As a neurodivergent person, my experience of perimenopause felt very different to my neurotypical peers. I’m not alone, with research suggesting that this is a difficult life stage for many people who are autistic or have ADHD.

Hot flushes were the least of my problems in perimenopause. I’ve always been sensitive to heat and even the British summer is uncomfortable, but I have ways to deal with the discomfort. What I wasn’t prepared for were some of the other things that the decline in oestrogen levels would bring.

My ADHD symptoms increased, and my stimulant based medications became less effective. Anarchy had taken over my brain. I couldn’t focus on a task for very long, I kept losing things, I was miserable, and I couldn’t sleep. I was much more disorganised, and I worried that things would only get worse if I didn’t start hormone replacement therapy (HRT).

There isn’t much research on the impact of perimenopause on ADHD, but some research suggests that hormone levels in those assigned female at birth do have an impact on ADHD symptoms at different stages of life including during periods, in the perinatal period and during perimenopause.

I’d always noticed that at certain times during my menstrual cycle, my ADHD medication was either less effective or didn’t work at all. Every month there were days I had to write off as unproductive. Yet the prescribing of ADHD medications doesn’t reflect this, the dose remains static throughout the month. Researchers found that increasing the dose of stimulant based medications during the late luteal phase of the menstrual cycle could improve mood and cognitive symptoms of ADHD. It would make sense that the fluctuations in oestrogen levels during perimenopause would also negatively impact ADHD symptoms.

Changes in hormone levels during perimenopause can cause executive function issues, even in those without ADHD. A 2015 study demonstrated a possible role for prescribing stimulant-based medications to perimenopausal women without an ADHD diagnosis. None of this surprised me. Some of those around me going through perimenopause suddenly showed more empathy towards me as a person with ADHD once they became forgetful and scatterbrained.

Unsurprisingly, the intersection between perimenopause and autism has not been well researched either. I received my autism diagnosis at 44, a year before I started experiencing symptoms of perimenopause. For some late diagnosed autistic people, the onset of symptoms were what led them to seek a diagnosis of autism, with heightened sensory issues and emotional difficulties leading to them reaching crisis point.

Most nights, I woke up covered in sweat before I started treatment for perimenopause. My sensory issues mean that the slightest change in sensation, temperature or even a single bead of sweat would wake me up. My skin would itch to the point I wanted to tear it off, but some of the creams that helped had a smell or texture I could not tolerate. The smell of other’s perfume was heightened and made me uncomfortable, and focusing on a conversation when there was background noise became impossible without noise cancelling headphones. Certain sounds would become distorted to the point I would feel nauseous. It wasn’t just my ADHD that became supercharged but my autistic traits too.

My GP initially offered me clonidine to manage the hot flushes. I broke down in front of her. I was at the point where I couldn’t cope. I knew my hormone levels needed to be addressed to improve my functioning. Eventually, she agreed to prescribe HRT. The hot flushes disappeared within days and the itching improved over the next few months. I started to sleep better once the night sweats resolved. My senses remain heightened, but I’ve found ways to cope with them.

The difficulties in accessing hormone replacement therapy (HRT) have received much press attention in recent years. For autistic people, this can be compounded by previous negative experience of using healthcare services, and lack of understanding of autism among healthcare professionals. Autistic people can also experience issues accessing perimenopause and menopause care as social and communication differences, such as expressing emotions, mean that their symptoms aren’t taken seriously by healthcare professionals.

Until recently, most research on autism and ADHD has focused on boys and men. There is comparably little research on neurodivergence in those assigned female at birth, particularly the impact of hormone fluctuations at different life stages. More research is needed in this area to understand how we experience perimenopause and menopause, and the barriers we face in seeking care.

Given that we experience worse health and often have worse experience of healthcare services than neurotypical people, treatment for menopause and perimenopause needs to be holistic and tailored to our unique needs. Healthcare needs to be adapted to give equitable access to a diverse population. Like many other diverse groups, a one size fits all model of healthcare just doesn’t work for us.