Divergent Menopause (previously The Autistic Perimenopause)

Sam Galloway
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  • MENTAL HEALTH

Fiercely advocating to raise awareness on temporary fluctuations and regressions in capacity during our neurodivergent menopause transition. A safe space for our community to unmask, co-regulate, and share knowledge to self-advocate. samgallowayaudhd.substack.com

  1. 4D AGO

    You’re Not “Dry.” You’re Underinformed.

    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

    17 min

  2. MAR 27

    (Live) Perimenopause as a Burnout Accelerant 🎥🎧💕

    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

    1h 40m

  3. MAR 17

    Who Taught Us Not to Know Our Bodies? 🎥💕🗝️

    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. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    19 min

  4. MAR 13

    The Autism Establishment Has a Problem

    The recent debate sparked by autism researcher Uta Frith has exposed a growing divide between traditional autism research and autistic lived experience. As more adults identify as autistic and the autism spectrum continues to expand, an increasingly urgent question emerges: Who gets to define autism? Researchers? Clinicians? Or autistic people ourselves? Read the full article on Substack: Divergent Menopause Direct link to the essay post In this episode, I unpack the controversy surrounding recent interviews with Professor Dame Uta Frith and reflect on what the debate reveals about the past, present, and future of autism research. Drawing on my own experiences as an autistic ADHDer (AuDHDer), parent of autistic children, and survivor of perimenopause, PMDD and surgical menopause, I explore why many autistic people feel triggered by this discussion, and why autistic voices must be central in conversations about autism. In this episode • The controversy surrounding recent interviews with autism researcher Uta Frith • Why some researchers believe the autism spectrum has become “too wide” • The growing divide between traditional autism research and autistic lived experience • Why masking, sensory needs, and late diagnosis are still debated • How generational views of disability shape autism discourse • The rise of autistic-led research and advocacy • Why many autistic people feel distrustful of traditional research models • The urgent need for research that improves autistic quality of life • Future research questions that could genuinely help autistic people Topics discussed Autism research, Neurodivergence, Late autism diagnosis, Masking and autistic burnout, Medical misogyny, Self-diagnosis, The social model of disability, The double empathy problem, Neurodivergent mental health, Autistic menopause About the host Sam Galloway (she/her) is an autistic ADHDer (AuDHDer), writer, and creator of Divergent Menopause. Following her own experiences of neurodivergent perimenopause, PMDD, and surgical menopause, Sam writes and speaks about the intersections of autism, neurodivergence, hormones, and midlife mental health. Her work focuses on peer support, advocacy, and helping neurodivergent people navigate difficult transitions. Content note This episode includes discussion of: • medical gaslighting• medical misogyny• mental health services• suicide and suicidal ideation Please take care while listening. Discussion questions This topic has sparked huge debate online, and I’d love to hear where listeners land: • What do you think the biggest gap is between autism research and autistic lived experience? • Have you ever encountered professionals who dismissed masking or sensory needs? • What areas of autism research do you think deserve more attention? Support the publication If this episode resonated with you, consider becoming a paid supporter of Divergent Menopause. This publication runs on a patron membership model, and paid subscribers help fund independent writing and advocacy centred on neurodivergent lived experience. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    31 min

  5. FEB 14

    The Quadruple Empathy Problem

    Hello and welcome to Divergent Menopause with Sam Galloway. Today I'm going to read to you the quadruple empathy problem. Autism, ADHD, menopause, and why we are still the ones expected to adapt. Empathy. According to the Cambridge Dictionary, the definition of empathy is the ability to share someone else's feelings or experiences by imagining what it would be like to be in that person's situation. Empathy the ability to share someone else’s feelings or experiences by imagining what it would be like to be in that person’s situation Source: Cambridge Dictionary This Elder Millennial vividly recalls standing in front of the bathroom mirror in my locked family bathroom, aged 7 or 8 or so. Forcing tears to stream from my eyes, my crying voice rasping, feeling the hot slime from my sinuses dripping down the back of my throat, I didn’t feel sadness. Perhaps we can grow out of alexithymia, but the act of crying on cue did not prompt emotion. Reflected back to me in the mirror was a girl who cried, smiled, and laughed at all the wrong times. Many hours were spent alone learning to morph my face to look how it was expected of me. “Too much”, “not enough”, “too sensitive” and “insensitive”, were some of the labels attached to me whenever my childhood response was perceived to be misaligned with the social expectation. Learning the rules of emotional expression was arduous and exhausting. Watching the neurotypical girls whisper about me, then trick me into thinking they were my friends before not long later calling me fat, ugly and ginger, was my daytime schooling. Where was their empathy for me? Burnout regularly ensued. Life was endlessly confusing. For reasons still unclear to me, as a girl screaming and crying in pain when I was injured and hurting was deemed over the top. Yet silently sobbing myself to sleep was apparently fine. I learnt that as long as I could hide my emotions from others, I was safe. The agonising intensity of my emotions was not for public consumption, and my pain and anguish was supposed to be kept private. Crying into the mirror, was an instinctual exercise in social masking. Self-set homework was studied only by the special girls like me, in secret, whilst everyone else got on at home with learning more traditionally academic subjects, and playing with easily found and kept friends. My social skills learning was autodidactic in my early years, but would pay off in time when I took it upon myself to achieve an upper second-class honours degree Bachelor of Science in Psychology. The classic Psychology undergrad degree A.K.A. the neurodivergent thinking woman’s endeavour to cognitively grasp concepts behind individual and collective human thoughts, motivations, neurology and behaviours. Including (neurotypical) empathy. Using our strengths of curiosity, pattern recognition and intellect, we endeavour to compensate for the neurodevelopmental lagging skills that made too many of our childhoods a misery. The unrelenting stereotype of neurodivergent people is that we cannot comprehend the emotions of others, never mind be able to empathise with them. It would still be two decades before my autism and ADHD were identified. Despite our extreme efforts to performatively show our emotions in a dignified, standardised and socially acceptable manner, many female and AFABs pre-diagnosed autistic, ADHD and AuDHD can also gaslight ourselves into thinking that we can’t be neurodivergent. How can we be neurodivergent when we show too much emotion, rather than none at all? Our emotional dysregulation can trigger us to weep, and seeing such intense public displays of empathy can make other people uncomfortable. Neurodivergent empathy looks different. But our late identification has prompted family members and society at large to think that we are just jumping on the “latest trend” of autism and ADHD. For those of us who are exquisitely high masking and often with co-occuring giftedness, the assumption is that we can empathise in a neurotypical way, but we choose not to. Too often, we are regarded as arrogant, manipulative, and over- or under- performative. When we eventually receive a diagnosis, having fought a lifelong battle to fit in with the people who love us the most yet understand and accept us the least, it becomes clear that neurotypicals also have difficulty showing us empathy. Our emotions look different. Our empathy looks different. Many late diagnosed neurodivergent women and AFABs, consider ourselves to be deep empaths. For decades, we have masked our emotional intensity, and yet we are often the first to donate to worthy causes and to cry at distressing world news stories. The challenge for us isn’t whether or not we can respond emotionally to others. The challenge for us is self-regulating our emotional responses. When the intensity of our emotional responses is socially unacceptable, we are labelled “too much” and/or “not enough”. Sobbing in work meetings. Melting down during minor disagreements. Shutting down when newly bereaved. Our emotional intensity sets us apart from the majority. To me, this is an advantage to being neurodivergent. But we hide it, moderate our emotional responses, and stop our faces from giving us away, in order to avoid rejection. When the societal norm is to visibly empathise swiftly then move on, our deep empathy is feared and misunderstood. Public crying is deemed shameful, and being told to “grow up” as kids really meant “keep it to yourself”. Hiding our pain doesn’t stop us from feeling it. We made it our mission to pass for normal, and we were picked apart regardless. Our natural response as neurodivergents is pathologised as emotional dysregulation, and we are medicated, therapised and/or shunned to obscure our differences from the world. Many of us learn to shield ourselves from our emotional triggers, for example, by actively avoiding live footage broadcasts of global catastrophes, and the effects of their aftermath. Other neurodivergents may enter politics, education and other influential institutions to try and change systems from the inside in a bid to improve life chances for all, reverse the climate crisis and drive other social justice causes that they empathise with deeply. By midlife, we have learnt to mask and moderate our neurodivergent empathy and emotional responses. Repeated rejections, perceived “failings” on our part and collapsed relationships have taught us to hold it all inside whatever the cost. Lived experience tells us that we are not safe acting as ourselves in the world at this time. It can be hard to know where the line is between who we inherently are, and who we are pretending to be. We may know when we are okay to be around other people, scheduling our social engagements around our menstrual cycle. Some days and weeks we can’t be trusted to people. As highly sensitive people, we respond to our hormones with the entirety of our minds and bodies, and so we may avoid certain people and activities when hormonal volatility is predicted. Hormonal flux becomes unpredictable as we approach the menopause transition. We no longer possess the self-regulatory capacity to moderate our every word, action and facial response. Regressions in functioning occur, and our second nature skills of masking are lost. It can be terrifying to go into meltdowns from triggers that you have coped with masked for decades. In perimenopause, this can trigger the sense of intense loss of self. But there is light at the end of the tunnel. In the later stages of neurodivergent perimenopause and beyond, fewer f***s are given. Literally and metaphorically. We can come back to ourselves, find our neurotribe, and settle into a lifestyle that lends itself to managing our energy expenditure. We align the generous gift that is our empathy where it is validated, wanted and most needed. Neurodivergent-driven research on the topic of empathy in the menopasue transition is developing, and what follows is a selection of the work on empathy so far. The Double Empathy Problem Many of us late diagnosed neurodivergent adults will have come across the theory of the double empathy problem whilst trying to figure out why we have felt so misunderstood for much of our lives. Often attributed as an issue for autistic people when communicating (or trying to) with neurotypicals, the double empathy problem originates from a much wider concept. First coined “the double empathy problem” by autistic researcher and sociologist Dr. Damian Milton in 2012, Milton drew on the notion that people of different cultures may often struggle to find some common ground, and experience communication breakdowns in the process. ‘Simply put, the theory of the double empathy problem suggests that when people with very different experiences of the world interact with one another, they will struggle to empathise with each other. This is likely to be exacerbated through differences in language use and comprehension.’ UK National Autistic Society: The double empathy problem Misunderstandings in mixed neurotype relationship dynamics have for too long been considered the fault of the neurodivergent partner. And this goes for all types of neurodivergence, despite the strong link the autistic community has with the double empathy problem. It is just as likely to be an issue for a stereotypically enthusiastic and energetic ADHDer or AuDHDer to be brushed off as “annoying” and “too much”. The double empathy problem theory provides reassurance that we are not the problem. Our supposed social deficits and communication differences are only apparent and obstructive when we are communicating with people who do not share our neurotype. This is why finding our neurotribe is invaluable to adults who self-identify as or are diagnosed neurodivergent. “I don’t understand you” is too frequently said to neurodivergents by their neurotypical partners, as tho

    26 min

  6. JAN 16

    This Barbie Has No More F***s Left 💕 🌸 🎧

    For anyone who’s ever silently lost their s**t at doctors, hormones, or Ken: this is your AuDHD Barbie, finally done pretending. Originally titled. "Introducing AuDHD Barbie". Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression. I am Sam Galloway (she/her), an autistic ADHDer, 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! 🎢 This is a snapshot in time of Barbie in midlife, who is late diagnosed Autistic, with co-occuring ADHD (AuDHD), in the throes of hormonal flux and she does not have enough f***s left to give. In this spoof piece, let me take you into Barbie’s messy Dream House where our protagonist can safely self-regulate and drop her social mask… AuDHD Barbie - or just “Barbie” to her friends - ignored her ringing phone, as Ken came through to her voicemail message: “Hi, it’s Barbie. Please do not leave a message. Text me, but only if it is important. Bye.” “For f**k’s sake, Ken”, Barbie muttered under her breath finally picking up as Ken rang through yet again. “This had better be important”, Barbie seethed down the line. “No, I don’t want to go to the beach party. I already told you! None of my clothes fit me anymore and my stupid period just started. How can I be bleeding again? It is only sixteen days since my last - hello? Ken?!” The dead phone line was the most soothing sound Barbie had heard all day. Barbie high fived herself. Period talk always made Ken cut his conversations short. Barbie believed that sand was cursed, and a cold shiver coursed through her body at the thought of ever having to go to another beach party again. This gave some light relief to her otherwise 24/7 hot flush. It was all right for Ken to go, he wasn’t experiencing hormonal mania making him rapidly lose muscle mass, bone density and his entire sense of self. Yes, things were just fine for Ken as always. Whilst he grinningly pumped iron and mainlined a creatine and protein powder blend on the daily, Barbie was forgetting to eat. Her only exercise was to burn calories through hanger-induced meltdowns. Her lifelong body dysmorphia was now at its peak. Looking down at her bloated meno belly, Barbie felt that she was retaining more water these days than there was in the entire ocean. ‘Calorie deficit diets’ were no longer working for her. Nor was intermittent fasting, the 5-2, Mediterranean, Paleo, Keto, Whole30, low FODMAP, low histamine, or eating only even numbered quantities of beige foods during even numbered hours of the day. Barbie collapsed into her sensory swing, kicked off her high heels and threw them across the room. They had been digging into her cankles, and she applied an ice pack to the ankle she had badly rolled earlier that day. Not for the first time, she dry heaved at the sight of the thick dark hairs growing at right angles out of her once dainty feet and toes. What is wrong with me? she wondered to herself. I used to love beach parties and hanging out with Ken. Now I just want to kill him every time he comes near me! God, he is such a dick. Barbie excavated the teetering mountain of hot pink dirty laundry to find the remote control for her cooling fan, trying not to disturb her sleeping cats. Turning her fan on to the max helped redistribute the air flow, which was currently carrying the unmistakable odour of the cat s**t in the nearby litter box. For f**k’s sake, Ken! Barbie thought to herself again, as rage filled every fibre of her being faster than any number of mindful deep breaths could diffuse. Scooping the cats’ s**t is a blue job. Why haven’t you f*****g done it? Even if she had wanted to, Barbie couldn’t scoop the litter boxes; not with her tennis elbow, frozen shoulder and splinted hypermobile wrist that her doctor had said in no uncertain terms were not symptoms of perimenopause. “Well, Ms AuDHD Barbie, you are in the prime of your life”, the doctor had told her earlier that day, whilst attempting to look both up her itchy short skirt and down her scratchy scoop neck top. Barbie could feel hives emerging across her chest, but she resisted agitating them with her brittle nails. She would wait until she got home, and then rub them raw until they bled. Bliss! “Allow me to assure you that you are too young to be experiencing menopause symptoms”, her doctor went on. “And, might I add, that you do not look autistic, and you are far too successful to have ADHD. Your lab results are fine. Your estradiol is at normal levels. You are still a very fertile young woman.” His lack of eye contact was now vexing her, ironic given that her own reported discomfort at holding a gaze was flagged in her recent autism assessment. Yes, for decades she had masked endlessly, with her iconic plastic moulded smile rouged to constant perfection. But now she felt ready to tear off the mask and stamp on it right there and then in the doctor’s office. “Look,” the doctor had gone on, “I will note your concerns but, for the record, I am of the professional opinion that you have nothing at all to worry about. You are seeking diagnoses unnecessarily. There is no cure nor treatment for neurodivergence or perimenopause anyway. This trend of over diagnosing autism and ADHD is getting out of hand! We all know that males are 1,000,000 times more likely to be neurodivergent than females. Not to mention the fact that women cope with it. Why would a woman of your standing want a diagnosis when you have managed fine all your life until now?” Barbie was mute. Situationally, not selectively. Despite scripting the discussion in advance over and over in her head, she could feel her neck and face burning, hot tears pricked her eyes. She sniffed them back. A thousand retorts would fire around her mind like pinballs in the hours and days that would follow, yet for now she froze in despair and panic. Her ever saggier face remained static, fixed with a wry smile. Barbie’s now unfocused eyes were blurring off into the distance, as she wished she could be anywhere else. “This is all in your pretty little head. How does Ken feel about all of this?”, the doctor went on. “I can increase your SSRI dose but I cannot offer you hormonal therapy because the significant risks are not worth the supposed benefits. You are fine. Keep doing what you are doing. I am here any time you need to see me for support and advice.” Barbie was already so f*****g sick of being objectified and patronised, but medical gaslighting was a new one on her. She decided not to tell this professional pervert all the other worries she had noted down to prompt the consultation. Bleeding gums. Loose teeth. Itchy ears. Cognitive decline. Urinary incontinence. Insomnia. Losing all her stuff. Suicidal thoughts. And that the sight of Ken in all his so-called glory did nothing for her anymore, and that she was feeling dead inside. Particularly ‘downstairs’. Her vagina was rapidly becoming nothing short of warped, and some prolific Googling of the mind-blowing symptoms of perimenopause had led to a self-diagnoses of vaginal atrophy and pelvic organ prolapse. If Ken only knew that my vag feels like someone has taken a cheese grater to it, and that my kamikaze uterus is doing it’s best to sacrifice itself, Barbie thought, he might stop calling me all the time and let me live in peace. No. Despite feeling broken, Barbie hadn’t mentioned her more sensitive gynaecological ailments to this doctor, and instead made a mental note to find a neuro-affirming menopause specialist doctor, and develop her self-advocacy skills. Back in the sensory sanctuary of her Dream House, Barbie slipped into something a little more comfortable to see her through her impending shutdown. A black hoodie, compression tights that covered her multitude of coffee table bruises, and her noise cancelling earbuds. She zoned out listening to a perimenopause podcast to help her feel sane, informed and less alone. Barbie took off her shiny sleek blonde wig to free her own matted, unwashed hair, doused her hair in dry shampoo then tied it back out of her face. The regular intrusive thought of shaving her head returned, and she blinked and cleared her throat ten times whilst humming to try to make it stop, whilst pulling out tangled clumps of fallen hair from between her fingers. Barbie was alarmed at the amount of hair she was losing, and her male pattern hair loss and receding hair line made her cry in secret most days. The wig was just easier now than dealing with her own hair, and facing questions about it. Until she found a better doctor, she didn’t have the right answers anyway. 🩷 How are you feeling about Mattel’s announcement of the new Autistic Barbie? 🩷 Let me know in the comments! Cheers, and Thanks for reading Divergent Menopause. Paid subscribers make this work possible. 💕🐈 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    11 min

  7. JAN 3

    (Live) Perimenopause, Medical Gaslighting and Estrogen Patch Inefficacy

    Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression. I’m Sam Galloway (she/her) and I am an AuDHD woman four months into surgical menopause (hysterectomy and oopherectomy). If you are interested about why I needed the surgery, you can read more here. Thanks for joining me on this wild midlife ride! 🎢 Thank you to everyone who tuned into my live video with Sonia Voldseth, the creator of Menopause & Misogyny! TL;DR * This advocacy-focused conversation documents real harm caused by estrogen patch failures and loss of choice in Aotearoa New Zealand. * When menopausal and neurodivergent women aren’t believed, symptoms escalate into cognitive, emotional, and physical crises. * Menopause care is essential healthcare. It is not optional, not cosmetic, and not something women should have to fight this hard to access. Sonia and I are both fortunate enough to live in Aotearoa New Zealand. Sonia, originally from the United States, lives surrounded by mountains in Queenstown on the South Island, and I, London Irish in origin, enjoy beachside life on the Kāpiti Coast near the bottom of the North Island. Unfortunately Sonia and I have both been affected by the ongoing oestrogen patch debacle. In 2024, we saw a global shortage of oestrogen patches, which I wrote about here. Currently there is laboratory testing underway in response to many people reporting that their menopause symptoms have returned despite staying on the same dose and brand. This has coincided with a new formulation of this vital hormone therapy treatment. My fellow pedants may notice that today I can’t decide whether to spell it “oestrogen” (UK and NZ) or “estrogen” (US), but please know that I am referring to the same hormone, regardless of the spelling used. Remarkably, the sedatives and general anaesthetic still have lasting effects on my capacity to write articulately, now four months after my total hysterectomy with bilateral salpingo oopherectomy (cervix, uterus, ovaries and Fallopian tubes removed). Surgical menopause has been life saving to my mental health, energy capacity and general functioning, so I am not complaining. But, rather than feeling able to summarise our discussion myself, instead I include ChatGPT’s offering below. As ever, for accessibility, you have the options to watch the video (with or without closed captions), listen to the audio and/or read the transcript. AI-Generated Timestamped Summary 00:00 — Why this conversation matters 02:31 — Progress made… then undone 05:31 — Estrogen patch shortages & loss of choice (NZ) 09:01 — Symptoms returning on the same dose 12:01 — Collective patterns, individual gaslighting 15:31 — Neurodivergent risk & mental health impacts 18:31 — Estrogen as a brain hormone 22:01 — Why “just switch to gel” isn’t simple 25:31 — Sleep collapse as the red flag 28:31 — Admin, advocacy & exhaustion 32:57 — Suspected formulation change (mid-2025) 34:31 — Medsafe reporting & deflection 36:05 — User-error narratives & systemic gaslighting 37:42 — Absorption differences & dosing reality 39:58 — Brain fog, language loss & regression 41:25 — Estrogen receptor saturation explained 44:19 — Menopause is serious, not “just hot flushes” 45:37 — Generational harm & WHI fallout 47:03 — Surgical menopause & compounded harm 48:37 — Aging with quality of life 49:30 — Vaginal estrogen, bladder health & prolapse prevention 52:35 — Prolapse, gatekeeping & specialist care 54:38 — Medical training gaps (global) 55:10 — Vaginal estrogen & cancer-risk reassurance 56:07 — Solidarity over infighting 56:56 — Closing reflections, access & hope Thank you to fellow AuDHDer and PMDD survivor Kim Pitts for chatting with us in the comments about her personal experience of menopause and medical misogyny. Kim and I have previously chatted live (link below) and here is Kim’s Auti Peri Q&A. Cheers, Sam This work exists through collective care. A paid subscription is a meaningful way to support Divergent Menopause in 2026. Thank you! 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    1h 1m
  8. Anti-Goals: When Goal-Setting Makes Things Worse

    JAN 2

    Anti-Goals: When Goal-Setting Makes Things Worse

    Hello and welcome to Divergent Menopause, previously known as The Autistic Perimenopause: A Temporary Regression. I’m Sam Galloway (she/her) and I am an AuDHD woman four months into surgical menopause (hysterectomy and oopherectomy). If you are interested about why I needed the surgery, you can read more here. Thanks for joining me on this wild midlife ride! 🎢 Hello and Happy New Year to you! And just like that we are in 2026. Hooray, we made it! Ageing is a privilege, but it isn’t easy. All we can do some days is take one step at a time, one breath at a time, and keep on keeping on. And that is more than enough. Around this time last year I wrote an article about Anti-Goals, and it is still being read and shared daily! It is by far my most popular post so far, and it captures the spirit of those of us who reject and repel the January conventions of self-improvement. Demand avoidance is running high in my life and I have long been wanting to write a follow up article. My brain has forbidden it though, so I have compromised with myself and recorded this follow up video on the topic for now instead. As always, the video is optional and is accompanied by an audio only podcast alternative, and/or a transcript. For accessibility’s sake, I also include below a timestamped summary provided by ChatGPT. What’s helping you get through right now? What do you wish you had more support with? If you want to share in the comments, you’re welcome to. One word or an emoji is more than enough. ⏱️ AI-Generated Timestamped Breakdown 00:00 – New Year’s resolutions are nonsense (for many of us)Why January pressure is unrealistic, especially during hormonal flux, and why time is a social construct anyway. 00:01 – Why goal-setting can fail demand-avoidant brainsIntroducing anti-goals and why avoiding harm can be more useful than striving for achievement. 00:02 – When survival becomes the goalWhat anti-goals looked like at my lowest point: reducing pain, anxiety, depression, and suicidal ideation. 00:03 – You can’t reverse a spiral aloneWhy support and a plan matter — and why “starting from scratch” isn’t possible when you’re already overwhelmed. 00:04 – Different baselines, different needsWhy comparing yourself to people “optimising” their lives is harmful when you’re just trying to get through the day. 00:05 – Redefining success at homeFrom magazine-perfect homes to hygienic and safe: using tools (like a robot vacuum) to reduce energy drain. 00:06 – Pain management over fitness goalsWhy “I don’t want to be in pain” is a valid goal — and how medical support, warmth, medication, and pacing mattered more than exercise plans. 00:08 – Addressing the root causeHow hormonal instability drove pain, mood changes, and loss of self-care capacity — and why treating that came first. 00:09 – Hormonal treatment and surgeryMy path through HRT, chemical menopause, and ultimately hysterectomy/oophorectomy — and how stability changed everything. 00:11 – Survival before self-improvementWhy health span matters more than optimisation, and why there is still no clear medical model for neurodivergent menopause. 00:12 – Don’t waste energy on unachievable goalsChoosing meds, blood tests, and basic care over gyms, meal prep, or “doing it properly”. 00:14 – Accepting support is not failureWhy masking through struggle is dangerous — and how getting help allows us to later help others. 00:15 – Hormones as a buffer, not a cureMedication, therapy, cleaners, junk food, respite — whatever helps you get through now is valid. 00:16 – Incremental change, not January transformationsWhy progress is slow, nonlinear, and includes regression — and why that’s not shameful. 00:18 – Spending energy and money wiselyLooking at root-cause support (pelvic physio, hormone care, surgery pathways) rather than short-term coping fixes. 00:19 – What do you need right now?An invitation to reflect, share in the comments, and focus on getting through 2026 and beyond. 💛 Key Takeaway If you are neurodivergent and navigating perimenopause or menopause, your job is not to optimise yourself. Your job is to stay alive, reduce suffering, and be kind to yourself while you transition through this phase. Everything else can wait. That’s all for now. It is bedtime here and I am delighted to report that my menopausal sleep is phenomenally better than my perimenopausal sleep was this time last year! I hope that whatever you have planned for today, that you can afford yourself some peaceful time to rest. Cheers, Sam If this post helped you feel a little less alone, a paid subscription is how you support this work and help keep it going. No pressure! Just here if and when it feels right. 😊 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    20 min
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About

Fiercely advocating to raise awareness on temporary fluctuations and regressions in capacity during our neurodivergent menopause transition. A safe space for our community to unmask, co-regulate, and share knowledge to self-advocate. samgallowayaudhd.substack.com

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