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. Sep 18

    🎧 What If We Stopped Asking Which Kind of Perimenopause Care Is Right?

    Moving Beyond the Natural vs Medical Menopause Divide What happens when “natural” and “medical” become identities rather than options? In this conversation, Kate Codrington and I explore the pressure to have the “right” kind of menopause, and what happens when our beliefs about menopause care start to become rules we feel we have to follow. We talk about: the natural vs medical menopause divide why “natural” can become an identity rather than simply a preference the shame or sense of betrayal that can arise when we need medical support why menopause shouldn't become an identity test the pressure to cope without medical intervention the problem with replacing one rigid system with another self-advocacy when you don't know which path to take why Kate says “there's no rush” moving beyond the constant “is it this or that?” Kate's question: “Does this intervention make me feel more of myself or does it take something away?” why our menopause needs can change over time the importance of personalised and individualised menopause care the reality that access to menopause treatment options isn't equal for everyone One of the things I loved most about this conversation was the recognition that there doesn't have to be one fixed answer. As Kate puts it: “The lack of path sends us into a flat spin and then we grab hold of one thing or the other thing in a panicked kind of way.” Perhaps the answer isn't to find the correct menopause ideology. Perhaps it's to slow down, gather information, pay attention to ourselves, and ask what we need now. If you're listening rather than reading, come over to the post and tell us: Have you experienced the natural vs medical menopause divide? And has your approach changed as your menopause has changed? Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

    🎧 What If We Stopped Asking Which Kind of Perimenopause Care Is Right?

  2. Aug 27

    🎧 Dear Menopause: Thank You for Saving My Life

    One year ago, Sam Galloway entered surgical menopause following a hysterectomy and oophorectomy. After years of debilitating perimenopause, she expected menopause to be another battle. Instead, hormonal stability brought unexpected gifts: stability, certainty, clarity and the beginnings of cognitive recalibration. In this deeply personal follow-up to “Dear Perimenopause: F**k You”, Sam reflects on the first year of surgical menopause, neurodivergence, sensory overload, mood stability, cognitive changes, self-advocacy and what it means to stop trying to become the person you were before perimenopause. This is not a story about menopause being universally positive. It is one neurodivergent woman's story about finding unexpected relief after years of hormonal chaos. Content note: This episode discusses suicidal ideation, reproductive loss, miscarriage, ectopic pregnancy, medical trauma and mental health. 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! 🎢 Dear Menopause, One year ago today we became acquainted with each other when I emerged from my elective gynaecological surgery that gifted you to me. Even though I told my doctor last month that I think the honeymoon period between you and I has now worn off, I am still utterly enamoured by you! Happy First Anniversary to us! If you hadn’t arrived when you did, I am not sure I would still be here. Not only have yo usaved my life, but you have given me so many precious gifts that, now combined, vastly improve my quality of life. Stability. Thank you, Menopause, for the gift of stability. During the surgery, my uterus, cervix, one remaining Fallopian tube and - best of all - my ovaries were all removed. Yes, you are a medical and surgical Menopause and I know that many people see that as a bad thing, but I think you are The Best Thing that could have happened to me. Before we made things permanent between us, I had dallied with you. My hormone blockers induced a temporary, reversible chemical menopause was a great trial, but nothing else even comes close to you. Temporary ovarian suppression gave me some relief of my turbulent perimenopausal pre-menstrual dysphoria disorder (PMDD), but when you came along after my surgery I knew you were the real deal. My dear Menopause, you have stabilised my mood so that I am no longer at the mercy of my hellish hormonal flux. No more “good week” versus “bad week”, and no more rapid mood de-escalation. No more waiting to find out just how low I will go, this time. It is no exaggeration to tell you that you have saved my life. No more intrusive thoughts nor threats of harming myself or my family. No more suicidal ideation. My mental health and mood stability are at an all time high. Well, my mood itself is not at an all time high, but nor would I want it to be. Instead it stays within a narrower range of “safe” for the first time in my life. Does that feel boring sometimes? Yes, a bit. But it’s about time my ovarian hormones weren’t running the show. Certainty. Thank you, Menopause, for the gift of certainty. One of the worst things about Perimenopause for me (and there were so many horrendous things to choose from!) was the chronic uncertainty. It spiked my anxiety just wondering how long it was going to take. Would I be one of the lucky ones who has a shorter 8 year perimenopause, or would my transition have taken a lengthier 14 years? There was no way of ever knowing. It was a waiting game, and, as a neurodivergent ADHD woman with absolutely no sense of the passage of time, it had already felt like a lifetime of peri had consumed me. How I hated the changes that were occurring during The Change. I never knew what whack-a-mole symptom was going to ruin my day next. The sheer horror of having no control over my symptoms was abhorrent to me. My Autism makes me want to call the shots, or at least have a copy of the manual memorised. But there is no manual for neurodivergent perimenopause. No manual either for neurodivergence, nor for the menopause transition. What a sick joke to put us through all this prolonged uncertainty without a roadmap nor with the reassurance that we would survive the journey. My dear Menopause, you gave me the roadmap. All signs were pointing to you by the end. If my exhausting self-advocacy for my elective hysterectomy and oophorectomy (ovary/ies removal) hadn’t gone to plan, I had no hope of continuing on that road for the long haul. The certainty you have given me is multi-layered. The relief from being certain that I will no longer experience menstrual bleeding is enormous. Sensory overload came with every bleed I had ever had, and that s**t accumulated beyond belief over my three decades of menstruation. No more menstrual cramps ever. Now whenever I get a pelvic twinge, I can be pretty confident that I will find relief in using the bathroom - that my bladder or bowel is the culprit and that my lagging interoception won’t lead to me sitting on the sofa in a puddle of blood because Taskmaster hasn’t finished yet. As for the blood itself - the always shocking vibrancy, the smell, and its viscosity as it pooled then poured - I can’t even… Every perimenopausal bleed triggered me. After my five pregnancies, all planned and wanted, with only two children to show for it, every bleed I had in my thirties took me straight back in my mind to a time when I was losing a baby. Two early miscarriages and an ectopic pregnancy. When I met you, Menopause, it was my second major gynaecological surgery. Both saved my life. One ended a pregnancy, the other ended my fertility. I know that so many women are saddened by the loss of their fertility when you reach them, Menopause, regardless of their status as parents or not. But I needed you. You healed me from the medical trauma that had come before you. The first time I had woken up after in recovery, my abdomen covered in freshly sutured incisions where the laparoscopic camera and surgical tools had shortly before accessed my innards, I was screaming at the nurses to give me my baby back. Thus I was heavily sedated in my secede surgery when you arrived, Menopause, and I was glad of it. There was no question that I had wanted my reproductive organs removed, because it gave me the certainty of never losing a baby or a pregnancy again. Clarity. Thank you, Menopause, for the gift of clarity. The certainty you gifted me was accompanied by the clarity that the way I could see things from then on, no longer tainted by the highs and lows of my ovarian hormones. No more uterus after surgery meant no more progesterone needed to maintain the health of my uterine lining which meant no more progesterone intolerance which meant no more suicidal ideation. Yes, I could rephrase that dreadful sentence but now I have the clarity that what is left of my lifetime is short. My finite time and precious energy therefore hold greater value, and I need to stop wasting it with my formerly pedantic ways. Although I still do not sense the passing of time (Menopause, you have not cured my neurodivergence as I gratefully knew you would not), I now fully grasp the value of it. And that is why I still spend hours on the sofa watching Taskmaster and building LEGO sets. Not because I am in too much pain to move and need something else to focus on, which was the case over a year ago, but because I have now survived Perimenopause and, in my mighty wisdom and clarity, I know that the mighty Taskmaster Greg Davies and his assistant little Alex Horne are worthy of my valuable time and attention. Knowing where to spend and invest my time now is only half the story though. My dear Menopause, you now tell me when we are rapidly approaching a waste of our time, and we swerve it together. (Although, alas, my doom scrolling habit has not yet evaded me…) These days it is so much easier to ignore the b******t that surrounds us. Your gift of clarity comes with a wonderful capacity to moderate my tolerance for others. Namely, I have lowered my tolerance threshold so we can avoid anyone who doesn’t like this unmasked Menopausal version of me. Conversely, your presence brings with you an improvement of my rational responsiveness. I am less likely to meltdown, shutdown or become mute during times of stress and confrontation. My responses are more deliberate, and I can take a pause before I speak. My impulsivity is better moderated and, as and when I lose my s**t, I know it was deserved and not just a hormonal reaction. Recalibration. Thank you, Menopause, for the gift of recalibration. Perimenopause absolutely tore my highly masked undiagnosed neurodivergent self to shreds. I was already struggling to function in this world, when peri was established I was in tatters. No part of me was untouched by the hormonal flux. I regressed significantly, losing independence and self-care skills, reduced mobility, disengagement from everyone around me. It was jarring and terrifying, and many times I felt as though I was losing my mind. My cognitive regressions felt enormous, although they went largely unnoticed by others. Perhaps a combination of my residual masking capacity and the fact that most of my intellect was experienced in my inner world and had gone unseen for so long, I no longer felt like the same person anymore. My sensory calibration was wrecked, and I had no energy left to pretend everything was fine. And so I hid away at home, and kept my disturbing difficulties to myself. There I could control the sensory inputs and just about cope with them. It shrunk my world beyond belief. After surgery, the constant uniformity of my hormone levels caused my brain and body to

  3. Aug 20

    Dear Perimenopause: F**k You

    In this episode of Divergent Menopause, Sam Galloway reads her brutally honest “f**k you” letter to perimenopause. A decade of rage, grief, chronic pain, cognitive changes, suicidal ideation and medical uncertainty, ending with the decision that finally changed everything: surgical menopause. This is not a tidy menopause success story. It's a story about surviving a menopause transition that nearly broke her, and finding something unexpected on the other side. Why write a “f**k you” letter? It is so cathartic to rage onto the page all of that pent up anger, frustration and grief caused by a certain person or event. You can get all those things you wish you had said, the ones that are still keeping you up at night, out of your system which can feel like an enormous relief and release. I would not recommend sending it to the person though! You don’t want to invite more emotional harm or rekindle past conflict into your world. Some people like to ceremoniously burn their “f**k you” letters so that they are never discovered or read by anyone else. Take good care of yourself in the process, if it doesn’t feel like a helpful tool for you, or the right time to write a “f**k you” letter, it’s best avoided. This one flowed for me though! Let me know in the comments if you have ever written a “f**k you” letter. If so, did you found the process therapeutic, triggering or something else? Dear Perimenopause, I love to hate you. You were the bane of my assistance for too long, and still you are all I can talk about. Everyone is sick of hearing about you. When you first showed up, I knew it was inevitable. You arrived much sooner than I expected, and nobody believed me when I said you were here. Apparently I was too young for you or some b******t. You clearly didn’t give a f**k that I was in my mid 30s with two tiny kids, acclimatising to life in a new hemisphere. I thought I’d fallen on my feet arriving here in Aotearoa New Zealand in 2016, but out of nowhere you crept up on me, tripped me up, kicked me to the ground and shat all over me. Thanks for that, Perimenopause. I honestly thought I would eventually learn to live with you, but you wanted me dead. Now I see right through you. You are a dangerous and insidious silent killer. You choose the most vulnerable victims. Yes, Perimenopause, I know there are many people who love you, but they don’t know you like I do. They are the lucky ones. Why couldn’t I have had the version of you that other people revere? You’re supposed to be transformative, illuminating and empowering. What the f**k did I ever do to you to deserve this? The first sign of you was the burning inflicted upon my eyes. They were dry as f**k. The pain was so intense that I mistook you for sunburn, for hayfever, for eye cancer even. You frightened the life out of me. I had to pay to see an eye specialist. Do you know you’ve cost me a f*****g fortune in healthcare over the years, Perimenopause? Anyway, the eye specialist told me that my eyes were dry because of my age (whatever that means) at only aged 36 or so. My eyes are still dry nearly a decade later, and I apply lubricating eye drops all the time. All The Time. You cause me to cry tearlessly, you still put my family at risk when my eyes drive out and throb whilst driving, and you have stopped me from painlessly watching my children grow up. Perimenopause, you cost me their childhoods. My boys are now 14 and 11, and they still often ask me, “Why are you so grumpy, Mummy?” Every time, I blame you. Yes, you, Perimenopause. You have stolen years from me that I’ll never get back. You stopped me from being the calm mother I was born to be, and morphed me into this depleted, shambolic husk of my former self. Did you know I used to be a nursery/kindergarten teacher before I homeschooled my own kids? Together my students and I explored this magnificent world with curiosity and joy. But then you came along and turned me into hateful, shameful woman who frequently dissociates from those I hold most dear just to make it through each day. Until I met you for myself, I knew nothing about you, except that people avoided talking about you for some reason. When I was a child, you were only mentioned in hushed whispers and euphemisms like “women’s problems” and “the change”. I think it’s because they were scared of you, and too many people still are. Your medical demands have cost me the money I could have spent exploring this not-so-magnificent-anymore world with my own children: shaping their futures and building them up. Instead because of you, Perimenopause, I can’t even even sit on a f*****g bike saddle and explore our neighbourhood with them because you, you f*****g b***h, have lacerated my vulva and shrunken my labia, thus rendering me unable to rest for long, unless sat crosslegged on a soft sofa cushion, TV remote in hand, with Taskmaster playing on repeat. Perimenopause, you have shrunken my world (and my labia). And what the actual f**k have you done to my metabolism?! First you wrecked my sleep, spiked my cortisol, and turned my appetite up to 11. Now I can only stay awake when aided by sugar by day, yet I can’t sleep at night. That doesn’t even make sense. Why don’t you make any f*****g sense?! All this sugar you’re making me eat has f****d me sideways. Whilst I am consuming it I can feel my vagina turning thrushy, and my boobs get itchy. You really are getting on my t**s. I feel like I’m a size of a house. One of those red brick suburban outer London houses that my husband and I were lucky enough to buy when we were newlyweds. The type of house you can extend out the back and up into the loft space to make extra room. Rather than expand the house, we left London, before moving back to his home of Aotearoa New Zealand. Regarding my metaphorical house of a body (please forgive me, Peri, if I am none too articulate, only you have completely f****d over my cognition, my working memory and my vocabulary, you beastly b***h) and my actual house: I am now residing inside a house I cannot manage to upkeep without a dedicated team of support workers, because you’ve brought so many compounding and devastating regressions to my ability to function as a parent. And just when I was getting used to my cognitively reduced, yet physically expansive self, and feeling like I could accept myself under the Health at Every Size paradigm, the zeitgeist turned on me. Now, thanks to advances in weight loss medications and their widespread popularity, we are back in the heroin chic years that I thought were behind me. Every time I even look at a chocolate biscuit now, I can hear the tiny top model Kate Moss telling me that “nothing taste as good as skinny feels” and hey presto, Perimenopause, you push me off the disordered eating cliff with both hands, laughing at me as I crash up on the rocks. Just like your little sister Puberty did back in the 1990s, when Kate Moss was huge (culturally, not in size nor stature). Do you know what was the worst thing was about you? You gave me chronic uncertainty. I had no idea how long I would be suffering from you. How bad things might get. No idea how much more I could take. My mood was in constant flux. Chronic pain, energy depletion, rage. You frightened the life out of me and I see you are still busy doing it to others. What about everyone else who is suffering like I did? Why do you show us some of us no mercy? How do you decide who will be your next victim and whose life you will give meaning to? How are you still so unknown to people, Perimenopause? Why don’t doctors see you for what you really are? Healthcare professionals should be warning us about you. We should all see you coming. You should be declaring your arrival, red flags in hand. Yes, Perimenopause, I do know that many other people see your advent as a sacred rite of passage. And I agree that you are an inevitable life stage for those of us who are fortunate enough to survive beyond our youth. But my experience also tells me that you are far from benign. You can be lethal. The mood crashes and suicidal ideation you brought pushed me to my limits, yet I refused to become a statistic. I would not let you win. Because of you, I have had my entire reproductive system removed. I elected to undergo major surgery, consenting to the risk of medical complications or possible death, to end your hold over me. One of us had to go. I fought so hard for what was my only chance left at life. Drastic measures were crucial, and I was running out of time and options. The suicidal ideation you gifted me showed no reprieve so, Perimenopause, your termination was necessary. You had to be stopped! So to get rid of you once and for all, almost one year ago to this day, both my ovaries, my one remaining fallopian tube, my cervix and my uterus were surgically excised. And do you know what? It’s the best thing I’ve ever done! Now that I’m rid of you though, I’m stuck with your big sister for life. Menopause, dear Menopause. Early, surgical Menopause, to be precise. Compared to you, I love and adore her! Yes, you gave me my neurodivergent understanding of myself, Perimenopause. And for that I am grateful. But for everything else you burdened me with, you can go f**k yourself. You shall never darken my door again. Stay away from my friends. Perimenopause is dead! Long live Menopause! Cheers, If this letter spoke to you… You don’t have to agree with every word I’ve written here. You don’t even have to like perimenopause as much as some people seem to. But if you’ve ever needed somewhere to put the rage, grief, confusion or sheer f*****g exhaustion of navigating menopause in a neurodivergent body, I hope Divergent Menopause can be that place. Everything here remains free to read and listen to. If you’d like to help me keep making it, you can become a paid patron or founding patron. You’re not paying to un

  4. Jul 23

    Why Menopause Sleep Isn't "Just Anxiety": Neurodivergent Women, Hormones, Misogyny and the Cost of Exhaustion

    What happens when menopause, neurodivergence and chronic sleep deprivation collide? In this live recording, Sam Galloway explores why menopausal insomnia is often dismissed as anxiety, how hormones affect sleep, why women carry so much invisible labour at night, and practical strategies that have helped her navigate surgical menopause. Topics include HRT, vaginal oestrogen, sleep apnoea, bladder health, executive dysfunction, neurodivergent sleep, pelvic floor physiotherapy, melatonin, Calm sleep stories and the importance of community. Resources mentioned Medical professionals: Dr Kelly Casperson on Substack - Vaginal Estrogen Show and Tell video Dr Megan Neff on Substack Books / Workbooks: Neurodivergent Sleep Workbook: Restoring Sleep for Busy and Sensitive Brains — Dr Megan Neff Assessment tools: MENO-D (Menopause Depression Rating Scale) Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

  5. Apr 26

    Burnout De-escalation and Damage Limitation in Neurodivergent Menopause 💐 🎥 🎧

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

  6. Apr 17

    The Divergent Menopause Q&A: Tell Us Your Story!

    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: divergentmenopause@gmail.com 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

  7. Mar 31

    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

  8. 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

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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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