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 overlap
Why burnout can feel cyclical and retraumatising
The grief of losing your “high-functioning” self
Why doing less is not failure
How internalised ableism worsens burnout
Practical ways to stabilise instead of “fix” burnout
Why neurodivergent burnout recovery is the opposite of neurotypical advice
This is not a polished recovery guide. It’s what burnout actually looks like while you’re in it.


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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 underrepresented
The risks of silence and lack of support
The importance of lived experience alongside research
What to expect if you take part
If 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&A
Content 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&A
Tell 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 voice
We 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&A
By 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]
Let’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 me
For 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
* Irritation
Urinary 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 orgasm
Physical 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 2025
If 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 risk
The 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 – End

Resources:
Meno-D: A rating scale to detect depression in menopause

The 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 Title
Why So Many Women Don’t Know Their Own Anatomy
Episode Description
In 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 bodies

A note on language
This 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.


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