding, and general unpredictability around my health, mood and wellbeing. Fortunately my experience of severely debilitating symptoms in my menopause transition is not the case for all autistics.Up until midlife, I was mostly able to channel my energy and intellect into socially masking and compensating for my constant, numerous challenges. When autistic perimenopause started, everything fell apart. I had masked so well and for so long that I had no idea I was even autistic before perimenopause began. I had always had a general inkling that I was different from everyone else, but for no discernible reason. The gap between my peers and I widened when life as I knew it became unbearable in the early stages of my autistic perimenopause. I was so emotionally and sensorially dysregulated, that it became impossible - and undesirable - to continue masking. As is the case for many late diagnosed females, seeking diagnostic assessments for our own children in this life phase is often the catalyst for self-diagnosing our own neurodivergence. I happened upon signs of female autism after researching the topic regarding my kids, and saw how it made sense of my own life until that point. So midlife is often extremely complex for neurodivergent women.Many consider it liberating, but I am not yet at that point.The shame and confusion caused by our unconscious and involuntary masking can present with increased meltdowns, shutdowns and regression in our communication and skills. Imagine brain fog, but instead of wondering why you walked into the room, you may wonder why you exist in this realm, and why you have had to evade social rejection your entire life. Imagine a hot flush, but instead of unbearable sweating and discomfort, you become hysterical and no longer want to be inside your own skin. Imagine not knowing why you feel the way you do, but instead of seeing your own GP and starting HRT, you are referred to adult mental health and think you are losing your mind. Mental health services do not necessarily comprehend the link between neurodivergence, mental health and hormones, so many end up misdiagnosed and given psychiatric drugs and therapies that do not improve symptoms. Hormonal mood issues require hormonal treatment (HRT/MHT), as the root cause needs to be addressed before symptoms can be alleviated.When we don’t understand ourselves, and doctors don’t understand autism or menopause, we are unsupported and may feel hopeless. The risk of death by suicide is three times higher in autistic women than in non-autistic women in midlife. This should be a known crisis point. Although we are at the very early stages of academic research into autistic perimenopause, I believe that severe menopausal depression should necessitate an autism assessment, since the link between neurodivergent suicidality and fluctuations in reproductive hormones is so strong. It is an enormous disservice to autistic women that there are major data voids in autistic perimenopause, and also that there is not enough specialised (or any?) support for us. Medical systems are patriarchal, misogynistic and ableist. It is frightening to be going through this transition with no emotional or practical support.When did your autistic perimenopause symptoms start and what were/are they?My first symptom was dry eyes. I had recently emigrated to Aotearoa New Zealand from the UK and was unsure whether it was hayfever from the new-to-me native Kiwi flora pollen. It didn’t feel like hayfever though; instead my eyes were burning and felt sunburnt. My two homeschooled sons were under 5 at the time, and I had to drive them to activities every day. In agony, I regularly had to pull the car over and would cry tearlessly several times a day. The optician reassured me that it was nothing sinister, but when it continued with repeated regular application of over the counter lubricating eye drops, I had a private referral to an eye specialist.As homeschooling mothers often do, I have to take both children along with me to all my medical appointments. When I eventually saw an eye specialist she told me, “I am not calling you old, because I am the same age as you, but this is because of your age”. This was the first occasion where perimenopause was missed, and all because I was 37 - too young to be “menopausal”, surely? INow I despair when I reflect back on that time. This was only around 2018, and both a medical specialist and I had no idea that perimenopause could start in our mid-late thirties. How many women my age had been referred to her and been told “it’s because of your age” without being told that it is actually a symptom of fluctuating/low oestrogen?The most we are told about dryness as a symptom in perimenopause and menopause is about dry vaginas! Dry eyes are not an uncommon perimenopausal symptom, yet continued medical misogyny and unintentional gaslighting fails to give us the proper diagnoses in midlife, or when nearing midlife.Women are often socialised to be so frightened to admit their age to others. Perhaps the eye specialist may have felt that she was bravely broaching the social taboo of menopause whilst sparing my feelings and pride? When I think back to what might have been, I wish I had been empowered and informed by instead being told “this is a common symptom of perimenopause, and hormonal symptoms require hormonal treatments”. Eye drops are great, and I have to still use them constantly, it is practically a stim these days! But what I needed was an oestrogen buffer from that point in my life onwards, as that could have been preventative of developing other uncomfortable symptoms as a result of perimenopause.Dry eyes was a distressing and disconcerting symptom, and is one I continue to have despite HRT. It is a cause of, and can result from, chronic sensory overload. This was not helped by the life changes resulting from uprooting across the world with my husband and kids. All the societal expectations of being a woman “managing” a household whilst appearing willing and grateful were too much for me when my capacity was already so drastically reduced by fluctuating hormones, and continuing to spiral.As my little boys were growing up, I noticed their neurodivergent traits. Whilst researching this, I happened across a YouTube video presentation by Professor Tony Attwood into the female presentation of autism, and totally related to everything. I immediately self-diagnosed. I was privately diagnosed autistic and then ADHD before my fortieth birthday, and before either of my children had reached the top of the public mental health waiting list. Late-diagnosed autism is increasingly common as The Lost Generation of female autistics are slowly becoming identified later in life. In midlife, our masks are impossible to maintain, our basic self-care skills may regress and we have very limited energy. This can lead to increased sensory meltdowns, emotional dysregulation and episodes of The Rage. Our regressions can be mistaken for general burnout, but autistic burnout and autistic perimenopause are wholly different beasts. I know I repeat it a lot, but autistic women are three times more likely than non-autistics to die from suicide in our midlife years. Appropriate support and health care are essential, but services are uninformed and lacking skills in working with autistic women.It was at the time of my neurodivergent uncovering that I needed a periodontal gum graft, which was a harrowing experience given my extreme and pre-medicated anxiety at that time, with a long recovery. My periods soon began to get closer together, spontaneous and heavy. They quickly became one long permanent bleed, which caused immense sensory overload and daily distress. This chronic bleed was accompanied by constant lower back pain and cramping, as well as low iron levels and absolute exhaustion. Eventually I ended up having a Mirena inserted when having a check up with a gynaecologist. This was fantastic and my bleeding immediately stopped, and with it went my pain and constant sensory overwhelm. I am quite worried about pain that will accompany the removal of the Mirena in the future, but perhaps I will end up having a hysterectomy to put an end to all of this in the meantime. (Update: Mirena removed, and I remain on the public gynaecology list to discuss the prospect of a hysterectomy…)I have had countless multiple system symptom clusters throughout my perimenopause to date: all over body rashes, hairline recession and thinning, increased facial hair, bladder stress incontinence, exhaustion, anxiety and panic, hot flushes, extreme bloating and constant eating, too fatigued to exercise, lack of libido, constant sweating and body odour, palpitations, tinnitus, muscle and joint pain, frequent injuries, intrusive thoughts and suicidal ideation.My functioning regressed to a very debilitating extreme, where I was immobilised by fatigue and complete lack of motivation or initiative. Brain fog and word finding problems made my autistic communication issues even harder, so asking for help was challenged. It seemed the more help I needed, the more unobtainable it was.I have also discussed my symptom progression in this podcast episode. What happened if/when you presented with autistic perimenopause to a healthcare professional?My GP is great - he job shares with his wife and so I have the option of seeing a male or female GP. I usually see him because he has experience working in psychiatry which is invaluable in supporting me to manage and titrate my ADHD stimulant medication. Not to mention empathising professionally with my lifelong anxiety. I had spoken to both the GPs briefly about my perimenopause symptoms but they did not have experience in this. I had had a recent ultrasound scan to follow up on my bleeding issues and the female doctor said, “No, you can’t be (peri)menopausal because I can see from your scan that you had just ovulated”.By this point, I had read up extensively on perimenopause to the detailed extent, as only a hyper focused neurodivergent woman can! Having had to self-advocate for myself and advocate for my neurodivergent children by educating doctors on the female and more subtle presentations of autism and ADHD, I had no energy nor motivation left to educate them on perimenopause. It was essential for my regressing capacity that I see a specialist as soon as possible, and one with a neuro-affirming approach to working with autistic patients with a complex background and presenting with severe perimenopausal symptoms.Finding such a doctor continued to be prolonged due to New Zealand health system waiting lists, and needing to fund a private consultation and ongoing reviews. All the while I was regressing further and losing skills to care for myself, channeling my energy into looking after my children and maintaining a crumbling facade that I was coping.Seeking medical support was met with repeated refrains of: “You are too young to be perimenopausal”, “You don’t need HRT”. I had to go private to be taken seriously. It was extremely validating to finally meet a doctor who trusted that I knew my body well enough to know that something was changing.What has your treatment protocol been in managing your autistic perimenopause?My hypersensitivities and sensory processing differences are accommodated using a range of therapies, in order to support my emotional regulation as much as possible. I also need to use autism specific techniques such as energy accounting, pacing, spoon theory, scheduling rest, personal training, using visual timers, having a cleaner and support worker. I have had to learn about and embrace chronic illness support strategies, since my perimenopausal capacity/mood fluctuations and treatments have at times caused immobilisation and/or total shutdown. My Dad has recently died and the grief has exacerbated all my symptoms too, and it is impossible to unpick which issue is causing which symptoms and treating them in different ways.At this stage I have HRT doctor with an interest in neurodivergent perimenopause. She has diagnosed premenstrual dysphoria disorder (PMDD) retrospectively, therefore hormonal fluctuations are potentially volatile times. In order to flatline my natural hormone production, I am now in a chemical menopause. Using a drug called Zoladex, I have regular implants injected into my subcutaneous belly fat of GnRH-analogue. This has suppressed all ovulation and zeroed my hormone levels so that the fluctuations can no longer occur, thus no longer causing my mood and capacity to soar, plummet and spiral in such an unpredictable way. Add-back hormones are titrated using HRT and I use oestrogen patches, oestrogen gel, testosterone gel, a Mirena IUD and Utrogestan pills (used vaginally at night) for Progesterone, Ovestin for topical oestrogen cream. This is currently working well and I have a familiar regimen. The chemical menopause is temporary and reversible, although I have no desire to have another period ever again.This is not standard practice in working with perimenopausal patients and, as far as I am aware, Zoladex is primarily used to suppress hormones when treating breast and prostate cancer patients, as well as for some gynaecological conditions including PMDD and endometriosis. Not all women will be comfortable with this treatment plan, but I was desperate as I was experiencing suicidal ideation when my hormone levels plummeted, and had no consistency in functioning and capacity as a parent. My grief for my Dad was crippling, adjusting my anti-anxiety/anti-depressant medication dose made it worse. My usual ADHD stimulant medication was causing an extreme daily medication rebound, plunging me into a depressive state. ADHDers are at increased risk of suicidality, because we have lagging emotional regulation, and we are spontaneous without thinking through the consequences.I was in a constant state of apathy and unable to engage with people, so it was critical that my treatment plan take my hypersensitivity to medication, HRT, my own hormonal fluctuations and demands placed on my energy at that time, in line with my autism and ADHD diagnoses.Since there is so little academic research into the menopausal transition as experienced by autistic people, we either receive no appropriate treatment, do not respond to typical treatment, or we are required to be trailblazing guinea pigs. I have taken the latter option, since I have researched the topic in depth and have a HRT doctor who is willing to support me in trying different treatment options. Although there is very little research so far, she can identify patterns in her patients who present similarly to me and other case studies she is aware of.My HRT doctor is a fellow visual thinker, and she produces her own graphics and information sheets for her patients, as well as for free via social media. These are useful accommodations especially to neurodivergent people, as we deserve equitable access to health data and medical knowledge in a range of presentations. Due to our executive functioning challenges and communication differences, we have unique struggles in accessing adequate healthcare in midlife.Autistics often have co-occuring conditions such as ADHD, anxiety, chronic illnesses, hyper mobility conditions etc., which are also sensitive to hormonal fluctuations. We may find ourselves constantly trying to balance our hormones and trying to create holistic equilibrium, rather than ever truly distilling peace in our homes or seeking a “cure”. We don’t want to be pathologised our cured, but we deserve to live with a quality of life that minimises our challenges, boosts our strengths, and not having to mask our differences in order to make other people feel more comfortable. Having additional support needs ought to make us in greater need of adequate perimenopausal healthcare, yet disabilities often present extra barriers in accessing the right services. Sometimes we are too complex and/or too far outside the norm to be properly understood and supported, which is incredibly ableist and medical gaslighting is rife for our community.Telehealth is an excellent leveller where available, as it removes access barriers, reduces the postcode lottery effect, limits the impact of executive functioning challenges that prevent us having to be somewhere at a certain time and having to rely on childcare, which is scant for many neurodivergent families. Zoom and video calls make it easier for vulnerable patients to safely access medical care, with less re-traumatising if they have previous medical trauma. Text reminders of appointments are invaluable to people like myself who do not feel the typical passing of time, and have a limited working memory (which is close to nonexistent in perimenopause).Having paperless appointments and medical admin is really efficient too because then we can’t lose prescriptions, misplace medical letters nor need to be responsible for rebooking follow up appointments etc. Digitising these steps improves accessibility for everyone, and I especially appreciate my doctors sending my prescriptions directly to the local pharmacy with three months worth of repeats, so that all I need to do is turn up to collect my medications. Assuming they are not in short supply as oestrogen patches were earlier this year. I am dependent on a high dose of HRT to optimise my functioning capacity and stabilise my mood, so I was required to call all the local pharmacies and in other regions around Aotearoa New Zealand, and get my patches mailed out to me. It is a cruel irony that the more support you need, the louder you have to shout for it. Oestrogen gel has become a great alternative and has a secure supply chain currently. How has your everyday life been impacted by autistic perimenopause (your caring/employment responsibilities, hobbies, relationships etc.)?The lives of autistic midlife women often feel like we are constantly firefighting, battling one family crisis after another. Our constant state of hypervigilence exacerbates our anxiety, making symptoms worse. Many of us are simultaneously raising autistic children, whilst supporting (undiagnosed) autistic parents, and running on empty.During perimenopause, our increased sensory and emotional dysregulation can make it much harder to parent. It is awful that the timing of this clashes with our children’s puberty, and I for one have many a pointless argument with my kids for no apparent reason other than we are just all completely strung out. If I didn’t know I was autistic and perimenopausal, the chronic guilt, shame and embarrassment would completely overwhelm me. Without HRT and anti-anxiety medications, I would be an inconsolable raging mess.Neurodivergent parents tend to have neurodivergent children who require more/different care, attention, energy, motivation, focus and so on from us than neurotypical children do of their neurotypical parents. Our children require 24/7 co-regulation, are often inconsistent sleepers, need reasonable accommodations around their education. Many parents are either constantly trying to engage with schools to have their children’s support needs met, or homeschooling them. It is ironic that the more support needs a child has, the less capacity their perimenopausal parent often has to offer them. (Or is that just me..?)There are no external support services available that ensure parents get adequate respite where I live. What few public services that do exist are over-subscribed, under-staffed, under-funded, and their philosophies may not align with the emotional safety of neuro-affirming practices. Often our children are also anxious and depressed due to their neurology, but even neurodivergent children experiencing suicidal ideation from a young age will often not be deemed at risk enough to reach the threshold for child and adolescent mental health services (CAMHS). So we watch our children struggling, and devote all our energy into their needs, whilst our own needs go unmet.My household management demands are greater than those of the average too, with everyone in my house only eating a limited range of “safe foods”. These options often change with no prior notice and I can end up with a freezer full of foods that one child would only eat one week, then refuses to ever touch again (I’m looking at you, frozen pizzas). At a time in my midlife when I should be modelling a healthy diet, preparing nutritious meals and enjoying family dinners every night, by dinner time I am often on the sofa in a total shutdown.I co-sleep with my ten year old as he would otherwise wander around the house at night hysterically looking for me. This is totally the norm in many neurodivergent families and there is no great rush to change this, but it is not ideal when I am already fairly insomniac, waking up at night with a bulging bladder, and can not moderate my own body temperature.I spend al lot of my time advocating for my kids with the health service, to receive appropriate care and support. It is an enormous burden during autistic perimenopause, but it is the only way to cope in this world which has not been set up for autistics. This “work” is of course all voluntary, unpaid labour, requires hours of research into the best support for neurodivergence, all whilst facing criticism and blame for parenting the way I do and my children behaving as they do. It is all thankless, exhausting and demoralising.Are there things that make or have made your menopause transition especially difficult for you as an autistic person? If so, what kinds of things?All of the above, it has just been awful! It is getting better in my chemical temporary menopausal state, but having a permanent conclusion from a surgical menopause (hysterectomy and oopherectomy) with carefully titrated addback hormones is my treatment plan. Not knowing if or when this may occur is frustrating and keeps me on edge all the time. So I guess the constant uncertainty layered with years of random unexpected symptoms is especially difficult for me. I hope to/anticipate feeling more settled physically, emotionally, sensorially, cognitively and psychologically once I am post-menopausal. Are there things that could make or could have made your menopause transition easier for you as an autistic person? If so, what kinds of things?* Being assessed simultaneously as autistic, ADHD and perimenopausal, with an appropriate care plan immediately put in place. * A disability doula AKA “Crip doula” which is a fellow disabled (or in this case autistic/neurodivergent) person who offers a cross between peer support and dedicated practical care, given to a newly diagnosed disabled person. If someone could have taken my hand and led me through the assessment/self-identification process, explained and supported me with disability funding and carer support based life admin, encouraged me to unmask safely, create a neurodivergent-friendly home space where I could learn who I am and what I need. Instead, I am still having to figure this out for myself as I go along…* A network/community of neurodivergent people who readily accept newcomers and show us the ropes, so to speak. A place to feel whole and validated at my most vulnerable. What really happened for me instead was that I completely cracked to pieces, having to rebuild and assimilate my life around autistic perimenopause. I still feel fractured even though I have formed a great network alongside like minded, late diagnosed, new found friends. It shouldn’t have to be this hard. * People talking about “autistic perimenopause” so we know what to expect. If only it were a term that we already had in our everyday lexicon, but we are all working on that now together. Instead of that, we are lucky to approach perimenopause already knowing about it, and recognising autism in ourselves. * Meno-D being part of the screening process for people experiencing mood changes in perimenopause to assess risk of menopausal depression. * A whole family screening process for neurodivergence and co-occuring mental health conditions. If a child or parent is being assessed for autism, ADHD or similar, surely the immediate family should be assessed. As they say, the apple never falls far from the tree. It would save people so much money, grief and stress if we could all just be identified at once and get on with our lives. Instead of that, we spend years of asking ourselves “Am I? Aren’t I?” and “Are they? Aren’t they?”. We retell our traumatic family stories to every professional we engage with over and over again, retraumatising ourselves by no fault of our own. It is unnecessarily harmful. If we were to able to opt in to family assessments, we could put an end to the intergenerational trauma of all going through life undiagnosed until we hit a crisis point. * Not having to explain everything to other people who didn’t believe nor validate me* Reassurance that auti peri can be entirely different from regular perimenopause, and that it is a vulnerable and complex yet inevitable life transitionWhat supports, resources and services are available to people experiencing autistic perimenopause where you live?None specifically, and perimenopause is a relatively newly known issue here in Aotearoa New Zealand. The Davina McCall documentary was definitely an eye opener here for lots of women. I am from London, so I can’t comment on what menopause knowledge there has been prior to this in Aotearoa New Zealand. Currently there are many doctors who are interested in learning about treating perimenopausal women, but I don’t think it’s the norm yet in the public health service or in primary care.There are a couple of high profile female doctors who do a lot of brilliant work on social media, educating other GPs and lobbying the government around getting more HRT options available here. The oestrogen patch shortage was a pretty critical issue as the supply was worryingly low at one point. I have had to make many calls to pharmacies and chase up my prescriptions so that I didn’t run out and experience suicidal ideation again. The doctors often work independently of each other though rather than collaboratively.New Zealand is part of The Australasian Menopause Society (AMS) which has an excellent website with loads of information sheets, plus a database with AMS Members who are doctors with a special interest in women’s midlife and menopause health. Many of the AMS Members listed are GPs who run private clinics alongside their general (public) clinics. This results in midlife women having to pay a lot of money to get ongoing healthcare that the patriarchal misogynistic public medical system can not provide. This leads to inequity in access to adequate menopausal care based on financial constraints and racial discrimination in a bicultural country (Māori indigenous people and Pākēhā European-descent NZers).As it requires the individual GP to have an interest in menopause and women’s midlife health to educate themselves, there are enormous inconsistencies around whether or not you will have someone to see at your local GP medical centre. Some doctors are aware of the symptoms, are confident at treating/exploring menopause and prescribing HRT, and others are not.New Zealand has a laidback culture where people do not like to be seen to complain, and they just get on with things. This is pretty undermining for women who need additional support in midlife, but might be afraid to let others know, or not know who can help them.There are some great books on perimenopause by New Zealand based authors: ‘Don’t Sweat It’ by Nicky Pellegrino, ‘This Changes Everything’ by Niki Bezzant, and ‘Hormone Repair Manual’ by Lara Briden. It is definitely a topic midlife Kiwis are getting more familiar with.There are private GP clinics, public GP clinics, public and private gynaecologists, and patients are definitely subject to a postcode lottery. Also, word of mouth is an important element of anything here in New Zealand, people like getting recommendations. This is helpful for perimenopausal women who don’t have the energy to spare seeing different doctors hoping they might be able to help.We have experienced a shortage of HRT patches this year, and frequently have pharmaceutical supply issues affecting female patients. We have fewer approved pharmaceutical medication/HRT options here than in other parts of the world too, which is frustrating. Oestrogen gel has only just been approved for funding by the public health system, and women often have to pay a premium to have their menopausal symptoms medically managed. Many HRT items are cost-prohibitive to many women.In order to receive adequate menopause treatment in Aotearoa New Zealand, a woman needs money, tenacity, energy, education, knowledge, connections, confidence, initiative, and the executive functioning skills to follow through on daily HRT regimens.It is medically misogynistic that we are needing to work so hard for the right treatment, to enable us to continue working so hard in our undervalued, overworked and thankless tasks.What kinds of services, resources or supports would you find most helpful?* Websites, webinars, podcasts, online group coaching (I can find one-to-one coaching really intense)* Leaflets - I love a leaflet, but haven’t seen any about autistic perimenopause…* Community groups - in real life and online. Homeschooling groups are great for this! There is nothing unique about my story - lots of former teachers opt to homeschool, and many of us realise our neurodivergence in midlife as our kids are getting assessed. There is a wealth of untapped potential community support and networking within this demographic. * Disability doula - this would be the dream for anyone needing intensive support following a new diagnosis of neurodivergence. I don’t know of any doulas specialising in neurodivergence though. I have compiled a roundup of resources on autistic perimenopause here. What is the easiest way for you to access information about autistic menopause?Visually: online, posters, academic research articles, TV.Auditory: Podcasts and audiobooksI struggle to read books these days, but I do love an ebook with the accessibility feature on my phone enabled to read aloud to me. What would you wish for all people to know about autistic perimenopause?That autistic women are at three times higher risk of dying from suicide in midlife than non-autistic women. We are an extremely vulnerable population yet many autistic women continue to go undiagnosed and unidentified as such due to medical misogyny and the stereotype of autism being a white young boy lining up his toy trains. This does an enormous disservice to us all. For those of us with co-occuring ADHD, it is important to be aware that 1 in 4 ADHD women have attempted suicide. Women are often misdiagnosed several times over by the time they reach midlife with anxiety/panic/personality disorders, when it had been autism all along, with patterns of dysregulation/depression in line with their hormonal fluctuations. Yet these patterns are often only spotted retrospectively, by which point women have been blamed for their differences as labelled as difficult, lazy, over dramatic, over sensitive, insensitive etc. We are always labelled by others, but I for one was delighted to trade in all those societally-labelled moral character flaws for the correct labels of autism, anxiety and ADHD. With those misguided labels comes decades of shame, guilt, regret, self-loathing and so on. This all continues to affect us well into midlife, with our symptoms becoming so extreme in midlife that, if we don’t know we are autistic and perimenopausal, we may assume we are losing our minds and are a burden to everyone.Our autistic communication differences make it more challenging for us to communicate effectively with doctors and healthcare practitioners, which is a risk factor in getting the support needed to improve quality of life. HRT is definitely a life-preserving treatment for me; without it, I would have taken my own life. Many women are unable to access information to educate themselves. We may lack the self-advocacy skills to voice our feelings. We are vulnerable to medical gaslighting and medical misogyny, believing misguided doctors who tell us we are too young to be perimenopausal. There are structural barriers to accessing medical facilities for many autistics with mobility limitations resulting from chronic illness or other conditions or disabilities.Is there anything else you’d like to share regarding your autistic experiences of menopause?I have rambled long enough, so I am going to stop now! Thanks for reading my Q&A, and here is a medal for you if you made it this far! 🥇💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

“Hello this is Sam Galloway from The Autistic Perimenopause: A Temporary Regression in New Zealand.I'm currently inside a blanket fort I've built myself.I'm hoping my cats and kids don't try and come and take it off me while I'm recording.We are just going into Autumn here in New Zealand which is fantastic because I've been boiling and hot flushing all the long summer so it's nice and dark here in the evenings which is good.Suits my mood.I hope wherever you are in the world it's bright and cheery. Goodness knows we need it. ☀️Today I just wanted to talk through my neurodivergent perimenopausal discovery timeline which is just an explanation of how I came to self identify as autistic, ADHD, highly anxious, and also recognise that I was in, still am, in perimenopause.”Listen for more! 💕🎧 ▶️Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi, I’m Sam! Late Diagnosed Neurodivergent, Tenacious Midlife Struggler, and Autistic Perimenopausal Advocate.Welcome if you’re new to The Autistic Perimenopause: A Temporary Regression! Thanks for being here if you are already a regular reader. My mission is to support you during your neurodivergent menopause transition by providing:* Information* Validation* RegulationYou are not alone 💕I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕TL;DR3 top tips for starting to identify our support needs:* Take up space and make your voice heard.* Accept and lean into fluctuating capacity.* Identify triggers/people/environments/tasks that you actively avoid. Poll results show that 72% of respondents don’t yet know what their needs are, 85% lack a safe support community/network, and 97% are not getting enough support in autistic perimenopause and beyond.No wonder we are so vulnerable to deteriorating mental health in midlife. Is it because we have masked our entire lives, hiding our needs even from ourselves?Those of us socialised as female have been discouraged from showing and meeting our needs, and instead being of service to others at all times. Is it any wonder we show our confusion and rage when demand made on our energy outweighs our capacity?💕Poll results are in, and it is worse than I had expected. But let’s not lose hope! We will work it all out together over time. Huge thanks to the 39 respondents so far to the recent poll (one of them was me so I am now patting myself on the back!). Due to my distinct lack of tech skills and foresight, the poll is open forever, so feel free to vote any time! You can find the poll in this post. Scroll to the poll! 👇Poll ResultsHere are the results (as of 12/3/2025):What do the numbers show us? This may be the least scientific data analyis ever, so strap yourself in. I am super grateful and shocked to have surpassed one thousand subscribers strong in the past week! Thank you to everyone who has given me your time, I know and appreciate how precious and finite it is. 💐 💝 😘There were already 39 respondents when I recorded the video to discuss the findings and my reflections. Ethics, biases, moral grounding of my research etc.? There will be no statistical analysis on these small numbers, but I think we can use them as representative of a small snapshot of engaged members of this community. If nothing else, the results suggest that those who were able to respond are definitely in need of support. We will work through all of this and figure out what supports we need and how to get them. It can’t be a rushed job, and it is not my intention to resolve all the entrenched trauma and hyperindependence behaviours so many of us have developed in life as coping mechanisms. Let’s be clear, I am not qualified to do any of that work with you (sorry!). I wish I could do more, but I am committed to do what I can and share what I have learnt the hard way…Let’s start with a complete mindset shift so that we can give ourselves the self-compassion required to do this work. My belief is that we are all in need of more support than we are currently receiving as we transtion through autistic perimenopause and beyond. So, without further ado, and for those who can not tolerate the Windy Welly background noise in the video (I am sorry, I tried to reduce it post-edit but it refused to be silenced), here are my take aways from the results.💕What are the foundations to getting support in autistic perimenopause?* Accept that nobody is supposed to be totally independent, and interdependence is in our DNA (fact check this spurious claim later, Sam).* Grieve for our missed opportunities and the struggles we have survived thus far. * Accept our neurodivergent self-identification/formal diagnosis.* Voluntarily unmask at home to learn what is is to be authentically you.* Identify your sensory preferences and requirements.* Set up your home for regulation and emotional safety. * Notice what chores or tasks you actively avoid. Accept that these may overwhelm you. Can they be delegated or dropped altogether? (Hair washing is a lifelong trigger of mine. When I experience functioning regressions, I get my hair professionally washed and dried at a salon. It is quick. and I don’t have to get my face/ears wet.)* Release unnecessary demands, toxic people and avoid your triggers as much as possible.* Barter/exchange favours from your safe people. (During periods of intense perimenopausal insomnia, a friend has taken my child to homeschool meets for me. In return, I deep cleaned her bathroom. Not because she expected anything in return, but I felt I owed her, and it was a useful and manageable task that elicited joyous hyperfocus on my part. Dopamine all ‘round!)And self-compassion goes without saying here!Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️Radical self-acceptance is our goal. It isn’t easy, but try to remember one, some or all of the following recommendations…* Autistic perimenopause is a life phase that exacerbates the asynchronous nature of our neurodivergence. We are in a state of constant flux, while our hormones go absolutely haywire. Your capacity is likely to reduce. Don’t be frightened, this is temporary. Accept the regressions. They will pass. * Avoid overexplaining your struggle to the people in your life who will not accept your differences. If you feel unsafe around them, trust your gut. Shame on them for not believing you nor supporting you enough. * Know that there are other people who are just like you. I am proud to be one of them! There are many things I can not do now that I used to be able to, or would highly mask to look like I could do them. Now I refuse to even try. Does that make me a failure? No. So if you can’t do things now that you previously could, please know that you are not a failure either. * If other people are judging you for showing that you have needs, that is their problem. If they aren’t already supporting you, and have no intention of doing so, do you really want or need them in your life anymore?* Perfectionism is impossible, and it isn’t fair to expect it from ourselves.* Respect your need for recovery time and accept social hangovers after you have pushed through and done hard things. * Plan time to regulate at home alone as much as you can/need to. * Do you have a chronic illness, premenstrual dysphoric disorder (PMDD) or another co-occuring condition? Can you predict when you are going to regress/be dysregulated? Anticipate those phases and ensure you have blocked off enough rest time for yourself. Incorporate pacing into your schedule in advance, rather than retrospectively. If you already have access to supports, book them in for those times you know you will need them. * Stop trying to do all the things you find the hardest in life. This workbook could help you:I hope this helps, please let me know in the comments to what extent you are already embracing and accepting your own needs. Has this post offered any insights? What do you think would be beneficial in helping ourselves through this difficult phase of accepting that we always had support needs, that they went unmet, and that now we owe it to ourselves to redress the balance? 🥰 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

The world can feel like a sensory onslaught and drive us rapidly from regulated to the verge of a meltdown in the right wrong conditions. I am so sorry if the background noise of this video also drives you into sensory overload. Rather than cause harm, my goal is to share how Sensory Processing Disorder (SPD) can take a regular everyday situation, and turn it into a sensory nightmare for anyone who has SPD. There are triggers everywhere. Sensory Processing Disorder is:* A common co-occuring condition for neurodivergent people, that turns this world into a total misery-inducing, tormentous ordeal. Unless you are lucky enough to altogether avoid wherever other people are in general, and crowds of people specifically. * The reason noise cancelling headphones were invented. * What Occupational Therapists are legendary at supporting people with. I was wrong - not all autistic people have SPD, as I said in the video. I am sure I heard that somewhere, but I can not back that up with research despite scrolling for hours to attempt to do so. The best I found was that 90-95% of autistics have SPD. I was fairly distressed and highly masking whilst filming this video, and was pretty hasting in suggesting that my kids and I are medicated to go out into the world. Whilst this isn’t necessarily the case - and I did not have the capacity to explain myself very articulately - I do use medications as part of my toolkit to cope with this world, and to be able to function within it. Although the extent to which I function day to day is debatable! Apologies for not returning to the pool to re-shoot the video and provide correct data, but I never want to go back ever again. Of course, I will have to go back next week for the next sensory onslaught my kids’ swimming lessons.Do you have SPD? Let us all know in the comments!There is a free online self-test linked below that could suggest whether or not you too are blessed with this condition. To know for sure though, you will need to see a qualified practitioner for an assessment. Whilst a range of professionals may be qualified to assess you, I would recommend seeing an Occupational Therapist who is neurodivergent, has SPD or at the very least has a strong interest in these areas. They can work alongside you to design a sensory diet that supports your needs and sensory preferences. It has nothing to do with food though! I will cover this in another article soon. (Please remind me when I inevitably forget…)ADDitude Magazine online: Symptoms - Signs of Sensory Processing Disorder (SPD) in AdultsSelf-test - Sensory Processing Disorder: Adult Symptom Test for SPDTreatment - How to Treat Sensory Processing DisorderFun fact: Sam Galloway is an AuDHDer who self-medicates using coffee! If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️Podcast episodes about adult SPD:There is a quick three question poll for autistic perimenopausal people asking about your current support needs:Please come on over to this post to fill in the poll. It will only take one minute but will help our community. There are 25 responses so far, thanks so much to those people! I think we will all be surprised at the results so far. They show we have a lot of work to do as a community to identify our support needs and access a network that will support us accordingly. I hate the idea that we are all struggling and suffering alone. Here’s the post, just open the link and scroll down to the poll..! Easy peasy, please and thank you. 😊 What People Are Saying 🥰💕 Thanks so much for starting this Substack. I'm in early perimenopause and a neurodivergent Mom. All the unknown is hard around here and this journey is no different. I love bringing together the voices of lived experiences and so appreciate that you're sharing yours and building this community. Thank you.💕 I find such relief when I hear my email go off and look down and see that it’s from you. You bring me comfort every single time I receive an email. I get to learn about myself and how to help myself. You are my guide and I am so very sure you are the guide of so many. Please please hear me when I say thank you for saving my life. Forever and always grateful.Come and enjoy The Auti Peri Q&A Series, where you can read about other autistic midlifers whose sensory processing issues have or still are impacting their daily life. Let’s all commiserate together…I would love to share your story! Please message me on Substack or email me back if you would like to be involved in the Q&A series. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hi everyone, Thanks for being here with me at The Autistic Perimenopause: Temporary Regression!I am delighted to be making some small regains in my energy, capacity and functioning levels that have been spiralling, regressing and lagging during my ongoing autistic perimenopause. I am fortunate to have enough supports in place right now, and have built my family’s life around my late-identified neurodivergence. They aren’t always happy about this, but I refuse to believe the “normal” way of life is best for everyone.Initiating these lifestyle differences has required extensive research, self-compassion and self-advocacy on my part, to the extent where this is a spin (special interest) of mine. Thus the topic of many an info dump! Of course, it also requires support of friends, family, our close community and the wider network in which we live. None of us can do it alone. That’s all got me wondering how you are getting along through autistic perimenopause? Temporary regressions are to be expected, although not everyone is equally impacted by them. Just as in autism, I believe that perimenopause is a spectrum, and a dynamic one at that. Our mood, needs and energy may fluctuate alongside our fluctuating hormone levels. When any of these are low, our support needs may be high(er). It is just how it is. No guilt. No shame. Frustratingly, when we find ourselves at our lowest capacity, it is often the hardest time to find appropriate supports. People who have seen us as “highly” functioning until now may not believe the regressions that we are experiencing, and may not see that we have increased support needs. Our lifelong social masking can backfire on us in this way, which is doubly difficult for us. Disclosing a late formal or self-diagnosis is not safe for all, nor in every environment we find ourselves in. There is no level playing field in neurodivergence. Internalised ableism can be prohibitive in accepting and recognising our own support needs. For those of us who are neurodivergent and/or chronically ill without obvious outward signs of disability, our invisible disabilities will go unseen. Schemes such as the Sunflower lanyard “encourage inclusivity, acceptance and understanding”.Why did we choose a sunflower?Without a visual cue, it can be difficult for others to identify, acknowledge, or understand the daily barriers faced by people living with an invisible disability.We searched for a discreet sign that is clearly visible from a distance as well as being distinctive, joyful, and dynamic. We chose a sunflower as it suggests happiness, positivity, strength as well as growth and confidence and is universally known. I have benefited from wearing my sunflower lanyard in airports, and this was vital when travelling from Aotearoa NZ to the UK and back last year when my Dad was dying. Grief stricken and sleepless, I would never have made the connecting flights without a member of ground staff supporting the flight and gate transitions, losing track of time and space in overwhelming crowded airports. Some airports provide additional information to support people who may be overwhelmed with visual guides, such as this photographic visual guide/social story for Wellington Airport. It is contentious though that we should need to “out” ourselves as autistic or having an invisible disability, condition and/or chronic illness, and be seen as “other” to be worthy of support. A widespread culture of collective care and mutual support would benefit everyone, but that is a dilemma for another day…For those of us with autistic children, we are fully aware and accepting of their dynamic individual needs. It is just how we function (or don’t function), depending on anxiety and environmental issues, amongst a multitude of other things. A child’s autistic meltdown is more acceptable than an adult who is melting down, but autistic children grow up to be autistic adults, and so this should be expected and accepted. I believe that with a late diagnosis/identification of autism we should also be given a prescription for self-compassion. If you feel you need permission to acknowledge your support needs in autistic perimenopause and beyond, then please take it now from me. I know too many of us have spent our lives so far masking our differences and lagging skills, and that is exhausting. In perimenopause, the energy we afforded masking in our previous decades will fluctuate, sometimes diminishing all together. It is okay - that is what is supposed to happen. So let’s all agree that a diagnosis of autism comes with associated support needs that do not need functioning labels of “high”, “low” or in between, since our individual responses to varied stimuli in our dynamic neurodifferences are what cause the immediate and fluctuating support needs. Not a predetermined level of ASD. Even if this was given to you alongside your diagnosis report, you don’t need to think about yourself in these rigid terms. What about you? Do you get enough support? Do you know what your support needs are? Do you have a safe community/network to help you meet your support needs?Please let us all know using this basic quick poll:I would love to know more about you and to share your story! I have been so honoured to already share the experiences of so many autistic people who are experiencing the menopause transition and beyond. There are a couple more Auti Peri Q&As yet to be released, and I am so keen to share your story and experiences of autistic perimenopause. Yes, you! If you would like to be featured as part of this series, please message me or reply to any of my emails. I’d love to share your story!Here is a summary of my intentions and purpose in running the ongoing Auti Peri Q&A Series:* Individual anecdotal narratives will elevate the autistic community as a whole.* Highlight and normalise temporary regressions as part of many people’s autistic menopausal transition.* Validate autistic menopausal transition as different from non-autistic.* Informally support public health preparedness for autistic aging.* Highlight systemic health disparities in autistic perimenopause.* Improve awareness of autism and menopause as separate entities, and autistic menopause as a whole.* Empower our unified voice.* Compile a bank of voices for newly diagnosed autistic to anticipate the aging process through the lens of auti peri.* Build our community up through our neurokindred life experiences.* Raise self-advocacy as a community effort, not just an individualised responsibility.* Share our wisdom.* Contribute meaningfully and anecdotally to the growing body of work and research into auti peri.These are the questions in The Auti Peri Q&A Series:1) What does “autistic perimenopause” mean to you?2) When did your autistic perimenopause symptoms start and what were/are they?3) What happened if/when you presented with autistic perimenopause to a healthcare professional?4) What has your treatment protocol been in managing your autistic perimenopause?5) How has your everyday life been impacted by autistic perimenopause (your caring/employment responsibilities, hobbies, relationships etc.)?6) Are there things that make or have made your menopause transition especially difficult for you as an autistic person? If so, what kinds of things?7) Are there things that could make or could have made your menopause transition easier for you as an autistic person? If so, what kinds of things?8) What supports, resources and services are available to people experiencing autistic perimenopause where you live?9) What kinds of services, resources or supports would you find most helpful?10) What is the easiest way for you to access information about autistic menopause?11) What would you wish for all people to know about autistic perimenopause?12) Is there anything else you’d like to share regarding your autistic experiences of menopause? All I need in addition to your responses to these questions are a couple of sentences (or as much as you like) about yourself, your location, your personal pronouns and a photo that you would like to share. If you feel uncomfortable with sharing any of these, we can leave them out and/or use a false name. I will format all your responses into a post that you can approve before it gets scheduled for publishing. They get sent out to my email list which is currently in the 860s and is chock full of amazing people who will be so grateful to hear your lived experience. This really is emotive and vital advocacy work that I cannot do alone. I would really appreciate your support with this! Please get in touch with me if you would like to feature in this new series! Also look out for the posts in your email inbox. Thanks for giving your time and attention to this important and under researched topic. Together, we can make a difference towards enhancing the quality of life for our aging autistic neurokin.I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Join me for my next live video in the app Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Join me for my next live video in the app Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Hello everyone! Have you ever wondered why you feel so low, and whether you will ever feel better again? I have - in fact I still do! Wah! I want to share news of my current auti peri functioning regression with you, but am too far beyond capacity to type, edit and publish a long-form written post. So I am being brave today and sharing my first video post here on Substack!Please let me know in the comments if you like this format. Here’s a quick run down of what I discuss/monologue… Last weekend I ran out of the oestrogen patches that I absorb best and had to use a different brand. I regressed rapidly and significantly. Symptoms include: painful digestive issues, working memory lapses, difficulty in word finding, very low mood, The Rage, irritability, extra dry eyes (only two, and they are always dry), forgetting to take my meds, menstrual cramps and lower back pain. But wait, there’s more! * Feverish hot flushes and extreme body temperature dysregulation. * Disordered eating habits and inability to respond to hunger cues. * Simultaneous fatigue and insomnia.What a ride! 🎢Do you experience regressions like these? What are your symptoms?I would love advice on how you cope with them. Side note: I was overzealous on the accessibility functions in the video, not to mention unfamiliar with Substack’s AI-generated closed captions. Basically, I edited (barely) the video in the Capcut app, added subtitles in directly, then uploaded it here. So the closed captions can’t be switched off (sorry). But the neurodivergent and disabled people among us all know that’s for the best - accessibility features are a basic communication right for all. Accessibility should be the rule, not the exception.Apologies about all the verbal ums and ahs. I left them all in the edit because it’s authentic autistic communication. That’s why I am gazing up and across rather than looking directly into the camera. I have to look up to think, or mouth words don’t come. Plus, if I had stared into the camera lens, I think it would be pretty intense for all of us. Ha ha! I have had to push hard on the self-advocacy this week, and here is a recent post I published on the topic:Thanks for reading/watching! Wishing you a non-regressive weekend! Sam 💕I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

Kia ora koutou/Hello everyone! 💕I wanted to make an introduction post so new people can get to know who is already here. So grab your favourite bevvie in your favourite mug. You know you have one, and here’s a photo of mine (it’s the floral pīwakawaka/fantail bird mug):💕 Where are you from? I love to think of us all spreading awareness of autistic perimenopause all over the map!💕 What brought you to Substack?💕 Are you neurodivergent, or just neuro-curious?💕 How much do you already know about autistic perimenopause/menopause? 💕 What do you wish you had known sooner about autistic perimenopause? 💕 Do you come here often? (Oops, sorry. That last one is from my pre-marriage dating script from a couple of decades ago.)I’m Sam, mother of two neurodivergent kiddos. I am London-born, and now live in the stunning Aotearoa New Zealand. I’m late diagnosed autistic (at age 38) and ADHD (39). Better late than never is definitely the case here!Self-identified PDA (pathological demand avoidant/pervasive drive for autonomy - because things weren’t complicated enough…) I foolishly thought I would have it all together in time for my fortieth birthday and could finally live the neuro-affirming life my family surely deserve. Things would start looking up, right?! That was when things really started crashing down. Publicly - because at this time I had just graduated from the New Zealand Comedy School, and I could not remember my lines on stage. Wah! So live stand up comedy was a short lived hobby…It took another couple of years to realise that my capacity and cognition/working memory were diminishing, The Rage was beyond my control, and my self-care skills were regressing. Simultaneously, my periods started to change. Intuitively, I knew it was something “hormonal” in origin, but it would feel like a lifetime before I would really understand the calamity of autistic perimenopause on my own functioning. I am 43 now, and currently a shell of my former self. It has been near impossible to find any writing, research or resources on the topic, so here I am sharing my lived experience to contribute to the slowly growing, but urgently needed, collective body of work. What little research I do know about, I write about here at The Autistic Perimenopause: A Temporary Regression. And I have cats because, otherwise, what is the f#*king point in any of this? *gesticulates at life*😻 Harry (and Toby) starred in the fourth MeowStack feature below! 😻Menopausal Depression (because sometimes cats alone aren’t enough…)📣PSA 📣 Please refer to the Monash University’s Meno-D rating scale if you have any concerns about your mood or depressive states during the menopausal transition. You can take your results along to discuss with your doctor.Fun fact: I last scored a 33, out of a possible 48! Feel free to share your current score with us all in the comments. (Totally understand if you would rather not though…)The categories are:* low energy* paranoid thinking* irritability* self-esteem* isolation* anxiety* somatic symptoms* sleep disturbance* weight* sexual interest* memory* concentrationHere is a mental health first aid post from my archives that you may find helpful:☕️ PSA: Free Subscribers who would like to send me a one off tip without signing up to be a Paid Subscriber, the link below is for you! ☕️Come and share your cat photos, and why not tell us all about yourself at the same time in the comments? This is a safe space, and there will be no tolerance for discrimination: pet photos of all species are welcome here. If you have a Substack publication, please share a link with us so we can all get to know each other and enjoy your work!Sending virtual weighted blanket hugs and many regulating hours of your favourite boxset/Netflix series your way…I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

It is in my nature to live in a chronic state of fear. Before I was diagnosed autistic, ADHD and chronically anxious in my late thirties, I always wanted to hide under a rock, where I could be left alone and in peace, free of the demands of social interaction and sensory overload. Flotation sensory deprivation tanks were my second home. These days my anxiety shows up more as panic, resulting from the unending demands of parenting in a brain and body that feel they were not made for this world. Image description: Sam’s outstretched legs wearing black leggings and black ankle socks. Sam is suspended in “The Cloud” - a lycra hammock in her family’s indoor sensory frame at home. Cocooned in a womb-like red lycra, with light filtering in through the window. She is most likely trying to listen to a yoga nidra meditation track via noise cancelling earphones. Deep in autistic perimenopause, I am more now inclined to want to run away. Feeling trapped, resentful and “too grumpy” (in my sons’ words, although I fondly call it “The Rage”), my response is to want to escape from everything - and, just as hiding under a rock large enough to conceal my presence would have resulted in certain death, I have nowhere to run to. My instincts to fight (The Rage), flee (run!) or freeze (hide under a rock or, more practically speaking, in my locked bathroom) now manifest within me as burning pain, elevated blood pressure and a tumultuous sickened stomach.My exhausted body aches from perimenopausal joint pain making me walk slower than ever, and so it is ironic that I have never wanted to run away more from my adulting duties, yet I remain in autistic inertia. Even if I could go for a run, I would melt from the resulting hot flush, my bladder would undoubtedly leak and I would forget to take a door key. During my early twenties, I took up running as a new form of punishment to beat myself up with exercise. My eating and movement habits were disordered, and influenced strongly by my neurological tendency towards OCD. It took a very disordered determined mind to track daily runs mileage and calorific intake back in the days of analogue life. Young obsessives don’t know how easy they’ve got it with all the apps and smart watches recording their data to now brag share every movement on social media!Running away just isn’t a viable option any more, so I need to address this primal urge for what it is - my overwhelmed, dysregulated nervous system ringing alarm bells, and telling me I need to change my environment immediately and seek psychological safety. Upon reflection, my unmet need to run results from a double deluge of autistic burnout and carer burnout. I have a fear that things are never going to get better, and I will ultimately die a hopeless wreck with no lasting legacy… So it makes sense that to avoid this, I want to hide from myself and run away from my life. According to many menopause experts, rejecting societal expectations placed upon women all comes to a head in midlife, and post-menopausal women can relish what Kate Codrington refers to as their “Second Spring”. A time for inner growth and acceptance, free from the biological drive that fuels us to be accepted so we can form relationships and reproduce. I cannot wait for the time when my own periods stop and I am no longer at the whim of my surging and plummeting hormone levels.Before the responsibilities of mortgage, marriage and (neurodivergent) parenting, literally running away felt like a legitimate response to whatever was driving my undiagnosed anxiety. Growing up in London in the 1980s and 90s with an anxiety disorder had been incredibly frightening. I lived close to a Royal Air Force base during the Gulf War, there were constant local IRA bomb scares, and local high crime rates. I can recall taking a school trip on the London Underground and was convinced there was going to be a bomb onboard - certainly that’s what was implied by the deafening station platform and train tannoy announcements, with their insistence of “all passengers being vigilant of unattended luggage”. All the non-autistic pupils, free from the vivid imagination gifted me from my high anxiety and capacity to predict the worst possible scenarios, only took notice of the classic “Mind the Gap” announcements. By the time I had taken up running as an adult in the early 2000s, I was certainly more motivated psychologically to be running away from an imagined “someone”, rather than using the sport as a tool towards reaching my next athletic goal. I embodied high alertness, and was always looking back over my shoulder. I had the regular intrusive thought that I was going to be stabbed in the back on the streets of London, even in the outer suburbs where I lived. I was fear driven in every sense, and I responded to any real or imagined danger by pulling on my Aasics, taking my state-of-the-art Creative ZEN (failed iPod competitor) and plugging my ears into Razorlight’s ‘Up All Night’ album and pounding the pavements until I couldn't feel or think any more. It was therapeutic and self-medicative for me. I still play that album when I need to rage clean the house at speed thanks to the high energy associations I have with it…Running away was also a strategy I used in other aspects of life. As a newly qualified teacher in an infant school full of newly arrived immigrants (located close to Heathrow Airport), I had a strong drive to put my Reception (4 and 5 year olds) class’s needs above the wrath of my first (junior school minded) Head Teacher’s enforced daily whole school assemblies and guided reading sessions. Far more in line with the principles and guidance of the Early Years Foundation Stage curriculum of the time, I worked to develop a garden area where the children could engage in free flow play and take respite from the trauma and upheaval they may have witnessed in their four to five years. I also found the school’s insistence on Biff and Chip (Oxford Reading Tree early literacy programme in UK primary schools) as a tool for the children learning to read English quite pointless. Many of the children were mute in class, had rich cultural and linguistic heritages that deserved celebrating. I needed to engage them in learning the English language in a more natural, relatable, and less contrived, manner. The richness of their different cultures felt far more valuable than that of my own, since I had felt so innately dejected from and misaligned with my own society.In my first school as a teacher, I cried in my Teacher’s Cupboard every single day as a way of processing the overwhelm resulting from the incongruence between the Head Teacher’s results-driven agenda, and my pedagogy of age-appropriate learning through play and nurturing positive learning dispositions in my school children. (And also due to sensory overload of a classroom environment. I had become teacher to “save” the children like myself who had failed to thrive in this environment, yet it felt a hopeless situation where I could not save the pupils nor the system from the inside.) Writing this now, I still staunchly believe I was in the right, as autistic women, diagnosed or not, tend to be incredibly strongly principled, with research skills that could match any academic. When I could take no more, I left that school to teach in a Nursery School (3 and 4 year olds) where the staff’s philosophy aligned with my own. This was a better fit and I was comfortable enough there to teach full-time whilst studying towards my Masters degree in teaching and learning. There was a lot of pressure from the Head Teacher to push staff as hard as possible, and contributed again to another state of burnout.Feeling trapped, overwhelmed and overworked with no capacity to relax in my working environment, I ran away to take on another job at a different Nursery School. This was my final teaching job before I became a parent, and I have not returned to the classroom since. This Nursery School had a much more relaxed vibe that was a better fit for me, with a Head Teacher who shared and appreciated my values. (I have wondered about her own neurodivergence - she would return to school from Heads’ conferences and such and tell me that she had walked out telling them all that their drive for academic results over valuing each individual child was “B******t”. Legend!)Despite having more freedom and emotional safety to be myself, upon completing my Masters though, I was once again exhausted. (As much as I adore academia, and would still love to work on a doctorate programme, it feels like this is a goal for me to metaphorically run towards in years to come. Autistic perimenopause is not a safe time for me to be striving towards such destinations, as I fluctuate so greatly and it’s important to not set myself up to fail.) By way of finding reprieve, I made the following request to the Head Teacher, my boss at the time: “I need to go to Glastonbury Festival this year or I am going to lose my mind”. Thankfully, she interpreted this as a need to take mental health leave during school term time, which was accepted through the local education authority’s HR department. Phew - this was possibly the first year I had attended where I hadn’t needed to lie to my boss about my unrequested absence! Image Description: An unmasked Sam is looking and feeling very relaxed at Glastonbury Festival in 2009. She is wearing sunglasses, a brown sleeveless top, black leggings and a short short denim skirt. Sam is sitting on a camping chair and holding a bottle of flavoured water with tents and trees in the background.Glastonbury Festival was always my sanctuary. The first year I attended was a happy accident, the tickets were first prize in a newspaper competition! Had this luck not befallen me, I may still be unaware that there was such a place on Earth where I could ever feel so at ease. Glasto always falls on my birthday weekend - midsummer in Europe, midwinter here in New Zealand. I used to attend it every year, but I have sadly not returned since becoming a parent. Now that I live in Aotearoa New Zealand, I do worry that I may never get to experience this personal bliss again. Given my aversion to anything deemed popular or mainstream, I wonder whether I would enjoy it as much now that it is so popular and part of mainstream culture, and less so a respite for society’s misfits and champions of social justice. I just remember it as a place where I could finally fit in. A temporary community, free from the archaic societal expectations that can be enforced within walls and geopolitical borders. Image Description: groups of people in a a field under poles that are holding up flags, shade sails, hanging baskets of flowers and giant sculptures of flowers. People are seated on the grass, on benches, or standing. The sky is blue with some clouds and there is a single decker bus that may be a food truck.I recall Glastonbury Festival as a small dreamlike city created for a weekend from canvas and stage lights, where thousands of us had all run away from day to day life to communally take part in something spectacular. Alive in my memory, I can feel the Summer breeze on my face as it ripples through the flags in the Field of Avalon. The taste of the hot chai in the purple plastic mugs in the Green Fields, where I could lie back on a beanbag, soaking up the spices and serenity. It was always a location where I could achieve a mind-altering state, without any need for substance use or misuse. My default memories are of the sun breaking through the rainclouds as it set behind the main Pyramid Stage, and the ensuing uproar and outpouring of delight and unadulterated joy from the crowd. For some reason, the inevitable flooded long drop toilets are never in the forefront of my mind when I hark back to Glasto years gone by. Even thinking about the event now whilst looking back through old photos, my breathing and (recently elevated) heart rate slowing down as I think about the safety and emotional regulation in our collective unmasking.Image description: the “flag” my friends and I fashioned from a tent pole and a pair of socks at the Pyramid Stage at Glastonbury Festival.There was always such a vibe of hope and community for the future of humanity and environmentalism at Glastonbury. Social justice warriors congregated, relieved that we were accepted and validated as a highly sensitive community. It was always an enormous come down to leave Glasto and return back to day to day life after the surreal event. Back in “real life”, all colours were muted, smells were absent, and the buzzing ceased. Instead replaced by the dull drone of small talk, and the expectation to interpret my vivid internal thoughts into words, losing all their vivacity in the process. Back to feeling misunderstood, an outsider once again, depressed and anxious from the inevitable sickening loss due to the impermanent zeitgeist of my spiritual home. Back to now: pathologised for my natural way of being in this world. Exhausted from masking, trying and failing to fit in. Medicated to buffer and obscure my enigmatic presentation, making me more amenable to those outside my own inner mind. Vulnerable both here on the page, in my own home, within my community and out there in the world. I have mostly been authentically myself throughout my life. It turns out that running away doesn’t get me anywhere. I cannot outrun my differences. There is no destination to run to where I will feel at home, as I don’t identify well as human. I cannot hide away to shield my overloaded nervous system from the unending sensorial assault caused by existing in this world. Flotation tanks even operate within social constructs of time: booking sessions, that bring the relief from sensory deprivation to a crashing halt. The best autistics can hope for is to be heard and accepted for who we are, and how we experience this life that neurotypicals comparatively sail through. Justifying our need for accommodations places extra work on our minds, which are already struggling to cope. Autistic menopause is a phase of life where our masks unexpectedly fall, as the soul crushing weight of pretending to be normal surpasses our capacity to function. During autistic menopause, we need additional help. We are often trying to manage a household, paid and/unpaid work, growing children, ageing parents and everything else social norms can pile on us until we drown. Autistic burnout is the warm up act to the headliner that is autistic menopause. It gives us an idea of what we are in for: chronic exhaustion, regression in functioning, and a record low level of tolerance for sensory input.Rather than running and hiding from myself, my symptoms and society, these days I am more inclined to reject the expectations placed on me as a “good woman”. Reading Deborah Levy’s ‘Things I Don’t Want to Know’, this insightful quote stood out to me:“We did not yet entirely understand that Mother, as imagined and politicised by the Societal System, was a delusion. The world loved the delusion more than it loved the mother. All the same, we felt guilty about unveiling this delusion in case the niche we had made for ourselves and our much-loved children collapsed in ruins... Like everything that involves love, our children made us happy beyond measure - and unhappy too - but never as miserable as the twenty-first-century Neo-Patriarchy made us feel… If we felt guilty about everything most of the time, we were not sure what it was we had actually done wrong.”It seems we are expected to judge ourselves against covert standards that have been surreptitiously handed to us. The rules are unspoken, we have to figure them out for ourselves, then try and fulfil them. We compare ourselves to others, usually falling short, and feeling unspoken criticism to our very core. There is no barometer that we can measure ourselves with as autistic women and mothers, assessing how close to the expected norm we are running, and when we are off course. We must appear to be coping, achieving and progressing, regardless of our inner desires and mental state. I reject this, and I am coming to believe that we must forge our own paths ahead, sensing inwards for guidance, rather than looking outwards for reassurance and validation. We need to carry ourselves and run towards radical self-acceptance and authenticity; judging ourselves by our own values, and showing self-compassion when this is all too hard. Which it is and it will be, because this world wasn’t designed for humans to prosper, exploiting its resources and exploiting each other. That is just unfortunately how it has evolved to be in its present form. Yet we individually evolve from day to day, and have the reflexivity and authenticity to do so consciously. Getting older is a privilege, and we need to know who are to feel psychologically safe within ourselves. I am told this is what lies ahead for me, for us, in our Second Spring. Sounds blooming marvellous, I look forward to evolving alongside you. 🌺The Autistic Perimenopause: A Temporary Regression only exists thanks to subscribers who choose to pay. Please consider supporting my work. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe