Over the past few years, conversations about autism, ADHD and menopause have grown rapidly. Many people are only discovering in midlife that neurodivergence may shape how they experience the menopause transition.

In this Henpicked Lunch & Learn, we explored the emerging research, lived experiences and why more women are recognising these connections now.

The session featured Deborah Garlick, Dr Clare Spencer and Sally Leech.

Together they explored how menopause can amplify neurodivergent traits, why diagnosis can be complex and what support can look like for individuals and employers.

Why are more women recognising neurodivergence during menopause?

Deborah Garlick: We’re hearing so much more about autism, ADHD and menopause. Why are more women starting to recognise this now?

Dr Clare Spencer: Neurodiversity is an umbrella term that includes ADHD and autism. These are lifelong, heritable, brain-based differences and that lifelong aspect is really important.

What we’re seeing is that women, particularly older women, have often gone undiagnosed. ADHD has traditionally been associated with hyperactive boys, but girls are more likely to present with inattentive traits, so they can go under the radar.

Many women have coped incredibly well. They’ve gone through education, built careers, managed families and developed coping strategies along the way. It’s only now, with greater awareness and more research, that people are starting to recognise themselves in these conversations.

Why can menopause feel like a tipping point?

Deborah Garlick: And then menopause comes along and everything can change?

Dr Clare Spencer: Yes, and this is something I hear a lot. Women will say, “I’ve managed all my life and then suddenly the wheels come off.”

During menopause, hormone changes affect the brain. Oestrogen plays a key role in how our brain functions and when levels fluctuate and fall, we see changes in neurochemicals like dopamine, serotonin and GABA.

These are involved in mood, anxiety and emotional regulation. So when they change, people can experience:

• increased anxiety
• lower mood

The decrease in oestrogen also impacts cognitive function and so loss of focus, changes in memory and concentration can occur also. 

For someone who is neurodivergent, those changes can amplify existing traits. Coping strategies that have worked for years can suddenly feel much harder to maintain.

What’s happening in the brain during menopause?

Deborah Garlick: There’s a lot going on in the brain anyway during menopause, isn’t there?

Dr Clare Spencer: There really is. There are oestrogen receptors in many areas of the brain, so when oestrogen changes, it has a widespread impact.

One of the things people often notice is cognitive change — brain fog, difficulty concentrating, problems with working memory and word finding.

What’s quite remarkable is that memory pathways can actually shift within the brain during this time. It’s a period of neurological change as well as hormonal change.

The reassuring thing is that for many people, these symptoms improve over time as the brain adapts. But during the transition, it can feel very unsettling.

How do you know if it’s menopause, ADHD or autism?

Deborah Garlick: One of the big questions is how you separate menopause symptoms from ADHD or autism.

Dr Clare Spencer: It’s a really important question and it comes back to understanding that ADHD and autism are lifelong conditions.

You don’t suddenly develop them during menopause. So we look for patterns over time. For example:

• Were there signs earlier in life — at school, university or early work?
• Have there been challenges with focus, organisation, communication or anxiety for many years?
• Were symptoms worse at other times of hormonal change, such as premenstrual phases or postnatal periods?

That history is really important.

There are diagnostic criteria for ADHD and autism and traditionally ADHD diagnosis has required symptoms to be present from childhood. That said, there are different diagnostic frameworks and people can be diagnosed later in life.

It’s not always straightforward and it’s one of the reasons why seeing an experienced clinician is so important.

Why is perimenopause often missed?

Deborah Garlick: We often see that people don’t recognise perimenopause, and that’s when this can all start.

Dr Clare Spencer: Exactly. Menopause is defined as 12 months without a period, but perimenopause can begin years earlier.

What’s key is that it’s not just low hormones — it’s fluctuating hormones. Those changes can be quite erratic, particularly in early perimenopause.

For neurodivergent individuals, there can be greater sensitivity to those fluctuations, which means symptoms may:

• start earlier
• feel more intense
• be harder to interpret

And if someone isn’t tracking their cycle or is using hormonal contraception, it can be even harder to recognise what’s happening.

What came through in the Q&A?

Sally Leech: There were so many people sharing their experiences. A lot of it was about confusion, burnout and struggling to be heard.

We had people saying they’d always found life challenging but that perimenopause made everything feel unmanageable. Others talked about coping strategies collapsing, particularly during periods of stress or change. There were also questions around:

• how to even begin the conversation with a GP
• feeling dismissed or not taken seriously
• confusion about diagnosis and where to start

How can people advocate for themselves?

Dr Clare Spencer: It can be really difficult, especially when you’re already feeling overwhelmed. A few things can help:

• keeping a diary of symptoms and patterns
• noting any links to your cycle or hormonal changes
• being clear about how symptoms are affecting your day-to-day life

If you think you may be neurodivergent, seeking a diagnosis can be helpful, as it may open up access to more tailored support.

But if you’re not being heard, it’s important to keep going back, ask for a referral or seek out a clinician with experience in this area.

It may take time and more than one attempt to find the right support, but it is possible.

Is HRT the answer?

Sally Leech: There were questions about HRT — whether it’s the solution.

Dr Clare Spencer: HRT can be incredibly helpful for many people, but it’s not the only answer and it’s not always straightforward.

For neurodivergent individuals, there can sometimes be greater sensitivity to hormonal changes or medication, which means:

• side effects may feel stronger
• adjustments may be needed
• it can take longer to find the right balance

It’s about individualised care. There isn’t a one-size-fits-all solution.

What about support at work?

Sally Leech: There were also questions about how this shows up at work and what support looks like.

Deborah Garlick: This is where it becomes really important for organisations to understand that people may not have all the answers themselves.

Someone may not yet have a diagnosis. They may not fully understand what they need. But they know something isn’t right.

That’s where supportive workplaces make a difference. You don’t need a diagnosis to have a conversation or to ask for reasonable adjustments. What matters is:

• listening
• taking people seriously
• being open to working together to find a solution

And importantly, keeping the conversation going. Needs may evolve as someone better understands what’s happening for them. 

Why this matters now

Deborah Garlick: We’ve seen huge progress in menopause awareness over the past decade, but this conversation shows how much more there is to understand.

Dr Clare Spencer: This is still an emerging area in terms of knowledge. There is a lack of research and we need more evidence to fully understand the links.

But what we are hearing from lived experience is incredibly important. The intersection between neurodivergence and menopause can affect people cognitively, emotionally and physically.

And as always, thank you to everyone who shared so openly. These sessions matter because they help people realise they are not alone.