Autism, Menopause, and the Quiet Unravelling No One Warned Us About

A therapist’s lived experience of autistic menopause, identity, and mental health

Menopause is often described as a biological transition. For autistic and ADHD people, it is something much more complex. It is sensory. It is emotional. It is neurological. And for many of us, it arrives early, loudly, and without a map.

I am autistic ADHD – AuDHD, 60 years old and post-menopause. I am also a therapist. This work matters to me because I have lived it — not just in theory, not just through training, but in my body, my mind, and my identity.

At 42, I believed menopause happened in your 50s. I had no language for autism and ADHD. No understanding of how autistic nervous systems respond to hormonal change. What I did have was a growing sense that I was losing myself — and no explanation for why. I was unravelling.

Autism and ADHD menopause: when coping strategies stop working

Many autistic people spend their lives adapting, masking, pushing through sensory discomfort. Managing executive functioning challenges. Living with chronic stress while appearing “fine” to the outside world.

Menopause disrupts all of that.

Hormonal changes affect dopamine and serotonin — systems that already function differently in autistic and ADHD brains. Sensory thresholds drop. Emotional regulation becomes harder. Interoceptive awareness — the ability to notice what is happening inside the body — can become even more unreliable. Alexithymia can deepen - feelings are intense but difficult to name.

For me, this showed up as brain fog, memory problems, sensory overload, repeated injuries, and a profound loss of confidence. I developed coeliac disease. My focus disappeared. Skills I had relied on for decades felt suddenly inaccessible. I didn’t know I was autistic and ADHD (until I was 56). I didn’t know I was in peri- menopause. I thought I was broken.

Autistic and ADHD menopause often starts earlier

Research and lived experience increasingly show that autistic and ADHD people may enter peri-menopause earlier than expected — sometimes in their early 30s. Occasionally in their 20s. When this happens, it is often missed, misdiagnosed, or minimised.

Autistic women and autistic people who menstruate are more likely to be diagnosed with anxiety or depression during this stage, rather than having menopause recognised as a contributing factor. Many are prescribed medication without anyone asking about hormones, sensory changes, or autistic burnout.

When I sought help, I was told I was depressed. I was prescribed antidepressants. When I later asked about peri-menopause, I was told I was “too young”. No one joined the dots.

The cost of not being believed is high

Identity loss, grief, and autistic burnout is common. Menopause can feel like an unravelling of identity. For autistic and ADHD people, whose sense of self may already be fragile due to years of masking, this loss can be profound.

You may no longer recognise your body. Your tolerance for noise, people, light, or touch may shrink. Your capacity to work or care for others may change. The roles you once inhabited no longer fit.

Without validation, this can slide into shame.

I look back now with compassion for the woman I was. She needed understanding, not dismissal. She needed someone to say, “This makes sense.”

Autism, ADHD, menopause, and mental health support

I have been in Private Practice for ten years and work exclusively with autistic, ADHD and other neurodivergent clients. I support people through psychotherapy, counselling, coaching, and hypnotherapy, with a particular focus on autistic and ADHD menopause, peri-menopause, and post-menopause.

Mental health during menopause is not just about mood. It is about nervous system overload, sensory processing, identity change, trauma resurfacing, and the grief of becoming someone new.

My approach is affirming, validating, and grounded in lived experience. I will listen carefully and believe what my clients say. I will strive to understand what my clients’ bodies and nervous systems are communicating and advocate for them as they fully deserve.

“You are not failing — your body is changing”

Autism and ADHD does not disappear at menopause. In many ways, it becomes more visible. What once was manageable may no longer be. That does not mean we are weak or broken. It means our system needs understanding, adjustment, and support.

Autistic and ADHD menopause deserves language. It deserves research. And most of all, it deserves compassion. By Sally Nilsson