In the early 2000s, the Women’s Health Initiative study and its well-publicized concerns around increased cancer risk for women using menopause hormone therapy (MHT) set treatment for menopausal symptoms back decades. (It’s a much longer and more biostatistically intricate story than I will provide here, but you can read about the WHI and its major study limitations in a variety of places, including the fantastically well-researched book “Estrogen Matters,” by Avrum Bluming MD and Carol Tavris Ph.D).

In brief, prior to the problematic WHI study results being released, 29% of menopausal aged women in the UK were using MHT. After the WHI results and the accompanying alarming press coverage, this figure decreased to between 10 and 11% of women in this same age group. Similar decreases were seen in the US and Canada as well. In short, healthcare providers and women alike were afraid to utilize what we now know as health-promoting (and in some cases, lifesaving) treatments.

Without access to MHT, women were forced to largely accept uncomfortable and sometimes debilitating perimenopause symptoms, silently suffering and feeling bad that they were unable to think, feel and perform as they once had. Newer research as well as additional analysis of the original data in recent years has demonstrated that MHT is largely safe, and can be highly protective against chronic disease, some forms of cognitive decline and bone loss. This review article succinctly recaps the issues and why the original data was not sound.

The most recent position statement from the North American Menopause Society (NAMS) now states:

“Hormone therapy remains the most effective treatment for vasomotor symptoms (VMS) and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture.

The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation, and whether a progestogen is used.

Treatment should be individualized using the best available evidence to maximize benefits and minimize risks, with periodic reevaluation of the benefits and risks of continuing therapy.

For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is favorable for treatment of bothersome VMS (vasomotor symptoms, i.e. hot flashes) and prevention of bone loss.” (NAMS, 2022)

As a result of this newer guidance and the growing numbers of women entering the perimenopause years, women are increasingly speaking out -- loudly and widely -- about their symptoms and demanding appropriate hormone treatment.

Because so many women felt “gate-kept,” gaslit or otherwise kept at arm’s length from MHT, there has been a pretty significant groundswell in mainstream and social media, offering up opinions, resources, testimonials and calls to action for women in this age 45–55-year-old (generally) age group.

By 2030, the number of women aged between 45 to 55 will reach nearly 500 million, meaning that roughly 6 percent of the world’s population will be in menopause. (CDC)

In the past several years, dozens, if not hundreds, of books, podcasts, websites and even an Oprah television special have widely discussed the “menopause trend.” (We could now talk about how business is now trying to massively monetize (peri-)menopause, but frankly that will need to have its own separate lengthy post). Clearly, women in their 40s, 50s and 60s are not going quietly into middle age!

Overall, this attention and focus on understanding and treating perimenopause symptoms great for women. At the same time, it’s a flood of information that isn’t always accurate or immediately actionable for all women.

Who’s Still Missing from Much of the Research and Conversation?

While we know so much more about the menopausal transition now than we did 5, 10, 20 years ago, there’s absolutely more to learn to truly support ALL individuals who will undergo this phase, including non-binary individuals born female at birth, trans men, and neurodivergent women.

The rest of this article will focus on the latter group; neurodivergent (ND) women. Neurodivergence encompasses a variety of different neurological and cognitive differences, but for the purposes of this article I am using ND to refer specifically to autistic women, women with ADHD (attention deficit hyperactivity disorder) and women with both conditions (“AuDHD”).

To help you understand why these ND women may require additional resources, supports or treatments during the menopause transition, here are a few important points to consider:

Women are grossly under-diagnosed with autism and ADHD (see my upcoming post for history, reasons and data on this maddening and health-depleting situation).
Perimenopausal women with ADHD experience increased health risks as compared to their neurotypical (NT) peers, including an elevated risk of cardiovascular disease, increased brain deficits and memory challenges, and an increased risk of developing an eating disorder.
Individuals with ADHD tend to have lower levels of dopamine than NT individuals. Dopamine is a key neurotransmitter responsible for things like attention, memory, motivation, sleep, mood and emotional regulation. During perimenopause, dramatic decreases in estrogen levels lead to a corresponding drop in dopamine levels (up to 30%!), leaving ADHD women struggling (even more) to manage everyday life.

“It is understandable that when oestrogen is low or declining in an individual in whom important neurotransmitters such as dopamine are already low or dysregulated, these 'shortages' reinforce each other. Thus, women with ADHD may experience increased impairment in their mood, cognition, memory, sleep, and other domains of functioning.”

ADDitude Magazine surveyed 4,000 women with ADHD in 2022 about the impact of (peri)menopause. 70% of women said ADHD had a “life-altering” impact in their 40s and 50s, with 50% of women calling their ADHD “extremely severe”.
The National Autistic Society in the UK notes that autistic women may struggle with a number of issues during perimenopause and menopause, including intensified sensory sensitivities, difficulty with mood and emotional regulation, executive function challenges, difficulty with the lack of predictability around bodily or sensory experiences, difficulty recognizing internal body states or needs, difficulty recognizing and communicating emotions, and difficulty seeking support.
Women with ADHD and/or autism tend to have heightened reactions to hormonal changes. This may be one of the reasons many girls go undiagnosed until puberty, and why so many ND women struggle mightily with monthly PMS (pre-menstrual syndrome) or its wicked stepsister PMDD (pre-menstrual dysphoric disorder). Post-partum depression symptoms have been shown to be three times more prevalent (58% vs. 19%) in women with ADHD vs NT women.
While we don’t have a lot of studies specific to women with ADHD in perimenopause, other studies that evaluated the hormonal effects of pregnancy or usage of contraceptive hormones in women with ADHD have shown a marked increase in mental health disorders at times of peak hormonal change. So it stands to reason that the menopause transition may also be much more challenging for ND women than NT.
(Exciting update: A brand new review article was published this week from a group of researchers in Europe, which sheds some important light on the research gaps and challenges facing ADHD women at various points in the lifecycle. See article #5 below in the section on Sources & Resources).
A 2021 qualitative study found that mental illness and suicide risk peak at menopause for Autistic women.
Recent studies have begun to look at altered responses to typical menopause hormone therapy in neurodivergent women. Or, put in simpler terms, it’s entirely possible that ND women may require different MHT dosages, formulations or treatment strategies than NT women.
Cognitive changes often observed during the menopausal transition may also affect ND women differently, highlighting a potential need for updated medication strategies for ADHD, anxiety or depression as ND women age. Previously effective medications may no longer be as helpful, and individuals may require updated doses or new medications to help manage mental health symptoms.

The Big Picture

All of this is to say that neurodivergent women — who already struggle with executive function, memory issues, sensory challenges or mental health issues — are not just rolling into perimenopause on Easy Street. It’s really f-ing hard out there and most existing resources are not tailored to their needs.

And, most healthcare providers are not well-attuned to a) the menopause transition in general, b) how ND women’s learning styles and brains differ from those of NT women, and c) how ND women experience perimenopause and menopause differently; emotionally, physically and cognitively.

While I’m not a medical doctor, I am a healthcare provider and I see these women in my office EVERY. SINGLE. DAY. They are frustrated. They are confused about what is happening with their bodies and brains. They are either told to be REALLY SCARED of the body and health changes coming their way in the menopause transition (“omg your cholesterol! omg your blood sugar! omg your weight!”) or told “It’s no big deal” when it comes to symptoms and they should just tough it out.

They are also struggling to make diet and lifestyle changes, take prescribed medications and supplements, or figure out what their most pressing concerns are, because their brains are maxed out. And then they are shamed for not doing what they were told to do by the “experts.” (As if it’s all as simple as turning on a light switch). Grrrr.

My goal, in the coming months, is to build resources to support these women in a way that “meets them where they’re at.” To help them create and sustain changes to diet, exercise, sleep and lifestyle that can have real and lasting benefits on health, well-being and quality of life. Without making people feel like garbage. There’s enough of that in our lives already.

I’d love to hear from other women who relate to this topic about what’s hard for you, what might help, and just to commiserate. Message me!

*Important disclaimer: Not every can, should or needs to take menopause hormone therapy. Menopause transition symptoms can be highly variable and each woman’s genetics, health history, age, stage of life and lifestyle will factor in. Talk with your healthcare team about specific treatments for your individual needs.

Sources / Resources / Read More About This Topic:

Stute P, Marsden J, Salih N, Cagnacci A. Reappraising 21 years of the WHI study: Putting the findings in context for clinical practice. Maturitas. 2023;174:8-13. doi:10.1016/j.maturitas.2023.04.271
Gunter DJ. ADHD and Menopause: What We Know and What We’re Learning. The Vajenda. July 1, 2025.
3. Osborn C, PsyD MJ, Lin J, MS RJ. ADHD and aging. Understood. March 25, 2025. https://www.understood.org/en/podcasts/missunderstood/adhd-in-women-menopause
4. ADHD and hormones in women. https://www.drlouisenewson.co.uk/knowledge/adhd-and-hormones-in-women
Kooij JJS, de Jong M, Agnew-Blais J, et al. Research advances and future directions in female ADHD: the lifelong interplay of hormonal fluctuations with mood, cognition, and disease. Front Glob Women’s Health. 2025;6. doi:10.3389/fgwh.2025.1613628
Moseley RL, Druce T, Turner-Cobb JM. 'When my autism broke': A qualitative study spotlighting autistic voices on menopause. Autism. 2020 Aug;24(6):1423-1437. doi: 10.1177/1362361319901184. Epub 2020 Jan 31. PMID: 32003226; PMCID: PMC7376624.
Understanding ADHD in Women with Dr Jessica Agnew-Blais.; 2024. Accessed July 23, 2025.
“Why ADHD Is Different for Women: Gender-Specific Symptoms & Treatments” ADDitude. October 22, 2020. https://www.additudemag.com/webinar/adhd-in-women-symptoms-treatment-support-podcast-337/
Dorani F, Bijlenga D, Beekman ATF, Van Someren EJW, Kooij JJS. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research. 2021;133:10-15. doi:10.1016/j.jpsychires.2020.12.005
Craddock E. Being a Woman Is 100% Significant to My Experiences of Attention Deficit Hyperactivity Disorder and Autism: Exploring the Gendered Implications of an Adulthood Combined Autism and Attention Deficit Hyperactivity Disorder Diagnosis. Qual Health Res. 2024;34(14):1442-1455. doi:10.1177/10497323241253412