The Autistic Perimenopause

Dear Team Auti Peri, Thanks for being here, your presence means the world to me!Contents summary* Why I am taking August off* Things you might like to do to contribute at The Autistic Perimenopause* Exciting plans for September on nervous system regulation in neurodivergent hormonal flux with sneak preview!* Recap of the Autism Adapted Suicide Safety Plan with links to the Newcastle University document, and my previous video and audio step-by-step guide* Bonus content only in this audio recording: A real life cat fight between Harry and Toby when my son accidentally let them into the recording room to tell me that Harry had knocked over a plant pot in the kitchen. With cat squeals and inaudible flying fluff! Note to self: go and clean up the plant pot mess. With any luck, the cats won’t have peed on the soil/carpet… 🪴 🙄🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈With reluctance, I have decided that I need to take some time off to focus on my own health and wellbeing. It won’t be for long! A few weeks ought to do it. My little family is in desperate need of a holiday (vacation/break/total reset), and I haven’t taken any time off from The Autistic Perimenopause: A Temporary Regression since it launched in April 2024. So I am planning on taking off all of August for a personal mental health break. This is a one woman show, and this one woman is at risk of cracking up entirely. I fear if I breakdown completely this time, I may be unable to piece myself back together. If you are familiar with my work, you will know that I am adamant that a neurodivergent menopausal transition can be a distressing and prolonged time for many of us. I don’t know about you, but every single time I spiral further downwards at an alarming rate, I wonder if I ever will be able to reverse these regressions. I want so badly to make sense of my own menopause in the way aspirational writers do: the ones who tell us that this is an opportunity to live the second half of our lives with joy and purpose. They say, once we become empty nesters, we can invest our newfound time entirely in ourselves. This theory of the menopause in no way aligns with my lived experience. Those of us who suddenly find ourselves in neurodivergent perimenopause, often only uncover our neurological differences alongside our children’s diagnoses. Our midlives are lived outside the norm.We may not have an empty nest to look forward to. We are often devoted parent carers: we prepare different meals for everyone in the home to ensure safe foods are always available; we monitor and despair at our kids’ ever increasing screen time (just me?); many of us choose to homeschool - due to the failure of the mainstream schooling system, or from personal preference. For those of us who have neurodivergent kids in schools, we may find ourselves constantly meeting with teachers and special education needs coordinators (SENCOs), feeling belittled and blamed when our children naturally react to the school systems’ inability to accommodate them all of the time. And what about when our differently wired children grow up? With their spiky profiles and asynchronous development, they may not be equipped to leave home at the same time as their non-disabled, neurotypical peers. Yes, we strive for them to be independent. We see their pure brilliance. We want them to be happy, and preferably not gaming into their 30s in our basements, needing regular reminders to clean their rooms of dirty dishes and even dirtier laundry. And - for goodness sake - can’t they just take a shower AND apply deodorant without being verbally badgered to do so? Our families are often on a different trajectory entirely from regular families, which is why it cuts so deep when others have no awareness of the extra effort we put into helping our offspring assimilate into this world that does not have their best interests at heart, to say the very least. To be told that we are pandering, enabling and just plain parenting wrong is insulting. And it most often comes from those we love, rarely from the psychiatrists, therapists and support workers who are privy to the most intimate details of our volatile and tender day to day lives. Well, I don’t know where that came from, because I went completely off topic. How cathartic though, ha ha! Anyway, yes, I suppose I do need a break because of all the stressors above - perhaps you do too? - and also: * Down here in Aotearoa New Zealand we are months into the depths of Winter, and my body hurts from the cold. It is hard to motivate myself to get outside and I am quite possibly depleted of Vitamin D. I haven’t looked into this, but I had a B12 injection last week and am hoping to recover some energy soon. * My brain fog is absolutely off the charts, I can barely hold a conversation in person. I have loads of half written posts drafted, and not enough cognitive capacity to feel they offer you enough value to publish yet. I am extremely keen to get an article out to you on the topic of progesterone intolerance, but for the life of me I cannot remember what my lived experience of it has been. Which is ridiculous, as it is one of the reasons that I was recently approved for a hysterectomy! And I have no idea of the timescale for my upcoming surgery, which is very difficult to deal with as an autistic woman, especially with full time homeschooling parent carer duties and extremely limited respite and childcare options. * I am being treated for mast cell activation syndrome (MCAS) which is definitely exacerbating the brain fog and have started the antihistamines (H1 and H2 blockers). My body is in a state of alarm at all times, and I need to learn about the histamine elimination diet that can help my body and mind recover from the onslaught it perceives from stress, my regular diet and lack of refreshing sleep. Ironically, the MCAS-induced brain fog precludes me from understanding the complex underpinnings of a low histamine diet, which may be the primary way to combat the brain fog… But the MCAS is insisting that I rest, and I need to obey in order to reassure my nervous system that I am safe. * I have recently realised that I am most likely hypermobile and am now highly symptomatic with pain flares, ongoing gastrointestinal issues and worsening proprioceptive challenges. I think this is all highly pronounced now that I am around nine months into a chemical menopause, although I was probably asymptomatic hypermibile until now. I have signed up to The Zebra Club app for community, hypermobile-friendly workouts, and hours and hours of presentations to try and understand how to soothe my nervous system and understand my body’s needs, strengths and limitations. I have an unstable shoulder joint, currently aided by kinesiology tape, and have just taken delivery of my new firm compression tops to help with stability and proprioception. Basically, I am having to unlearn everything I thought I knew about how to move, sit, stand and so on, and relearn where my body is in space, how to stop bracing my muscles, and keep my joints within their safe, painless range. * If I were in a conventional employment arrangement, I would have statutory holiday leave entitlement. But it’s just me and my phone, and we are in a very compulsive, strained and unboundaried working relationship. Thanks to ADHD, I am “all or nothing”. Rather than the default being all in on my work, I need to switch over for a short time into going all in on rest. * The Substack gods are getting in my head, and I need to show them that I am in control of my own mind (which I am hoping turns out to be the case). My subscriber numbers are down, both free and paid, with paid rapidly approaching single digits. I need to stop checking the stats and break that habit. I love all my readers and subscribers, free and paid, and would find it extremely validating to find my paid subscriber numbers increasing. But I have zero control over that, and hope that people are finding value in my work regardless. I still offer everything for free and I would like to continue to avoid paywalling content that people may need and can’t afford to pay for at this time. Thank you to my paid subscribers for supporting all my hard work! 💐* I know we are all crazy busy and super stressed - my troubles listed here are far from unique and pretty minor on the grand scheme of things. I don’t currently have any more Auti Peri Q&A interview posts to publish because I haven’t received any responses lately, which is totally understandable. I am always seeking more Auti Peri Q&A respondents (here’s why), so please reach out if you are keen to participate.* A personal goal is that I would like to launch a proper podcast about neurodivergent menopause, to interview experts and advocate on a larger scale. I have been lucky enough to free up a room in my house which will soon become my writing and podcasting room. It currently houses many of my houseplants, a lot of my LEGO sets and a dumping ground desk already cluttered with paperwork. It is far enough up the hallway from where my kids play online with their friends, screaming and laughing, to hopefully not pick up too much background noise. I need to somehow sort out some optimal acoustic panelling or something before I can get started though. Oh and find guests. And create an intro/outro, find music, childcare *Sam enters major overwhelm…*🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈Here’s what you might like to doHave you listened to any great podcast episodes lately about autistic perimenopause, read any academic papers, or watched an insightful webinar on YouTube? If so, please share the links to any new credible, academic or informative resources about autistic perimenopause and beyond in the comments of the 💕 Resource Roundup 💕 page which was last updated in October 2024. (Or any links to older stuff that I missed!) If you are reading in the Substack website version, you can find it in the tab headings here:* Have you explored the archive at The Autistic Perimenopaus

Hi, I’m Sam Galloway and I have been writing from the nuanced and complex intersection of neurodivergence and menopause for over a year now at The Autistic Perimenopause: A Temporary Regression. I am so glad you are here!Content warning: ectopic pregnancy, abortion, miscarriage, blood, surgery, chronic pain. Every week I forged a sick note for my high school physical education (PE) teacher that said I couldn’t do PE that week, because I was on my period. Every week my PE teacher told me that I needed to learn to get on with it, because I wouldn’t be able to get out of work as an adult just because of my periods. Looking back now I wonder why she didn’t question the frequency of my weekly periods, although we were discouraged from speaking about such matters in my Catholic girls school. The PE communal changing rooms were catty, b****y spaces, where other girls would eye my stretch marks and cellulite, deepening my disordered eating tendencies and low self-esteem. Puberty took me early on. By 11, I was already bleeding, and my weight was double that of my peers. Not curvy, just substantial. Dealing with periods early on in an environment that hushed their presence was difficult. In primary school we received the cursory talk of sex and periods, but it was vague and scant, given the Catholic nature of my education. Emphasis within the curriculum was on theology, with morality based upon being a good girl. In high school, when we were supposedly being taught about contraceptives and birth control, our religious education (RE) teacher played a video about the instruments used to perform an abortion, circa 1995. I don’t know how much detail the video went into the procedure, because one by one every girl ran out of the classroom upset. Being highly sensitive, I was the first to leave, hysterically crying and feeling distraught at the images conjured by my own imagination.Second to leave was my 14 year old classmate and close friend, who had confided in me that she had just had a miscarriage. Her boyfriend was 26. What was their intention in showing us that video? To scare us into not having sex for fear of needing to terminate an unwanted pregnancy? Was it legitimately part of the Catholic RE syllabus, or just a misjudged error on the part of our teacher, a former convent nun?The desired effect wasn’t achieved, as so many girls left school early to have babies. I still don’t understand why frightening girls off abortion was preferential to teaching us how to use contraceptives, and learning about our reproductive systems. Luckily for me, my childhood house was opposite the local community clinic. On Thursday evenings they had the sexual health clinic, and my more cautious wise teenage friends and I would go regularly for check ups, the pill and free condoms. I was clearly unschooling myself from an early age to look beyond the narrow view presented by my so called education. Even back in high school, my periods always came accompanied with extreme menstrual cramping and lower back pain. My bleeds are still debilitatingly painful. Sometimes I am responsive to pain medication, sometimes not. Heat can help; diaphragmatic breathing; focused muscle relaxation. Managing the pain is one thing. Coping with the bleeding is quite another. Bleeding is not a neutral experience for me. I have tried all within my power to stop experiencing it, both consciously and unconsciously: not taking a “pill free week” when on the contraceptive pill, which elicits a withdrawal bleed (rather than a period resulting from ovulation and no subsequent pregnancy). The contraceptive injection in my late teens; the contraceptive implant in my twenties. Pregnancy, long term breastfeeding in my early thirties. When perimenopause took me by surprise in my mid to late thirties, I tried the Mirena IUD, in response to an extensive bleed that lasted many months. Now, I am in a chemical menopause using hormone blockers. In an effort to block out the sensation of bleeding, over the years I have used tampons to try and plug it up. Menstrual cups somehow alleviated associated period pains, although I never acted on the temptation to feed my collected menses to my rose bush. Now the rose bush is dead and gone, yet my bleeding remains. These days I wear period underwear at all times, as much to deal with unpredictable urinary leaking as much as to manage the constant threat of a sudden flow. Over the last week, old pain patterns have trotted out along with sudden, unexpected bleeding. Only this evening I could feel a trickle and couldn’t tell initially if it was a leak or a flow, although the accompanying severe pelvic pain unsubtly hinted at the prospect of yet another evening bleed, which I have had to face each night this past week. Thick blood oozing out of me and collecting in an unwanted pool is beyond what I can tolerate. The sight of it, the smell, the way it streaks and drips and soaks onto other surfaces is all too much.As a wise, kind friend told me a few days ago, “Your body is doing its best, even though you don’t like what it is doing.” She is right. Something is amiss, and I can only assume this hormonal blip is caused by my adding in an extra pump of oestrogen gel last week to my already high dose, in a bid to stop the hip and shoulder pain that has limited my movement recently. But my body is also exquisitely responsive to my mood, perhaps more so than is my mind at times. Tomorrow will be the first anniversary of my dear old Dad’s death, and it has been playing on my mind. I had a random bleed in the UK a year ago as I sat beside him on his deathbed, and another bleed in March this year when my Mum’s visit to us in Aotearoa New Zealand ended.Upon discussion with my GP, I was advised to anticipate further bleeding episodes should any more emotional events occur. Given the random nature of my bleeds, the intense pain, and my hatred of both random events and pain, I am especially glad to be awaiting a hysterectomy in the not too distant future…I cannot wait to no longer bleed. Anaemia is common for women who bleed heavily, and our iron levels need careful monitoring. The patriarchy likes its women too fatigued to put up a fight, so please do us all a favour and keep your iron levels within the normal ranges. Weakness from blood and subsequent iron loss makes me feel dizzy and dissociative, so I tend to eat a steak when I have bled to replace lost iron stores. I also conserve my energy by having a warm Epsom salts bath, then wrapping up in my dressing gown in order to complain endlessly about how much I detest bleeding.Pregnancy losses have been a feature of my adult life, having experienced an ectopic pregnancy and two miscarriages. Our bleeding patterns can communicate to us, if we are receptive to them. Which I am not; I am just reactive to and avoidant of them. Fortunately, when I was bleeding a long streaky prune juice coloured flow, another friend who had experienced an ectopic pregnancy advised me to do a pregnancy test. I was pregnant, but not for much longer, since the ectopic pregnancy was in danger of rupturing and within days I was in emergency surgery. Bleeding in pregnancy was my norm, even with my two out of five successful pregnancies. With my first pregnancy resulting in surgery, I was in constant panic at any sight of blood in my subsequent pregnancies. This week I found out that hypermobility can make bleeding in pregnancy more likely due to tissue fragility and potential clotting problems. Perhaps it is just as well I didn’t have that on the brain at the time.If only we were all prepared for menstruation, and allowed to feel empowered by our bleeds, not shamed for them. Red School is an organisation I wish I had known about decades ago. It feels too late now, my bleeds instill me with a sense of fear, not a sense of power…Imagine that knowledge of the full spectrum and power of the menstrual cycle is commonplace, and we all feel the utter rightness of having this experience within us. Imagine a world in which the menstrual cycle is respected as our spiritual practice. Imagine young people growing up in this menstrual-affirming world.Imagine a world in which menopause is recognized as a healthy, organic step in one's evolutionary journey stepping into the vital and powerful role of serving your community and the world. Imagine knowing that you’ll be profoundly met in the dignity and power of this new place you stand in post menopause.May we all trust our menstrual cycle and reclaim the spiritual significance of Menopause as the path to instate our full sovereignty. May we all recognise and relish our entitlement, dignity and authority to be channels for Menstruality and the Divine Feminine on the planet.Red SchoolI hope that, if are still cycling, you perceive your bleeds from a more holistic perspective than I have ever managed to muster. Looking back, had I learned from Red School, or any indigenous matriarchal culture, that my periods are sacred and healthful, not dirty and shameful, perhaps my pain perception would not be so debilitating. Maybe I wouldn’t actively want them to stop permanently and prematurely, had they not been something to be hushed and hidden in my Catholic school years and beyond. Perhaps I should soak my menses into the garden while I still can, and stand in my power in a bid to relish my entitlement, dignity and authority to be a channel for Menstruality and the Divine Feminine on the planet. Not long after the end of my high school years, my PE teacher was rumoured to have eloped with my Maths teacher, both of them married with families of their own. This was at a time when Catholicism and lesbianism were mutually exclusive. So I am glad that they managed to buck the good girl Catholic trend by midlife. I hope in doing so they reclaimed the spiritual significance of Menopause as the path to instate their full sovereignty. They are certainly better role models, acting on their previously covert love

How has this happened?Birthing two big babies vaginally over a decade ago has finally backfired on me. It’s been a slow burn, with bumps along the path that have led me to a diagnosis of mixed urinary incontinence. It shouldn’t come as too much of a surprise because I experienced extreme fecal urgency shortly after having my first son. He was born weighing a mighty 9lbs 6oz, and required an episiotomy, where the doctor took a pair of scissors to my perineum to dislodge him from my birth canal. I had begged them not to. Being a hyper independent woman, I wanted to “do it alone”, which I could have done, had the maternity staff not insisted on relocating me when I was already in transition from a pool for labouring mothers into a stark clinical birthing room. Their interference stalled my progress, leading to me feeling emotionally unsafe. Repeatedly I asked them if I had pooed myself yet, since I had learnt during antenatal classes that this was a natural sign that the baby’s birth was progressing. I had wanted to poo myself, but they misread this repetitive question for paranoia, anxiety, or something else that I should not have been made to feel in my vulnerable state. Everything slowed down to almost a standstill, and I ended up being instructed to lay flat on my back, feet in stirrups being told to “Push him out of your bottom!” Really it was all a recipe for fecal incontinence, and I have done well to recover especially considering that my GP at the time dismissed this as normal. Baby two born three years later was even heavier at 9lbs 12oz. I water-birthed him at home as an active resistance to unnecessarily over-medicalising his birth. This time around I tore, and stitches healed well after both births. My youngest was almost born in the downstairs toilet, as I was able to completely relax my pelvic floor muscles whilst sitting there, and felt the most comfort in a very uncomfortable situation. What is wrong with me now?Vaginal childbirth is often a contributing factor to later developing bladder incontinence, which seems to be the case for me. Leaking urine didn't really start until my kids became enthusiastic about playing on trampolines, and I wanted to get involved. Going for a wee right before a bounce was not enough to prevent me weeing again immediately mid-bounce. That was a few years ago, and I now know to stay well away from trampolines. My avoidance served me well again for a while, but very recently the leaking has become regular and with less obvious reason. I tried ignoring it and hoping it would just stop. It didn't. So I tried wearing period undies and thinking I could get away with it. Because everyone complains about leaking sometimes, right? A sneeze or a cough can be a common and seemingly unavoidable trigger. Besides, my advertising algorithm is now full of curvy, happy midlife women wearing incontinence pads and living their best lives! I thought it was normal and I just had to put up with it. Although my keen sense of smell meant that I would worry that I smelled of urine. It is one thing to know I have this problem without other people knowing about it too! But then the leaking started happening during my twice weekly personal training sessions. I love working with my trainer, and I told her what was going on. I started following the programme she set me to strengthen, and learn to relax, my pelvic floor. Last Friday it got so bad that I was leaking during the training sessions actively intended to stem the flow. What was wrong with me? Reverse lunge, drip. Reverse lunge, drip. Reverse lunge, drip. Luckily that was the same day that I was seeing the gynaecologist to self-advocate for my hysterectomy. The approval granted for the surgery was a huge weight off my mind, yet the weight of my burgeoning bladder persisted. The gynaecologist internally assessed me and diagnosed a stage one pelvic organ prolapse.Finally, I had an acceptable explanation for my urinary incontinence. It was a medical issue and not a moral failing on my part. I could live with that, and I found it oddly reassuring. All weekend I wondered if the prolapse could soon be repaired surgically during my upcoming hysterectomy. I felt vindicated in my urine leaking pattern - of course I was leaking if I had a prolapse. The prolapse must have occurred whilst birthing my baby boys, and I was asymptomatic until now. But then I worried that the surgery could in fact exacerbate the pelvic organ prolapse, worsening my bladder control. I knew I needed to be proactive in managing this condition, after listening to a great podcast episode on the topic:Why see a pelvic health physiotherapist?Here is a good visual explanation of what the female pelvic floor is and why it matters:Physiotherapist Fiona Rogers talks us through what the pelvic floor is and how it works.Do you know how to do a pelvic floor exercise properly or have you been taught to just suck everything up and in? Watch here how to do it properly.Fiona firmly believes if you understand where the muscles are and how they work then you are more likely to understand and learn how to exercise them properly.Credit: Pelvic Floor ExerciseHormonal changes during menopause can significantly impact the pelvic floor muscles, contributing to symptoms such as urinary incontinence, vaginal wall prolapse, and sexual dysfunction. A pelvic health physiotherapist can assess for muscle weakness, overactivity, or imbalance and develop individualised treatment plans. Interventions may include physiotherapy-guided pelvic floor muscle training, manual therapy, biofeedback, and structured relaxation techniques. These strategies are designed to restore muscular strength, coordination, and neuromuscular control, which supports continence, vaginal wall integrity, and overall pelvic health.Credit: Positive Pelvic Health Already armed with some basic information on my new hyper fixation, I reached out to Jennifer Dutton of Positive Pelvic Health. Jennifer is a pelvic floor physiotherapist who had been highly recommended to me. Amazingly, she offered me a cancellation for an in person initial consultation the very next day. Knowing that verbally retelling my medical issues is overwhelming for me, I brought along the notes I had prepared for the gynaecologist appointment. Jennifer took a very thorough medical background and was empathetic and reassuring. Upon internal examination, both standing and lying down, Jennifer said there was no pelvic organ prolapse present. She explained that vaginas and other organs supported by the pelvic floor will show natural signs of aging in midlife, as our skin loses collagen and oestrogen, also evidenced externally by how our faces, breasts and stomachs may also sag. Here is a video of Jennifer being interviewed about pelvic health, where she explains much of what she told me during my appointment:I wonder if the gynaecologists see any saggy vaginas in their medical training, as mine obviously can’t be a textbook model anymore! With my newly undiagnosed pelvic floor prolapse, I was able to spiral into a new panic about whether indeed my urinary incontinence was just a moral failing on my part after all…What is urinary incontinence?My current issues, known individually as urge incontinence and stress incontinence, together create a combined diagnosis referred to as mixed incontinence. Yay.Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people.There are several types of urinary incontinence, including:* stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh* urge (urgency) incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards* overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking* total incontinence – when your bladder cannot store any urine at all, which causes you to pass urine constantly or have frequent leakingIt's also possible to have a mixture of both stress and urge urinary incontinence.Credit: NHS webpage ‘Urinary Incontinence’.Autism, Interoception and Adult IncontinenceSo I am leaking on the regular, and trying not to blame myself for this recurring issue. It is so normalised yet hidden. TV ads for pads and absorbent pants proliferate, subtly telling us it is okay to leak urine, as long as nobody else knows. Well, f**k that s**t! When I leak, I tell everyone about it. Part of my neurodivergent profile has been a lifelong shamelessness. I don’t feel a need to hide anything. I refuse to feel shame and embarassment for urinary incontinence, despite having a niggling sense of regret that it is happening to me. Urinary incontinence is just another social taboo to stack on top of all the others I make it my mission to bust. Why would being autistic affect my urinary continence? Especially seeing as I am not aware of having any intellectual disability which may be more likely to co-occur with toileting issues. If anything, before perimenopause I may have been considered intellectually gifted. Yet my cognition has declined in this life phase, and I cling to the hope that this regression is temporary and reversible. Interoception is our capacity to identify our internal states and needs. When this is reduced, as mine has been in perimenopause, and is combined with a regression in executive functioning skills, then noticing when I need to use the toilet, and acting on the urge, can lead to me not responding accordingly.Interoception Receptors on our internal organs are responsible for interoception signals that provide information on our internal body and emotional states. Experiences: urge to urinate, hunger, temperature, pain, sadness, joy, anxiety.Interoceptive Over-ResponsivityWith interoception over-responsivity the person feels too much of their internal signals. They “over-feel” their internal sensations. Si

Thank you so much to the incredible Tamsin at 3 Red Cabbage Heads - poetry, knitting and essays of life on Substack! For more amazing bespoke knitted ambhibians and other creatures, check out Tamsin’s Art Makes section.Newt flew all the way from the UK to NZ. No - on a plane, silly! Newts can’t fly. If they could, I wouldn’t be such a fan of them. *shudders*My Nan’s house in Alperton, London was as urban as could be - the opposite of the rural village of Cornelistrum, Co. Galway in Ireland from where she hailed. In her London garden aged 6 or so, I used to stand on some loose bricks to chat to the little girl who was Nan’s next door neighbour. There was a deep garden pond full of aquatic life that was rare in such a built up residential and industrial area in my little friend’s garden. On the days I used to tiptoe on the brick step, and my friend couldn’t come out to play, I would find my own entertainment. From beneath the overturned red bricks, if I was lucky, I would find tiny little British smooth newts, also called common newts. They were unfortunately not so lucky, because it was only at 2 weeks shy of age 44 (today) that I learnt that newts are not to be handled with dry, bare hands. Oops…🦎Back to the Newt of today! After the long journey, I noticed that Newt arrived with a flat white! ☕️How very Kiwi of her! She will need it to help her cope with the jetlag although she is already acclimatising well. The beastly cats are a bit much for her, but I am sure they will all be firm friends soon.Tamsin kindly sent Newt on her way with a wealth of accessories, all of which I am trying to dissuade my ragdoll cats, Harry and Toby, from eating. Dear Sam, I am so excited to come live with you in a land that is so far away! I am really looking forward to it - and my new name if you give me one!Love Newt🐈☕️ Newt and I would appreciate a flat white should you wish to buy us one! ☕️🦎🃏🐾🧸Awwww, what a cute pair! Goodnight xxThe Autistic Perimenopause: A Temporary Regression is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.P.S. This was my first solo Substack live. For more of my random shenanigans, download the Substack app. 😁 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Welcome to The Autistic Perimenopause: A Temporary Regression. I’m Sam Galloway and I have been documenting my despair fiercely advocating here for over a year now. Time flies when you are dissociating having fun! The Autistic Perimenopause is a safe community space for sharing our lived experience of our neurodivergent menopause. Together, we explore how hormonal flux affects us day to day, how safely unmasking helps us to self-regulate, and how to hang on when it all feels too much. Cat photos proliferate in this joint exploration. Quality of life should be high for everyone, but I suppose it is all subjective. Yes, I am living an objectively good life in the beautiful Aotearoa New Zealand surrounded by people I love and who love me. I have food, albeit overpriced; clean drinking water; and a warm, mould-free home - which isn’t a given in this country for some abysmal reason. But things don’t feel right. I am drained and have close to no motivation to get out of bed in the morning. Yes, I am depressed, but my low dose daily SSRI does a reasonable job of both levelling out my mood, and cutting my rumination-prone worry loops. I utilise a wealth of other pharmaceuticals in an attempt to brighten my gloomy emotional landscape, but my impending sense of doom remains. I have habituated to this, and I function remarkably well most of the time, until I don’t. I am trying to be rational and balanced, but that is hard right now. My cognition and mood continue letting me down in neurodivergent perimenopause. My pelvic pain flares out of nowhere, and my body temperature soars despite the presence of a Kiwi Winter, and the promise of an imminent polar blast. The world is on fire, and so am I.Rationally, I am aware that far worse things are happening to much better people than myself across the world right now. Yet woe is entirely me, and I am most certainly woe. My low mood is not a choice, and my worry at the thought of my perimenopause stretching out who-knows-how-long into the future sends me into a panic stricken state, bordering absolute desolation. Not to say that I am feeling suicidal, but I believe that something must change now. I cannot take much more. My current state of perimenopausal hell is unrelenting. Yes, hormone blockers should be flatlining all variability of hormonal rollercoasters to my mood and cognition. I suppose they are - I am in a temporary, reversible menopause thanks to GnRH Analogues which I have written about previously here, here and here. But the pelvic pain, fear of unexpected bleeding and many other symptoms are too much to continue to bear. I am in the fortunate position of living in a country where, in the right medical circumstances, I could have a hysterectomy without needing to pay. My aftercare would be in excellent hands, the risks of surgery would be well managed, and my chance of recovery is positive. A hysterectomy is the name for the surgical procedure where the uterus (womb) is removed. This induces an immediate and irreversible surgical menopause, which is my current goal in life. It would be difficult to manage my household and parenting duties in the short term, since recovery can take 8-12 weeks, but given my ongoing low mood and lack of energy, these daily tasks are already draining. Once recovered and healed, with well-titrated add back hormones (hormone therapy) and following a healthy lifestyle, I am optimistic that my life can get back on track. Am I being naïve? Major surgery isn’t something we usually elect to endure, but I have previously survived emergency surgery for an ectopic pregnancy, and so have some experience of recovering in a gynaecology ward. Everyone else who was there advanced me by decades. The other women were having routine hysterectomies, and looked upon me with obvious sorrow and pity, as I wailed for the nurses to “Give me my baby back”, had endless meltdowns and reacted adversely to prescribed painkiller tramadol, hallucinating about newborns. This time I foresee the promise of gynaecological surgery to be liberating. Empowering. Worldview enhancing. Should I get my wish, I will awaken from surgery in my crone era, albeit feeling raw and sore. Yes, I know some people do not want to have hysterectomies. Those requiring them for sudden and unexpected medical reasons sometimes report feeling bereft of their womanhood, but I do not think I will feel that way. Having my uterus, cervix and ovaries removed would be anticipated and understood by me. I have fully researched the options, and I believe I have a strong case for needing a hysterectomy in my very near future. My gynaecology referral has been accepted and, within the coming month, I will be meeting with a gynaecologist who unknowingly holds my fate in her hands. My greatest fear is meeting with a specialist who is yet another gatekeeper of surgery within the public health system. I am pretty sure that, if I had medical insurance, I could have requested a private hysterectomy a year or more ago, and be fully recovered by now. Upon Googling the named specialist on my appointment letter, her medical staff profile states that she offers a “highly patient-centred approach, taking time to listen and understand her patients and their priorities, allowing her to recommend and guide her patients through a range of treatment options”. A wonderful gynaecologist colleague of hers has told me that she is an excellent laparoscopic (keyhole) surgeon; and my HRT doctor has said, “She is known for being lovely”.Doesn’t she sound like just what I need? This has my mind at ease a little, but while I am busy self-advocating for myself and possibly sounding over confident in myself, my shoulders are hunched and my stomach is clenched. I am a ball of nerves. I am scared of having to express myself; terrified of unleashing the full weight of my emotions. Scared of having surgery and absolutely petrified that it may be denied me. If there were a way to communicate all of this with the gynaecologist in advance, I would do so. The trauma from retelling my autistic perimenopause story in person to professionals over and over again is unrelenting and soul-destroying. And the thought of sharing this writing with her makes me feel awkward, exaggerated and, quite frankly, a bit of a dick. Yet I can’t convey in a short clinical appointment everything I need to get across, when the gravitas of this meeting holds mine and my family’s future in the balance. So I think, in the name of self-advocacy, I will share a print out of this all so that I don’t miss anything. Or have a meltdown. Or go situationally mute. Several friends have offered to accompany me, as has my husband, which is so kind of them. I want to be able to “do it alone” which I know results from my trauma-driven hyper-independence. Is it better to go into these appointments alone, or to take a support person? If Harry, my emotional support cat wasn’t such a scaredy puss, I would take him along. Toby is more sociable, maybe he can come along for support…Unfortunately, I know that taking a man along to medical appointments is one way to be taken more seriously, since lone women are quick to be medically dismissed. It wouldn’t surprise me at all if one of the questions will be, “And what does your husband think you should do?” If we were both there to tell the doctor that we don’t want any more children, would it make a hysterectomy more likely? I wish I didn’t have to give this all such detailed thought, and I can’t believe I am so envious of women who have already had a hysterectomy. What is wrong with me?! Yes, I have given this a lot of consideration, and I believe a total hysterectomy (uterus/womb and cervix) with both ovaries removed is the best option in my case. So to follow in my next post will be an informed account of the many reasons that I need a hysterectomy as soon as possible, please and thank you!The reasons I have brainstormed, and that are storming my brain as I write this, are: * Progesterone intolerance* Premenstrual dysphoria disorder (PMDD)* Menopausal depression and suicidal ideation* Thickened endometrium and associated cancer risk* Pelvic pain* Fear of further bleeding* Bladder stress incontinence* Adenomyosis* FibroidsAll of these are current ongoing issues, some of which are newly diagnosed and have been present for decades unbeknownst to me, whereas others have developed more recently and acute. Combined, I believe I have a good case for a hysterectomy, with the added bonus of initiating a surgical menopause. I have too much to say on each topic and am struggling to condense it all down, but I wanted to share my current state of mind with you (sorry!), and check in to ask how you are feeling at the moment? Have you had a hysterectomy and did you find it improved your symptoms? Have you been advised to have a hysterectomy but feeling hesitant to proceed? To be continued…I will keep working on my protracted argument for why I believe I need a hysterectomy - to share with you, and with my gynaecologist. Although I am clearly passionate about it, my PDA (pervasive drive for autonomy/pathological demand avoidance) is absolutely running the show. It is telling me not to write my case for a hysterectomy, and so far I have listened. But now I need to get it written because, if I don’t, I will have to verbally articulate the impact that every issue listed above is having on my quality of life. This may well result in a meltdown followed by a shutdown, or vice versa, and I will lose all social communication skills. I have learnt this the hard way. To take the pressure off myself, and to stick two fingers up at my PDA, I am sharing the above to set the tone of my desperate plea for a hysterectomy, and will flesh it all out soon. (Whilst hoping my gynaecologist will agree to flush out my uterus, cervix and ovaries!) My ADHD time agnostic brain is still on the “not now” side of the “now/not now” time warp of the upcoming consultation, but it will

Trigger warning: Discussion of suicidal ideation, depression, gynaecological healthcare, chronic pain, pregnancy loss, death, cancer, surgery, blood, medical misogyny, mental health conditions. Please take care when reading. If you make it to the end, cute cat photos await you. But no pressure. 🐈 🐈Art therapy is a recent and later in life addition to my emotional toolkit. And thank goodness, because I need all the help and catharsis I can glean right now. So when my art therapist, EJ, texted me to offer a cancellation this week, it was an easy “Yes!”EJ kindly brought along the prompts and materials, showing me how to begin the process of creating a mandala. Fortunately for me, my kids didn’t want to participate in the session, so I was able to vulnerably and fully explore the issues that are currently coming up for me around my upcoming gynaecology appointment. I lovingly created this mixed media piece using watercolour pencils, metallic gel pens, glitter glue and a thick black marker. This artwork is special to me because it represents the story of my uterus and I, which has been deeply troubling of late. The realisation came to me that, whilst I have no control over the outcome of my self-advocacy for a hysterectomy, I am able to express my feelings without needing to talk about it. I wanted to create a piece that represented the multi-layered symptoms, conditions, joys and losses afforded to me so far by my uterus, whilst exploring what its removal may mean for my future. It is a bold artwork that illuminates the fleeting shimmering joys, alongside the chronic pain and spiralling darkness. The feedback from my art therapist, EJ, was, “This is next level creative, Sam. I love how you have been taken on a journey in the making of this image. There is so much force and energy.”What does this artwork represent?I am scared. I feel like I am at war with my womb, and it is winning. At times, I feel like I want to die, but I refuse to let hormonal depression dictate my narrative. And so I push back harder against it. There are gynaecological gatekeepers who want to prohibit initiating my surgical menopause. I was told, “Public gynaecology doesn’t have time or resources for this, Sam”. This from a usually sympathetic doctor. Perhaps I hadn’t explained my symptoms clearly enough; or perhaps I had, but I didn't say the key phrase they are required to hear from a patient before making a specialist referral. Eventually my request for a referral was supported by my neuro-affirming female menopause specialist GP. Internal scan results backed up my case, showing my now-thickened endometrium (lining of my uterus). A known cancer risk. Plus adenomyosis and a small fibroid. Public gynaecology have now accepted my referral, and I have an appointment within the next month. I have started to write an article on the basis for which I believe I need a total hysterectomy (uterus/womb and cervix surgically removed) and a bilateral salingo-oopherectomy (both ovaries removed - and take my one Fallopian tube too whilst you’re at it!) as soon as possible. Finishing the article continues to elude me, yet my goal in writing it is to share information with others (advocacy) and give a print out to the gynaecologist on the day so I can convey my case without needing to rely on speech or my memory recall (self-advocacy).It is vital that I write it - I had intended to publish it last week. But I didn't. So I was going to publish it today. But I couldn’t. I have a mental block that I need to overcome. No doubt as the appointment looms nearer my ADHD brain will switch from “not now” to “now”, bumping it to the top of my to-do list. The art therapy session gave me an outlet to express all the internal stories held between my womb and I. Most of them offer no happy endings. Some people may find them fascinating - their twists and turns illuminating; whilst others will find them boring, repetitive and protracted. My ongoing autistic perimenopause is a particularly arduous tale of peril and pain. I want nothing more than to reach the end, and survive to tell the story. An explanation of the artworkSo what does it all mean? You may have noticed that I only drew one fallopian tube because, devastatingly, my first pregnancy was ectopic. I bled heavily, the prune juice coloured blood that is characteristic of ectopics. Emergency surgery ended the pregnancy before it ruptured, thus saving my life, but it cost me my very much wanted pregnancy and my right Fallopian tube. Whilst both my ovaries are still healthy, they were very sore when probed and poked at by the sonographer who did my most recent internal scan. “I will make a note that they hurt”, she told me. In my artwork, the fertile bloom that is my right ovary, emerging from healthy foliage, represents the fact that both ovaries continued to ovulate. The further fruit of my womb resulted in two sons. Between my two eventual full term pregnancies, I had two early miscarriages. Bleeding has been a feature of my pregnancies - the two successes and the three losses. I no longer bleed as I am in a temporary, reversible, chemical menopausal state. Yet my most recent bleeds were triggered by being at my Dad’s deathbed last July, and upon my Mum’s return to the UK after her three month stay with us in Aotearoa New Zealand. My bleeds both traumatise me, and occur when I am feeling at my most emotional. My hormones and bleeds affect my mood, and my mood affects my hormones and bleeds. You may notice the light trickle of bleeding in the artwork representing this part of my menstrual self-expression of despair.The block black line rising up from my right ovary, bereft of it’s fallopian tube, shows the two way link between my hormone production and my mental state. The three jagged silver protrusions pushing externally from my right ovary represent the pain I have felt through my fertile reproductive years. In addition, they show the outward impact of my internal hormonal landscape on others. Namely, my late diagnosed pre-menstrual dysphoric disorder (PMDD) makes me especially defensive and enraged. My reproductive organs are contained within a black sphere of outwardly radiating rage and pain. They impact on my surrounding organs, affecting my bladder, bowel and digestive system. My pelvic floor doesn’t feel like it can carry much more of its burgeoning weight. Bladder leakage ensues from the pressure of holding up my ailing uterus. I am surrounded by impenetrable darkness. No light can come in, and there is no light within me. Blackness from uterus to brain. Depression. Darkness. Death.What are the medical implications alluded to in the artwork?The weight of my uterus makes me feel like I’m about to bleed at all times. The pressure wants to release, yet it has nowhere to go. My ovaries have been switched off using hormone blockers, to stop my constant bleeding, and manage my PMDD. High dose oestrogen HRT, essential to keep my mind wanting to stay Earthside, has resulted in a thickening of the womb lining, or endometrium. Possible hyperplasia - a risk factor for endometrial cancer. This thickening may not be significant, and a recent biopsy showed no sinister cell growth. Yet the weight of it all is enormous.My uterus is somewhat askew in the artwork, which was accidental, but let’s pretend I did that on purpose to represent my retroverted uterus. That’s right, it tilts backwards, making medical investigations all the more uncomfortable. According to Healthline New Zealand:A retroverted uterus is a standard variation of pelvic anatomy that many women are either born with or acquire as they mature. Actually about a quarter of women have a retroverted uterus. Genetics may be the cause.In other instances, the condition may have an underlying cause that is often associated with pelvic scarring or adhesions. These include:* Endometriosis. Endometrial scar tissue or adhesions can cause the uterus to stick in a backward position, almost like gluing it in place.* Fibroids. Uterine fibroids can cause the uterus to become stuck or misshapen, or to tilt backward.* Pelvic inflammatory disease (PID). When left untreated, PID can cause scarring, which may have a similar effect to endometriosis.* History of pelvic surgery. Pelvic surgery can also cause scarring.* History of prior pregnancy. In some instances, the ligaments holding the uterus in place become overly stretched during pregnancy and stay that way. This may allow the uterus to tip backward.I went into a tailspin when I read this. When I had laparoscopic (keyhole) surgery to remove my ectopic pregnancy, the surgeon told me they saw scarring on my right fallopian tube, which had caused the fertilised egg - my baby - to get stuck in the tube and grow there, unable to pass into my uterus. On the day of surgery the same surgeon had sympathetically apologised telling me that they don’t yet have a way to move an ectopic pregnancy into the uterus. Whilst I was writhing in pain and trauma, crying for my baby, she suggested that a grumbling appendix in the past may have caused the scarring. Now I wonder if the cause of my tilted uterus is the reason for the pain, or if the origin of the pain is what tilted my uterus.Did whatever caused my retroverted uterus cause the scarring to my fallopian tube and lead to the ectopic pregnancy? What caused it? Will I ever know?My pelvic pain is near constant. It stabs and radiates. Is that due to the subsequent scarring caused by my ectopic surgery? Or is it from adenomyosis? The only way to find out what is happening inside my uterus is to have it removed and investigated. Yet the pain is subjective and thus is unseen, unheard, disbelieved, dismissed, denied, minimised.Invalidated. Taboo. Hushed. Hidden. “Public gynaecology doesn’t have time or resources for this, Sam”. It is so easy to gaslight a woman’s pain when there is so little understood about it. Invalidation seems more prominent than investigation. Why was the contents of my

Content warning: if you experience fear of the dentist, please take care when reading. TL;DR*Fluctuating/reduced estrogen in perimenopause can mean bone density reduces in jaws, jaw changes, exposed teeth/receding gums leave us vulnerable to loosening/losing teeth. Prevention is definitely better than cure, especially in the case of periodontal disease.Avoid over brushing and under brushing. The Goldilocks Effect may just help you avoid a gum graft. *Guess what? I have no dentistry training, but my friend Dr Kate O’Hara, a retired dentist, has co-written the sciencey bit with me. This post also includes links to sources should you wish to read what experts have to say on this topic.Arriving home with a fresh, raw gum graft, having paid a fortune for the privilege, one traumatic day almost six years ago was harrowing. Fittingly, it was Halloween. My husband pulled up on the driveway, our two sons and I his passengers, returning home from Wellington late one Thursday afternoon. In the front passenger seat, I had winced all the way home. By the time we made it 50km North up the Kāpiti Coast Centennial Highway, I was mute, silenced by surgery. Eyes wet with tears, my usual compulsive comfort eating was now out of reach. Water and smooth soups were all that was on the menu, but they would not provide the dopamine I needed in an effort to self-medicate. It felt every bit like I was arriving home with a newborn baby, after having undergone the prolonged procedure, getting stitched back up, and nursing a tender vulnerable new existence. My tender palate had been harvested for a wedge of soft inner tissue that was then sutured in place, attaching it over the exposed roots of my lower front teeth. Believe it or not, it was exponentially more unpleasant than it sounds. It took all my self-restraint to keep my tongue out of the wound so as not to disturb the sutures and compromise the attachment of the gum graft, which would have caused further bleeding and rendered the surgery pointless. I was under strict instructions from my periodontal surgeon to seek immediate medical help should I experience any unmanageable pain, fever or blood loss. Hygienic maintenance of the site was my number one priority, in order to prevent infection.In hindsight, as is the case with my most distressing ailments of late, periodontal disease was probably due to the culmination of decades of undiagnosed neurodivergence and undetected early perimenopause. It was a lot to deal with, and I will spare you all the gory details. In telling you this though, I would also love to save you from requiring such a procedure by explaining what led me to the periodontist’s chair back in October 2019, aged 38. With any luck, you haven’t previously heard about or experienced periodontal disease. I certainly wish I hadn’t. What is periodontal disease? Please note: The following description has been co-written with the help of Dr Kate O’Hara, late-diagnosed neurodivergent woman, perimenopausal, qualified and retired dentist.Her explanations are italicised below. I would like to thank her for her help, I was feeling out of my depth with this section! Not to mention a little triggered by revisiting this upsetting time of my life.Periodontal disease is a severe form of gum disease. It is what happens to some people’s gums when more common gum disease (gingivitis) symptoms go untreated, but not in everybody.Your risk of developing periodontal disease increases with factors such as:* Genetics i.e. a family history of the condition* Poor oral hygiene* Smoking* Systemic diseases e.g. diabetes* Stress and hormonal changesWhat I wish I’d understood decades ago is that plaque builds up on teeth overnight. Dental plaque is made up of bacteria, saliva, food particles and (so I have been told) dead sloughed skin from inside our cheeks. Unlike the rest of the dry skin on our bodies, it cannot flake and fall off, instead it mixes with saliva and gets trapped in the gumline. Cleaning teeth thoroughly twice daily gives us two chances to remove plaque by flossing and brushing teeth before it forms tartar, also known by dentists as calculus. Any remaining plaque can harden - everyone produces tartar (calculus) but at different rates, and based on factors such as:* Saliva composition and flow* Poor oral hygiene* Smoking* Diet* Tooth crowding * Having fixed retainers can make cleaning more difficult especially behind the lower anterior (front) teeth.* What types of bacteria colonise your mouth - some people carry more of the periodontal disease causing bacteria than others.If left unbrushed and unflossed (or brushed/flossed sub-optimally) for 24-72 hours, remaining plaque may harden and become tartar that cannot easily be removed, except by a dentist or dental hygienist. The tartar can cause gaps to form between teeth and gums, under the visible gumline. This may lead to gum recession and thinning - coming away from the tooth, exposing sensitive dental roots, leaving them vulnerable to decay, and bone loss in the jaw. This bone loss needs preventing in order to reduce the chance of later tooth loss.These severe gum recessions are called periodontal pockets. The pockets are measured by a dentist and, at a certain measurement, may lead to a referral to a periodontist (a gum specialist). The periodontist will assess the condition and carry out more in depth treatment which may include surgical or non-surgical deep root cleaning and gum grafting. In most cases once the condition is under control they will refer you back to your dentist and or hygienist for ongoing monitoring and maintenance. I don’t want to upset anyone, nor retraumatise myself, by describing the procedure in any further detail. Here is an external link to a a basic description of the procedure, including benefits and risks of periodontal surgery. What are the common dental and oral symptoms of perimenopause?To contextualise periodontitis as a severe and fortunately rarer gum disease, let’s firstly list what we can expect as more likely, and less risky, symptoms that can occur during the menopause transition:* Gum and tooth sensitivity* Bleeding gums* Dry mouth* Burning mouth* Altered taste* Skin thinning of gums and palate* Grinding and clenching teeth (associated with anxiety, may only occur during sleep)* Overall reduction in bone mass density, which can occur in the jawbones occasionally leading to loose and lost teethMore information here: Oral health and the menopause: Experiencing problems with your teeth or gums? Discover how your hormones can play a part in these surprising symptoms (Balance)Unraveling the Connection: Menopause, Peri-Menopause and Periodontal Health (Pure Periodontics)Hormone Replacement Therapy shown to be highly effective in reducing gum disease (Oral Health Foundation)How Menopause Affects Your Oral Health (Healthline)Menopause and the microbiomeThere is still so little known about the inner workings of women and AFABs, because history has attributed our non-male biology, anatomy and menstrual cycles to witchcraft and hysteria. The human microbiome, not to mention all research into female bodily systems, have been scientifically explored less than outer space, which I find out of this world. Fortunately there is now a growing research interest into the role of the female intestinal (gut) microbiome, the oral microbiome, and the role that fluctuating hormones play in the menopause transition and beyond. Menopausal shift on women’s health and microbial niches (Nieto, M. et al., 2025) highlights that, during the perimenopausal transition, fluctuating hormone levels impact the microbiome. The changes to the microbiome communities leads to oral, intestinal (gut) and urogenital health complications and makes us susceptible to disease. ‘The gradual decline in hormone levels during perimenopause disrupts the balance of the microbiome, leading to a variety of anatomical conditions and health complications…‘… Estrogen influences microbial communities while microbes can metabolize and influence estrogen levels. Thus, the interaction between hormones and the microbiome is complex and bidirectional. Understanding the menopausal shift encompasses how hormonal changes, environmental factors, and microbial dynamics affect menopausal symptoms and women’s health.’Source: Maria R. Nieto, Maria J. Rus, Victoria Areal-Quecuty, Daniel M. Lubián-López & Aurea Simon-Soro, npj Women's Health volume 3, Article number: 3 (2025)Are perimenopausal neurodivergent people more likely to develop periodontal disease?Ha, as if anyone has researched this! Sorry - I mean, there is currently no academic research indicating correlation nor causation between neurodivergent perimenopause and periodontal disease, as far as I am aware. Because nobody has studied such a niche yet.So, as usual, I will draw from my own lived experience of what factors I believe led to my own devastating dental demise…London in the 1980s was an overwhelming place and time for a sensitive little redhead such as I. Born with a tongue tie that was never released, and only diagnosed on the fifth day of my second son’s life, I was born with a tendency towards gingivitis (it means “gum disease”, so no redhead or ginger jokes, thank you). My Mum’s love language is dressmaking for herself and others. She loved to adorn me like a little doll in homemade outfits made of the prettiest scratchiest netting. I remember with alarm the tight elasticated sleeves that allowed them to puff out balloon style from upper arm to shoulder, as I cried and rapidly lost blood flow below the elbows. I was uncomfortable in my own outfits and in my own skin. Everything was too bright, too loud and too scary. How did I manage the discomfort imposed on me by my very existence?By thumb-sucking, of course! And here’s something I never tell anybody: I sucked my thumb until I was 11, and I used to keep my own stinky socks from each day and sniff them at night, tucked up under my nose, wed

Wowee, this post I released in the perineum festive break between Christmas and New Year 2024 has now had 10k+ views, 800+ likes, 100+ comments, and 100+ restacks:I am delighted it has resonated with so many people! I am still receiving comments on the post - although annoyingly not receiving notifications for them all…Thanks to demand avoidance, I have held out months before finally recording and releasing the audio voiceover. How apt!There are loads of comments in the original post if you would like to explore this topic further, and delve into what others have already said about it! Here is a quick recap of the intro to the post:Anti-Goals are:* Intentions that we actively avoid achieving.* A tool for demand avoidant neurodivergent adults to channel their precious and limited time, energy, focus and connections away from the tasks, people and responsibilities that drain us.* Anti-establishment, anti-capitalism and anti-productivity; thus aligning with many neurodivergent people’s mindset.New Year = New You? Just Say “No”!We have time - anti-goals are definitely best set mid year! 😜Cheers,It is an honour to host this community space for people in neurodivergent menopause. I dedicate many hours each week to respond to comments from all of my fantastic readers. Paid subscriptions make my advocacy work possible. Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Hi Team Auti Peri, My autistic perimenopause is an absolute shitshow right now. How is yours treating you? This week I have had bodily aches and last night I convinced myself to do the five minute evening yoga flow that used to be habitual. I don’t know if my body was aching because I hadn’t been doing it but, just as I was gently finishing triangle pose a muscle below my left hip absolutely wrenched itself! I couldn't breathe, whilst *trying* to breathe into it (those hypnobirthing sessions I took ten years ago are still paying off, baby! Ha ha, “baby”! Geddit?)Wincing, I hobbled all the way to the kitchen (where, alas, no soothing birthing pool and kind doula was awaiting me), grabbed the ice pack from the freezer and double dropped paracetamol. Inserted two Utrogestan (progesterone capsules) you know where, slapped my night time pump of oestrogen gel onto my arm and hoped it would soon stop hurting. Thanks to extreme HRT-defying levels of insomnia, I woke up several times in agony, struggling out of one awkward sleeping position into another. Nothing would stop it hurting, and 24 hours later it still hurts. Yes, I must have pulled a muscle, and normal injuries will occur in midlife. But I’ll be damned to believe that this agonising muscle pain isn’t distinctly down to perimenopause. Do I have evidence of this? Nope - you and I know I have no medical training whatsoever, apart from that one day first aid refresher course I took a decade ago. But, I know this is perimenopause! And I don’t know why I am still symptomatic when I am in a chemical menopausal state (it’s temporary, and reversible, much to my ongoing distress) caused by hormone blockers to alleviate my very late diagnosed premenstrual dysphoric disorder (PMDD). Alongside this treatment I am on carefully titrated hormone therapy (HRT/MHT) and things should be settled. I have never felt any less settled in my life!Fortunately I have doctors who are validating my lived experience of autistic perimenopause, and are empathising with my ongoing onslaught symptoms. I am waiting to see a public gynaecologist to have EVERYTHING removed by hysterectomy ASAP before I go completely out of my own mind. But what is it like when our doctors don’t believe us? When they dismiss our symptoms, and struggle to engage with our autistic communication? What is it like to be told by medical “experts” that, not only are you not autistic (“Or you wouldn’t be here and giving me eye contact”), but that you are “too young to be perimenopausal”. If you have heard either or both of these statements, welcome to the club. Just because they dismiss you, doesn’t mean you are wrong. Only you know what is happening in your body and mind for you at any given time. If they don’t understand that, I would recommend getting a second opinion. If that isn’t possible, you can take notes using a symptom tracker as supporting evidence. You may also wish to take along a trusted person who can advocate alongside you. Surely it’s harder for them to dispute you both? I would like to think so, anyway. Okay, so I am going to make some bold claims here. I have little to no supporting research, because there isn’t enough research into perimenopause, and the experts are still arguing amongst themselves and invalidating perimenopausal people everywhere. But I read all the time about seemingly random symptoms that occur in midlife that may be perimenopause related. Some of them may seem obscure. Perhaps they are, but those of us with interoception differences (either having heightened or reduced sensitivities in our internal states) are easily dismissed by healthcare practitioners. Speaking to you as an advocate in a peer support role, not from a medical background, I want to remind you - again - that if a doctor minimises your lived experience, it doesn't mean you are imagining these symptoms. For example, a common symptom is for menopausal people to experience brain fog. Often to the extent where we believe we are losing our minds, or in early stage dementia. This feels terrifying and shameful. We may feel like a burden to others and that our loved ones are better off without us. Please believe me when I tell you that lots of people feel this way, and I receive many comments and messages about this. It is not an uncommon experience, and it may be more widely experienced in the neurodivergent community, since many of us have been living with brain fog all our lives. At perimenopausal onset, our cognition may feel like it has dropped off a cliff. That is the inspiration for the latter part of my publication’s title: A Temporary Regression. I want to normalise this phenomenon. Oddly though, there are still doctors who say there is no empirical evidence that brain fog exists as a phenomena in perimenopause, which I frankly find ludicrous. There are many other symptoms that are more commonly experienced, but are kept on the down low due to societal taboos. Namely: low/no libido, and dry and/or atrophied vaginas and vulvas. Atrophy isn’t what it sounds like. Your skin may be sore or raw, you may have recurrent urinary tract infections (UTIs), but if you are waiting for your cervix to prolapse via your vag and descend out of your labia before you will eventually see your doctor, you are in for a horrendous time. I wrote about this a long time ago, so am re-sharing my post on vaginal atrophy in case you are interested (no OnlyFans content, I promise): We all know what the regular symptoms of peri/menopause are, right? Here is a quick refresher, with thanks to the Australasian Menopause Society (factsheet and infographic):* Changes in menstrual periods is an early symptom* Hot flushes* Night sweats* Problems sleeping* Pain in your joints* Tiredness* Anxiety or mood changes* Dry vagina* Overactive bladder or discomfortBut these stereotypical symptoms are just the tip of the iceberg. Well, maybe a better analogy would be a cliff face, with the main symptoms at the top, and the lesser known ones near the middle and bottom. If you get any or all to an extreme degree, you too may feel like you have been drop kicked off the top of the cliff, spiralling as you helplessly descend, hitting the ground hard, and feeling left for dead. I will spare you an infographic accompaniment to that gory metaphor…Delving deeper into the research 👓 we will find that around 34 symptoms are commonly stated:I haven’t found an extensive symptom checker, but more comprehensive lists are available. It is strange and unhelpful that menopause organisations list many possible symptoms, yet produce woefully short charts and trackers. Don't they know that we need thorough and comprehensive information?! Haven’t they heard of autistic perimenopause??!! No and no. So let’s keep pushing through. I hope you are still with me. Please don’t give up hope. I know of many excellent academic researchers pushing for our recognition and validation, but that is a long drawn out public dissemination process. Not to mention getting that information into policies, medical schools and primary care/GP practices. Whilst we wait for them to catch up with what we already know, we need to keep educating ourselves and staying in community. ***Hours of Googling later… If the academics don’t know this stuff, let’s not expect AI to have a clue!***The Join the dots: A-Z symptoms list is useful as the list includes a description of each of the symptoms listed. Please open the link for all the list items. There are other symptoms that are less taboo and more obscure. They crop up in midlife and we don’t realise they may be due to extreme hormonal flux. Here they are:Cold flushesScalp tinglingMetallic taste in mouthTennis elbowFrozen shoulderDry eyesBloatingBlood sugar dysregulationPhantom smellsHair loss/thinning/receding hairlineIncreased facial and bodily hair growthTinnitusBreast painBleeding gumsDental problemsBurning mouth syndromeElectric shocksBrittle nailsDizzinessHormonal acneOsteoporosisRoasaceaBody odourMelasma (darker patches of skin, usually on the face)Heart palpitationsSudden onset of phobias (e.g. driving)Body temperature dysregulationFormication (sensation of insects crawling on the skin)Weight gainHeadaches/migrainesDigestive issuesSkin tinglingSources of obscure symptoms: Uncommon Signs & Symptoms Of MenopauseWhat Are the Most Surprising Menopause Symptoms?10 surprising menopause symptomsI feel like the dyspraxic NDers amongst us 🙋‍♀️ will be all too familiar with this one already:Changes in spatial awarenessDuring the menopause, changes in the perception of depth of vision can occur, which can affect your awareness of surroundings. Your concentration can sometimes dip during this time, and your eyes can become drier. This can lead to clumsiness or being more accident prone.Source: HCA Healthcare UK 18 signs of the menopause that you might have missedNot to mention those of us who are self-identified or formally diagnosed as ADHD: Other Psychological and Behavioral ChangesConditions like obsessive-compulsive disorder (OCD) or attention-deficit/hyperactivity disorder (ADHD) have been shown to appear or worsen at menopause. Hormonal fluctuations change how your brain functions, and some women may experience:When it happens: Changes in mood and behavior can start in perimenopause.Possible symptoms include:* Impulsivity or risk-taking behavior* Heightened sense of caution or anxiety bordering on paranoia* Compulsive or repetitive behaviors (e.g., checking or cleaning)Source: Midi The Complete List of Menopause SymptomsYes, Midi, and the rest! 📋 🧠 🛑A lot of these symptoms may already be part of our neurodivergent experience of being in the world. But they may become more acute, frequent and even unbearable when our hormone levels are in extreme flux. That is one of the reasons I think we may find perimenopause absolutely horrendous. We have struggled with these symptoms throughout our lives, often with co-occuring chronic illnesses and anxiety disorders. Perim

Thank you to Kristi Keller 🇨🇦, Tamu Thomas and many others for joining my live video with Allegra Chapman!Bonus! Scroll to the end of post for a gratuitous cute cat photo... 🐈 ⬇️Let's talk about creativity, rest, and why you are doing better than you think — even on the hard days.TL;DR: Rest, Creativity, and Self-Compassion* Creativity looks different for everyone, especially if you're neurodivergent, disabled, menopausal or raising kids.* You don't need to create every day. Rest is part of the creative process.* Depression, ADHD, and PDA (Pathological Demand Avoidance/Pervasive Drive for Autonomy) can make creativity feel impossible — and that's okay.* Tiny goals (like opening a document) and body doubling (working alongside someone virtually) can help.* There are seven types of rest (physical, mental, emotional, social, sensory, creative, spiritual) — and we all need different kinds at different times.* Crafting, knitting, Lego building, journaling — all of these are real creativity and real rest.* Self-care is not selfish. You are worthy of it, even when you're not producing anything.* Build a creative practice that fits your energy, your mind, and your real life — not following somebody else's rules.💕 Start where you are. Go gently. You are doing enough.So much generous advice from Allegra about the balancing act of creating and resting, whilst managing motherhood and midlife adulting in general.You can subscribe to Allegra’s Substack at The Gathering. If you would like to work with Allegra she is running her Divergent Creatives course in June 2025 and is offering a time limited discount here. 💕Notes on accessibility: Apologies again for my numerous audio and visual tech issues, I hope the video is accessible to you. Closed captions are available in video playback. There is a verbatim transcript within this post. Audio alone may be triggering to those with auditory processing sensitivities from the second half onwards, hence why I had to stick my fingers in my ears whilst talking towards the end of the conversation. I sounded like I was in a cave! I don’t like caves…Note to my husband AKA Life Admin Time: Wayne Galloway, I need a new phone! 😭 ☎️Notes on AI as an accessibility tool in this post:Our discussion was full of self-compassion to inspire you and support our creative endeavours with as little energy and capacity that may be available to us at any given time. To this end, I have asked ChatGPT to summarise the video transcripts for you, because it is beyond my limited capacity. I use AI as an accessibility tool in some of my posts to ensure I can provide information as succinctly as possible, and I always disclose this to you. I have checked that the summaries (TL;DR above, and timestamped summary below, both in block text) provided make sense and reflect the vibe of our discussion. Even using AI to summarise I have spent two hours hyperfocused on drafting this post, argh! Clear and succinct communication is not a personal strength of mine, so here AI is providing the job of a virtual assistant: The longer summary…Timestamped Summary of "Rest and Creativity" Conversation00:00 – 00:16 | Introduction* The conversation opens about the need to talk about rest and creativity.* Sam shares personal struggles with depression and physical exhaustion in neurodivergent perimenopause.00:16 – 01:00 | Self-Care When You’re Exhausted* Basic self-care (eating, meds, water) was all Sam could manage during a recent depressive episode.* Hormonal issues made it harder; could barely leave the house for two weeks.* Creativity felt impossible when functioning at the bare minimum.01:00 – 02:10 | The Difficulty of Creativity in Depression* They discuss how masking struggles — like pretending to function while struggling inside — drains energy.* Parenting makes it even harder because there's no real option to retreat fully for self-care.02:10 – 04:00 | Redefining Creativity for Neurodivergent and Disabled People* Introduction to Allegra’s Substack mission: supporting creatives who are neurodivergent, disabled, chronically ill, or raising kids.* Breaking myths: You don’t need to create every day to be a “real creative.”* Allegra advises banning the word "should." Creative practices must fit individual needs.04:00 – 06:00 | Fighting the Myth of Daily Consistency* Allegra’s personal experience: writing two books without daily word counts.* Encouragement to ignore rigid advice and find what works for you.06:00 – 08:00 | Coping with Depression in Creative Life* Depression often blocks access to all the helpful activities (nature, creativity, movement).* When depressed, just surviving is enough.* Recommend creating a "self-care toolkit" in advance (like coloring books, prompts, knitting).08:00 – 10:00 | Creative Rest and Chronic Conditions* Case study: a participant in a creative program who could only manage 15 minutes a day.* Even tiny creative actions are valuable.* Rest can be creative.10:00 – 14:00 | PDA, ADHD, and Demand Avoidance* Discussion of PDA (Pathological Demand Avoidance) and its neuro-affirming term Pervasive Drive for Autonomy.* How PDA complicates creative work, even when it's something you want to do.* Challenges with ADHD, PDA, and creative resistance.14:00 – 18:00 | Crafting, Knitting, and Self-Compassion* Knitting discussed as a low-pressure creative outlet.* Tips: start simple (e.g., knit a scarf, not socks!).* Crafting seen as valid creativity and a form of therapeutic rest.18:00 – 22:00 | The Seven Types of Rest* Based on Dr. Saundra Dalton-Smith’s work (TEDx talk), explained through a book by Tamu Thomas:* Physical Rest* Mental Rest* Emotional Rest* Social Rest* Sensory Rest* Creative Rest* Spiritual Rest* Understanding these helps tailor rest for neurodivergent and busy lives.22:00 – 26:00 | Rest as Resistance* Rest is crucial for caregivers and neurodivergent people.* Respite can be as simple as headphones in the same room.* Recognising the emotional toll of caregiving and demanding lives.26:00 – 31:00 | Accountability, Body Doubling, and Tiny Goals* Accountability is a major motivator for creative people.* Body doubling (working alongside someone else) helps maintain focus.* Set very tiny goals ("open the Word document" — that's enough!) to overcome inertia.31:00 – 36:00 | Different Tools for Different Brains* Visual cues like leaving projects lying around and visible help ADHD minds.* Flexible habits ("rituals," not rigid routines) work better for many neurodivergent creatives.* Understand yourself first — then build systems around your real needs.36:00 – 42:00 | Nonlinear Creative Processes* Bullet points, mind maps, recording yourself — all valid first steps.* Finished creative work never starts polished — allow messy beginnings.42:00 – End | Closing Thoughts* Let go of the idea there’s only one "right" creative method.* Adapt creativity around fluctuating mental health and energy.* Self-care is a right, not just a means to be more productive for others.* Discussion ends with warmth and encouragement to honor your own rhythm.If you have read this far, thank you. Here is a photo of Harry as tax, overseeing the post-editing process. Here is social proof that I am indeed putting the ADHD into “But you don’t look neurodivergent!” (By the way, nobody has ever told me I don’t look autistic or ADHD, ha ha!):Wish me luck, I am relocating my dumping ground DOOM pile writing desk to another room in the house later today! 🤞Fun fact! Did you know the “DOOM” in “DOOM pile” stands for “didn’t organise, only moved”?Look at that basket on the floor, it has my proper mic in it. Regrets, I have a few…Two coffee mugs to be found in the photo! 🦊 🦊 If you would like to buy me a coffee, I would be very grateful!Until next time! I deep dive daily into neurodivergent perimenopause and report back here to help you stay above the water. Your donations help me to keep this community afloat. 🛟 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Hello! I just found out that today, April 24th, is World Hormone Day! It is already getting late into the evening here in Aotearoa NZ. But better late than never. I recorded a last minute video to share with you, where I talk about my hormone replacement therapy (HRT) regimen. There is no attempt to persuade you to try it (although vaginal Ovestin cream is the best!), but more of a run through of my regimen, and I share tips I have picked up to make application and absorption as unmessy and icky as possible. My professional background is in teaching/education and not medicine, so please don’t take anything I say as medical advice. I see my role as peer support and advocacy. Please see your doctor about HRT and midlife healthcare. This video isn’t scripted so I hope it all makes sense. It was getting late here, and I am in a depressive spiral for some reason. Therefore I copied and pasted the video transcript into Claude.ai to create an easy read timestamped description for accessibility. It was so dull that I asked Claude to make it fun. It didn’t disappoint! I am sharing it below (in the block text) if the video/audio aren’t your preferred way of accessing/processing information. There are closed captions on the video and also a verbatim transcript. Please forgive the “ums” and “ahs”, my ADHD meds were wearing off and I was staving off a medication rebound. Isn’t neurodivergent midlife fun?! *sarcasm*Fun & Quirky Video Guide: Sam's Hormone Adventure! 🎢The Opening Act 🎭0:00-0:14 - Meet our hero Sam Galloway from "The Autistic Perimenopause: A Temporary Regression" 0:15-0:24 - It's World Hormone Day! 🎉 (April 24th) Cue the confetti!The Estrogel Experience 💪0:25-0:54 - Say hello to Estrogel, Sam's estradiol buddy! 0:55-1:18 - Cool trick alert! 🧙‍♀️ Pumping onto the lid for sensory-friendly application 1:19-2:04 - The arm dance! 💃 Shoulder-to-wrist application technique 2:05-2:28 - Don't rub it all in! And keep it away from co-sleeping kiddos (no accidental hormone sharing!)Testosterone Time ⚡2:29-3:06 - Meet Testogel: possibly a neurodivergent's best friend! 3:07-3:37 - The quarter pump challenge 🎯 (precision matters!) 3:38-3:57 - Outer thigh gets the goods (buttocks are also an option!) 3:58-4:25 - The 5-minute waiting game before pants come into playPatch Party 🎪4:26-4:48 - Introducing the lifesaving patches! (Literally - "better than suicidal ideation") 4:49-5:32 - Math time! 25 + 75 = 100 (because 100s aren't available anymore) 5:33-6:16 - What's in the mystery packet? A much smaller patch than you'd expect! 6:17-7:16 - The Great Patch Direction Debate 🧭 Length-wise wins to prevent splitting! 7:17-8:12 - Warm it up! Press it down! Air bubbles are the enemy!Progesterone Parade 🎪8:13-9:56 - Utrogestan enters the chat (AKA: the one Sam struggles with) 9:57-10:55 - For some lucky folks: sleep, calm, and happiness! (Not for Sam though 😅) 10:56-12:04 - Tiny capsules with options! Oral, vaginal, or... elsewhere? 🤫 12:05-12:48 - Cancer prevention > side effects (but removal is the dream!)Cream Dream Team 🌈12:49-13:22 - The grand finale: Ovestin cream! ("You need this, guys!") 13:23-14:01 - Topical means local! Less problems in places it doesn't need to be 14:02-14:46 - The schedule: nightly for a few weeks, then twice-weekly maintenance 14:47-15:19 - Surprise family interruptions! 😂 Quick goodbye as real life happens!Bonus Round 🏆Throughout - Random husband and child cameos! Keeping it real! Entire Video - Zero filter, 100% authentic hormone talk!Claude.ai has hyped me right up, ha ha! ChatGPT, eat your heart out. Right, I’d better go. I need to shower and apply all the gels, patches and pop all the pills. I hope your hormones are being kind to you today! Cheers, This week I have shared all my hard won HRT geekery and enthusiasm. Your support helps me raise awareness of autistic perimenopause and advocate for us all. Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Hello!If you are new here, welcome to The Autistic Perimenopause: A Temporary Regression!I am Sam - a late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause.Today I am deep in the midst of neurodivergent perimenopausal misery, so let’s see if I can put words in an order that conveys anything of interest and/or that makes sense… 🤞This week I have spent one million hours researching, writing and editing this and other upcoming posts. Your support allows me to keep this community thriving. April is Premenstrual Dysphoric Disorder (PMDD) Awareness Month, as well as Autism Awareness Month. Yippee! 🎉Geopolitically, the awareness drive doesn’t seem to be hitting the mark, with those in power denying us any sort of respect or rights. But let’s pop that aside for now and imagine we are receiving the support and respect we deserve for being the differently wired legends that we know we are. 💕What is PMDD?Premenstrual dysphoric disorder is a cyclical, hormone-based disorder that impacts approximately 1 in 20 reproductive-age women who were assigned female at birth. The condition is often underdiagnosed, misdiagnosed or dismissed entirely by medical professionals, despite patient reports of debilitating anxiety, hopelessness and a variety of physical symptoms in the two weeks before menses.UIC Today: Suicidal thoughts, behaviors linked to hormone-sensitive brain disorderI know, I am sorry. As it was for me, so may it be for you: yet another co-occurring condition we can enjoy adding to the alphabet soup of diagnoses we are gaining in neurodivergent midlife. PMDD can be another great too-late explainer of why everything has been so s**t for those of us being destroyed by our menstrual cycles for decades. Yay. But contextualising past (and, in my case, current) hell is a winner, right? So, yes, PMDD is an actual “mental health disorder” and validates why many of us have felt beyond awful on a cyclical basis. Yet with no perception of time and as a lifelong time agnostic (thanks, ADHD!), it is unfortunate that tracking symptoms and noticing patterns over time is not a strength of mine. Whilst I can think back to the overflowing catalogue of times when former friends and ex partners have told me I am a “crazy b***h”, I wouldn’t pick up on that being, for example, the third week of every four week cycle. PMDD is not a hormonal imbalance. The hormone levels are not the issue, rather those of us with PMDD are neurobiologically sensitive to the fluctuations of oestrogen and progesterone levels through a normal and natural menstrual cycle. NB: I am so exhausted by PMDD and all the other midlife BS right now that I am not coping with, that I am struggling to figure out when to use the words “period”, “cycle” and “episode” in the correct context. And all this whilst my teen is sitting beside me as I write telling me about Fortnite…Here is a very short podcast episode from The International Association for Premenstrual Disorders and provides a succinct explanation of PMDD: In order for me not to provide you with the wrong information, let’s hand this over to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.I don’t know about you, but I cannot process that text right now. Therefore, full disclosure, I have asked ChatGPT to summarise this for an autistic audience in an easy-read style: ⬇️✅ To have PMDD, these things must happen:🌸 What is Premenstrual Dysphoric Disorder (PMDD)?PMDD is a serious health condition that affects some people before their period (menstrual cycle). It causes strong feelings and body changes.✅ To have PMDD, these things must happen:1. Timing of Symptoms* You must have at least 5 symptoms in the week before your period starts.* The symptoms:* Start before your period,* Get better a few days after your period starts,* Are mostly gone in the week after your period ends.2. At Least 1 Strong Feeling Symptom (Pick from this list):You must have one or more of these:* Mood swings (feeling very happy then very sad quickly)* Feeling angry or annoyed easily* Feeling very sad or hopeless* Feeling nervous, worried, or on edge3. Other Symptoms (To make a total of 5 symptoms)You also need more symptoms from this list:* Not enjoying things you usually like (e.g. friends, hobbies)* Trouble focusing or thinking* Feeling very tired or no energy* Eating a lot, or craving certain foods* Sleeping too much or not enough* Feeling overwhelmed or out of control* Body problems like:* Breast pain or swelling* Muscle or joint pain* Feeling bloated* Gaining weight4. How it Affects Your Life* The symptoms make it hard to do normal things like:* Going to school or work* Being with friends or family5. Other Health Conditions* PMDD symptoms should not just be part of another condition (like depression or anxiety), but PMDD can happen at the same time as other conditions.6. Keeping Track* Doctors should look at your symptoms for at least 2 periods in a row to be sure.7. Not Caused by Something Else* The symptoms are not caused by:* Drugs or alcohol* Medication* Another illness (like a thyroid problem)(Sam) Then I asked ChatGPT for a diagram to support the visual processors amongst us 🙋‍♀️⬇️⬇️Sam to ChatGPT:⬇️(Sam) ChatGPT could not fulfil this request, so let’s not get too worried about AI coming over here and taking our jobs and our women just yet.*** END OF CHATGPT AND AI USE IN THIS POST *** (apart from the transcript from my audio voiceover that Substack tech will hopefully write up for me later) 💕Why do I need to know if I have PMDD?Increased risk of suicidality is associated with PMDD, and that is why I want you to know about it. It is also more prevalent in the neurodivergent population, which I doubt will shock you.It is tricky, as it can take decades before we realise this chronic mental health condition affects us. I was diagnosed with it retrospectively after unwittingly undergoing the third line treatment for this little known debilitating mental health condition. Before I knew I had PMDD, I heavily masked my cyclical breakdowns, took a lot of time off work (I was a teacher in my 20s), binge ate chocolate, then manically exercised to compensate for it. I lost close friendships, stormed out of the house with no plan where to go and not knowing why I had put myself in that vulnerable position. I drove dangerously, and leaned into impulsivity. I raged and had intense meltdowns, smashing things a la Fern Brady in her autistic memoir, ‘Strong Female Character’. Whilst it is helpful to know now that I was a PMDD sufferer, I would have found greater benefit in that diagnosis decades ago. I could have planned my life accordingly. I masked to an exhausting extent, and made up for my self-destructive PMDD one-week-in-four episodes by pushing myself beyond my limits my three “good” weeks per menstrual cycle. Putting all my energy into hiding and excusing this “mental disorder” each month left me exhausted and susceptible to cyclical undiagnosed autistic burnout. So now I know that understanding myself sets me up to be more aware of potential challenges, and kinder to myself when they are genuinely insurmountable. People diagnosed with PMDD these days are able to request reasonable accommodations at school, at home and at work. In the laughably entitled podcast The Happy Menopause, interviewee and PMDD survivor, lecturer and researcher, Dr. Lynsay Matthews, states that PMDD sufferers may describe their episodes as: * spiralling* unravelling* out of control.And they may identify these patterns in line with the luteal phase (post-ovulation to your bleed, average days 14-28 of the menstrual cycle): * cyclical relationship crises (splitting up with your partner every month, losing friendships etc.)* cyclical addiction crises (patterns of alcohol or drug misuse, associated driving under the influence offences etc.)* cyclical psychosis crises (I don’t have examples of this but I am wondering about the misdiagnoses of Bipolar Disorder and/or Borderline Personality Disorder that so many menstruating autistics and ADHDers receive..?)💕Australia-based UK-trained GP with an interest in women’s hormonal health, who was interviewed on the Sexy Ageing podcast, Dr. Ceri Cashell, says:“Life’s short. You don’t know what’s around the corner, so to lose half or a quarter of your life due to these (PMDD) symptoms is horrific.”How do I know if I have PMDD?IAPMD provides an online self-screening tool that is not intended to be diagnostic, but may support you in knowing whether or not to pursue an assessment. The purpose of the self-screening tool is to help you identify whether you may have PMDD or Premenstrual Exacerbation (PME). PME, is a condition that is a worsening of symptoms of another disorder, such as generalised anxiety or major depressive disorder. It is a different condition to PMDD, but the two can be difficult to distinguish between. What a mindfuck.If you, like me, have used the oral contraceptive pill over the years, your PMDD may have been masked treated by this during that time. That can make it harder for us to know in hindsight that we have been struggling with this condition. Therefore, symptom tracking is required for an assessment and diagnosis.HOW IS PMDD DIAGNOSED?Premenstrual Dysphoric Disorder cannot currently be detected or diagnosed via a blood or saliva test. However, a blood test can rule out other conditions which would need to be managed differently to PMDD. The only way to definitively diagnose PMDD is to track the severity of your symptoms over two or more menstrual cycles.Download the IAPMD premenstrual tracking guide to identify a possible link between any symptoms you have been experiencing and your ovulation cycle.The trackable symptoms:* Felt depressed, sad, “down,”, or “blue” or felt hopeless; or felt worthless or guilty* Felt anxious, tense, “keyed up” or “on edge”* Had mood swings (i.e., suddenly feeling sad or tearful) or was sensitive

Hi Team Auti Peri,How are things with you? Just a short video as I am too tired to write a long form post, but I wanted to let you know that I am thinking of you. In last weekend’s post I walked you through writing an Autism Adapted Suicide Safety Plan. I would love to know if you found it helpful?As you might expect, I am still on a low after that! This video post is a little lighter, in the metaphorical sense. The downlights in the room were blinding so I filmed it lying down to pretend I don’t have enormous under-eye bags. Which is a lie.My face in fact looks like this:💼 💼👃👄Sorry, I am in a weird mood…Anyway, the notes I was supposed to be referring to in this video read as per the following (is that even grammatically correct? I am so tired): * You are the expert on yourself.* You know your own needs better than any doctor or professional.* It can take us a while to decode our internal signals, but we have to trust our guts(?).* It has taken me two days to figure out that I am feeling (mildly) depressed. The cues were 1) not leaving the house in two days, and 2) eating cheesecake directly out of the non-Tupperware tub.* Functioning labels are often rejected by the autistic community because assigning a level to our (dis)abilities will never account for our fluctuations and regressions in functioning and support need levels. * Pre-autistic perimenopause I would have considered myself to have been a “gifted” thinker in terms of my processing speed, ability to articulate myself and to manipulate many directions of thought at once. * Mid-autistic perimenopause I have regressed significantly and am continuing to do so. * Autistic and neurodivergent people are dynamic beings in a world that wants to label us and put us in boxes. Which is ironic given that the “experts” tell us we are autistic if/when we label, categorise, line up and box all the things! If you take nothing else from this video, then please hear this: You should go and have a nice lie down alone for a bit. (But maybe turn off the downlights first.) 📝 Thank you for reading! 📝 🎧Thank you for listening! 🎧 📼 Thank you for watching! 📼 🐈 🐈 Please subscribe if you like! 🐈 🐈 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Trigger warning: this post is entirely written on the topic of preventing autistic suicidality and self-harm. If you are sensitive to these topics, please take extra care of yourself. 💕Hi Team Auti Peri! Sorry for the bleak post but some of us in the community are on a real low. Naturally, this has led to us sharing cat photos in The Autistic Perimenopause chat group. We need and deserve more than just autism awareness. We need a collective social movement to prolong our lives to the same life expectancy of our non-autistic peers.This morning I watched an Autistica webinar on the topic of suicide prevention for the autistic population. Did you know that autistic women are 13 times more likely than non-autistic women to die by suicide? I didn’t, but I learnt this in the second webinar I watched. And I had previously thought that the “3x more likely” statistic was most up to date... If you are feeling suicidal, or have strong feelings and urges to self-harm, please know that you are not alone. Many of us also feel that way, and we all need to support each other through this. Hiding these feelings doesn’t help anyone, but expressing them to others and following a safety plan can save our lives. Autistics deserve to live as long, happily and healthily as anyone else, so let’s work on suicide prevention together. In this video post I will take you through the seven steps of the Autism Adapted Suicide Safety Plan (AASP) using this document developed by Newcastle University in the UK. 🎥In the previous post shared below, I outlined 10 tips to support you, with the AASP being the tenth tip:Autism Adapted Suicide Safety PlanReach out for help, and have an Autism Adapted Safety Plan (AASP) in place:The resources are suggestions to help you understand and complete the safety plan for yourself, or to support another person to complete their safety plan.Step 1 - What are my warning signs that I may start to have strong thoughts, feelings or urges to hurt myself and/or end my life? (e.g., reduced enjoyment in a strong interest, change in routine, change in patterns of sleep, eating, mood)Step 2 - What can I do to help distract myself? (e.g., engage in a particular activity or interest, a relaxation technique, or physical activity)Step 3 - People I can contact to ask for help: (e.g., family, friends, mentor, support worker). Remember to note down when people are, or are not, available (e.g., office hours).Step 4 - Professionals or agencies I can contact during a crisis: (e.g., Samaritans, Mind, A & E, Psychiatric Services). Remember to note down when people are, or are not, available (e.g., opening hours).Step 5 - What can I do to make the environment around myself safer? (e.g., throwing away things that could be used to harm yourself)Step 6 - How can other people help support me?How do I communicate distress? (e.g., I shut down, I have a meltdown)What stresses me/makes me unhappy? (e.g., loud noises, being touched, change of plan, too much information)What can help calm me/makes me happy? (e.g., a strong interest, a quiet safe place to calm down, just sitting with me, giving me my own space)How I would like you to communicate with me? (e.g., don’t ask me to look you in the eye, speak softly, use visual supports, use plain English, keep in mind that I may take what you say literally)Who I would like you to contact?Step 7 – Sharing my safety plan: It can be helpful to share your safety plan. This might be with a trusted friend or family member, health care professional, or support worker. Would you like to share your safety plan? Who would you like to share it with?Storing my safety plan: It can be helpful to think about where you will keep your safety plan so that you can easily access it if you need it (e.g., printed out, in my bag, in a ‘crisis box’, on my phone). It might also be useful to think of any prompts that could help you to remember to use your plan (e.g., having a card with the safety planning logo in it in your wallet to remind you that you have a safety plan).I really hope this video is helpful to you! Please let me know what you think in the comments. To fulfil your accessibility preferences, you can listen to the podcast episode rather than watch the video, and/or read the video transcript within this post. 🎧Please take good care of yourself. 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈 🐈‍⬛ 🐈I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

This direct message from a new friend on Substack this week has provoked self-reflection on my part, as well as being a reminder of how disempowered and uncertain we can feel during the neurodivergent menopause transition:“I have people around me on polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”Why are we so opposed and opinionated? I am guilty of pushing my own agenda on others, and I went too far via text message when recently advising another friend to drop the “withdrawal method” as contraception in a casual relationship. Like me, she is perimenopausal, and I was insistent that this contraceptive method cannot be reliably effective in our life stage, when our periods are unpredictable and our ovaries are forcefully making last ditch attempts at ovulation and conception. I was freaking out on her behalf, as the thought of me getting pregnant now is terrifying. I was so impassioned and preachy telling her my opinion, but it was an unwarranted projection of my own fears. I thought I was sparing her the risk of an unwanted pregnancy, and the avoidable trauma that can go along with that. My ADHD meds had worn off for the day and my interference filter was in the bin until the next day’s dose. I was letting my special interests of hormones, fertility and women’s bodily autonomy overcome my low capacity for listening to her views. Reading that back, I see how contradictory that is and how ridiculous I was being.I have since apologised to her profusely. Info dumping my special interests on others can feel so rewarding, and the dopamine that comes with it can overwhelm me. Missing my friend’s cues and discomfort - easily done over text message - only made it worse for both of us. Women and AFABs are socialised to be talked at and hold our tongue. Autistic women (me) once up on their soapbox are hard to quieten. Our friends may not tell us to STFU at the time, but they may b***h about us behind our back, which is worse. Do you have a friend like me who tells you their opinion without stopping to listen to yours?If so, I would like to apologise on both our behalf’s, and reframe our misguided interference as an offering of love and illumination. We are trying to show you that we understand your issue, and that we have the fix you need. That we have researched both sides and formed our conclusion, so that you don’t need to waste your time and energy on it. We’ve got your back!We are not looking for a fight, but we will often defend our opinion to the end, because it was hard won. I’ve said it before and I will say it again: info dumping is my love language. It is not an ideal love language… Most people would prefer to receive flowers over a barrage of texts telling them what to do for the best with their uterus.I know it is something I need to learn to control in myself, because it is pissing everyone else off. And I will come back to it when my cognition improves after this current regression. Or not. Anyway, back to the original point: “I have people around me on the polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”💕Bodily autonomyWomen and AFABs deserve impartiality when deciding on the best way to approach managing symptoms of perimenopause. The world is polarised in every way possible, more so now than ever. Can we say anything without receiving a barrage of comments, trolls and naysayers telling us we cannot do right for doing wrong?I want to take this opportunity to say that there are many different ways of living through the inevitable, natural and unavoidable menopause transition. Yes, I am heavily medicalised, monitored and hoping to end it all as soon as possible with a total hysterectomy for the sake of my mental health. But also yes, I did once consume my newborn baby’s placenta in a smoothie after a home hypnobirth in a birthing pool in my kitchen because I then identified as a “Crunchy Mama”. But we can change our minds at any point! In fact, immediately after mooing my baby out without pain relief, I insisted on using gas and air whilst having my perineum stitched back together because I had already been through enough. 🪡Boundaries are essential when making important decisions around our own health and wellbeing. Those boundaries include telling people that you have considered all options, and have decided what feels worthwhile trialling right here, right now. Many options in women’s health treatment are reversible and temporary anyway - perhaps apart from unmedicated births after the event, and surgical menopause. Feeling empowered to make your own choices, and having them supported by trained professionals overseeing your treatment plan, is vital. Your friends offering their support rather than judgement is a nice to have. It doesn’t need to determine what you do next.We don’t have to take sidesAll good teachers, child psychiatrists and similarly esteemed professionals will should tell us that we are the experts on our children, and that they will support us, backing us up with their expertise. We are pretty good at trusting our instincts when it comes to our children’s emotional safety and best interests. Rarely do we do the same for ourselves. Please know that you are the expert on yourself, and that the trained professionals you trust and work with on your perimenopause transition need to be experts in their field, and working alongside you as a partner. Optimising your quality of life and mental health at all times is what counts. We both know that your friends love you and want what’s best for you, but they might be misguided and biased on what you actually need right now. There are options for treatment that are medicalised and non-medicalised. The term “holistic” gets a bad rap these days. In its truest sense, holistic means our body, mind, spirit - and anything else I haven’t thought of - are interconnected. That we are one being. But “holistic medicine” is considered by some to be pretty woo-woo by comparison. What comes to my mind regarding “holistic medicine" is herbs, tinctures, compounds, sage bundles and other stuff I clearly haven’t researched for this article (sorry). Yet I consider my own menopause treatment plan to be fairly holistic - in the more holistic sense of the word - incorporating hormonal replacement therapy AKA HRT (micronised progesterone capsules, oestrogen gel and patches, vaginal estrogen cream, testosterone gel), hormone blockers, SSRI, strength training, plant based eating, protein powders, creatine, weighted blankets, artificial tears, yoga nidras, Ragdoll cats x2, podcasts, writing, and cathartically yelling at people who push me too far. 🧘‍♂️Yesterday I even tried to learn how to knit. Because I am desperate, and it seemed therapeutic, yet cheaper than most therapies.… 🧶Why Hormone Replacement Therapy (HRT) has bad PRHave you heard of the Women’s Health Initiative (WHI) study that wrongfully associated HRT with over-inflated risks of significant health issues? Because if you haven’t, I wouldn’t advise you read up on it. It’s since been disproven due to problems around research methodology, participants’ ages, and the outdated types of HRT that were offered at the time. Yet the repercussions of the WHI study still affects us all today. When we ask our doctors about being prescribed HRT, their computer will flash up a warning. ‘HRT prescribing guidelines have not been updated with the current evidence about HRT which means that when GPs prescribe they are warned by their computers that certain HRT products should not be prescribed.’Balance website, Dr Louise Newson: Understanding your GP – Four reasons why some women might not be able to obtain certain types of HRTGeneral practitioners are not trained in menopause during medical school to the extent that serves us, and nor are they required to undertake any further training on the topic once practicing. (Please correct me if I am wrong.)Medical misogyny fails women and AFABs every day, with the notion that menopausal people are subjects of hysteria continuing to prevail. You don’t have to sufferThe good news is that societal messaging on menopause is turning a corner. No longer a taboo, we are beginning to openly talk about it. Although I can only speak from own viewpoint in Aotearoa NZ as a middle class, native English speaking, white cis woman.We have a lot to learn from each other, but we all need to remain open minded. For the neurodivergents amongst us, and for anyone who has experienced previous bouts of hormonal depression and emotional/mood dysregulation (during puberty, pregnancy, using hormonal contraceptives, during IVF treatment, postpartum, PMDD and so on), we are especially vulnerable to recurrent depression due to the extreme fluctuations in perimenopause. These are potentially volatile times in our emotional lives. Menopause does not exist in a social vacuum. It affects entire families, workplaces, communities and societies. You are not being selfish by asking for more support in your day to day life, by seeking treatments, nor by having high standards of your healthcare providers. If you have seen beneficial results from ashwaganda, sprint interval training and sitting in circles with other women, I am very happy for you. Had I not sought neuro-affirming healthcare from a doctor who specialises in women’s health, with an interest in neurodivergence, perimenopause, and how the two intersect, I would have succumbed to menopausal suicidal ideation several years ago. When we say we need help, help is exactly what we need. We are not the “worried well”. Nor are we attention seeking. We are asserting our right to appropriate health care and medical advice. I don’t know about yours, but my friends can’t offer me impartial medical advice, or monitor my responses to different types of treatments that may or may not alleviate my psychiatric symptoms caused by fluctuating hormones. Nor can they ref

Have you heard of the Blue Zones? Before I was obsessed with autistic perimenopause (hard to believe there was such a time, I know), my special interest was longevity research findings and healthy lifestyle advice. National Geographic explorer and researcher, Dan Buettner, shares the optimal lifestyle principles believed to be responsible for extending the healthspans and lifespans of the oldest living human communities on Earth, in the idealistic Netflix documentary series: Live to 100: Secrets of the Blue Zones.Where on Earth are the Blue Zones?* Loma Linda, California, USA* The Nicoya Peninsula, Costa Rica* Nuoro Province, Sardinia* Icaria, Greece* Okinawa, JapanSome definitionsBlue Zones: regions of the world with the highest number of centenarians (people living to 100 and beyond) that Dan Buettner marked in blue on a world map, thus coining the term. With information galore to be gleaned and implemented from Dan’s New York Times bestselling books, countless podcast interviews, and now a Netflix series, we have no excuse to check out of this world early, right?Power 9: 9 commonalities found across the Blue Zones, that are thought to be lifestyle behaviours that can lead to a long lifespan, and healthspan.Lifespan: the length of time someone is alive. Healthspan: the length of time someone is free of dementia, chronic disease and/or disability, living with a good quality of life (which is highly subjective…)Mental health span: the length of time someone is free from significant mental health issues (including chronic stress, emotional dysregulation, depressive episodes), and able to function, cope and thrive despite life’s challenges. 🗺️I found Dan Buettner’s Blue Zones concept sexy long before it was well known in the mainstream. I even had a diagram of the Blue Zones Power 9 stuck to my fridge because knowledge is power sexy. But now that practically everyone is talking about the Blue Zones, I am no longer interested.Story of my life. The same thing happened when The Mighty Boosh got their third TV series onwards. The original BBC radio series was when it peaked!Not to mention when the now Taskmaster superstar Greg Davies’ incredible live sketch comedy trio, We Are Klang*, was scripted into a TV sitcom. Urgh, mainstream media. Yawn. They just lost all their appeal to me. I want to be the only person who knows something, and I want to be the one boring everyone else to death with it. If people then like it and quote it back at me, I’m out. But I know I shouldn’t be selfish with my longevity research special interest. We all want to grow old together beyond the midlife (ish) shitshow that is neurodivergent menopause. So many people rave about life improving for us post-menopause!Personally, I can not imagine feeling any worse than I currently do in autistic perimenopause, but I am trying to hang in there…A question I often ask myself is, if neurodivergent people could reverse engineer longevity to live in Blue Zones style conditions, could we all become centenarians?* You may find this YouTube clip highly offensive, in which case I can only apologise! It aligns with my vulgar British sense of humour… ☕️🗞️ This just in! 📰Blue Zones researchers report that…🙌 … Science Confirms: Coffee Can Add Years to Your Life 🙌☕️But what about us?Being late diagnosed neurodivergent can feel akin to being beaten up and left for dead. Yes, a diagnosis may feel validating and reassuring, putting our struggles to date into context. But rarely does it come with a plan or model to follow up with strategies intended to optimise our lives going forward. We may feel bereft of the person we could have become, had we benefited from the right accommodations and acceptance from others earlier in life, and from society at large. Where is the newly diagnosed neurodivergent’s manual we need to pick us up and guide us through midlife, and beyond? Sadly, academics are still at the research stage that tells us what we all already know: that The Lost Generation of Neurodivergent People (you and I) are at risk of poor mental health outcomes, chronic disabilities and untreated co-occuring conditions. Give it another twenty years, and we might know what to do about it. Research into the life expectancy of autistic people in the UKDr Judith Brown, Head of Evidence and Research at the National Autistic Society, said: “Autistic people continue to face unacceptable inequalities through a lack of understanding, barriers to vital services and inadequate care, which lead to poorer mental and physical health outcomes.“Without investment, improved understanding, inclusion and the correct level of support and care, autistic people will continue to see reduced life expectancy, with the most at-risk group in this study being autistic women with learning disabilities. This research should be a wake-up call for Government, the NHS, healthcare professionals and society as a whole that we must tackle the health inequality autistic people face.”University College London (UCL) News: ‘Premature death of autistic people in the UK investigated for the first time’, published online 24 November 2023It is bleak. Neurodivergent people often have a much shorter mental healthspan than the average population. I can’t think of a single year out of my 43 and counting that I haven’t grappled with mental health struggles that retrospectively co-occured alongside my undiagnosed neurodivergence. Fun fact: At birth, I weighed 8lb 7oz, and was already 9 months into a chronic existential crisis…What can really skew lifespan data is premature death by suicide. A shorter mental healthspan may cause the most vulnerable and least supported amongst us to have a preventably shortened lifespan. Risk factors for suicide in autistic peopleMental health challenges can increase the risk of someone taking their own life. About 8 in 10 autistic people will experience a mental health problem during their life. This compares to 1 in 4 people in the general population having a mental health problem at some point in their life.Some research suggests co-occurring ADHD can increase the risk of suicidality in autistic people. One study found possible explanations for this include increased depression, people feeling they are being perceived as a burden, and impulsivity (a key feature of ADHD) meaning people are more likely to be exposed to ‘painful and provocative’ life events.Gender diversity can increase the risk of suicidal acts. Autistic people are more likely to be gender diverse than non-autistic people.Autistica website, ‘Suicide and Autism’So, with all odds stacked against us, how can we reverse engineer longevity within the neurodivergent population? The Blue Zones Power 9! *mic drop**Picks mic back up* Don’t worry, guys! Dan and his Blue Zones have us covered! Let’s take each Blue Zones principle in turn and see how it fits into neurodivergent life. We need all the help we can get, afterall! But first, a message from Blue Zones’ own Dan Buettner (with all following italicised block quote text taken directly from the original research paper, Blue Zones Lessons From the World’s Longest Lived): “To make it to age 100, it seems that a person must have to win the genetic lottery. However, many individuals have the capacity to make it well into the early 90s and largely without chronic disease. Blue Zones uncovered 9 evidence-based common denominators among the world’s centenarians that are believed to slow this aging process.”1) Move naturallyThe world’s longest-lived people do not pump iron, run marathons, or join gyms. Instead, they live in environments that constantly nudge them into moving without thinking about it. They grow gardens and do not have mechanical conveniences for house and yard work.We are starting off with a banger, because I know that I move very unnaturally, and people have never hesitated to give me such feedback. As a child, I struggled with proximity to others. Observing what other people did with their hands was my mission as a teen, especially to figure out what they do with them when dancing… By midlife, I have had countless injuries from tripping up when running, smashing my hands and stubbing my toes when misjudging my motion through space. When autistics and ADHDers move naturally and stim, we are often discouraged from doing so. It looks weird, right? All that flapping, spinning, swinging and rocking makes the poor normies feel uncomfortable around us. Movement and exercise are sensitive topics for me, as I have a tendency to exercise compulsively, or not at all. No environment could nudge me into motion constantly without thinking about it. Nothing. As I was writing the introduction to this post yesterday we had a “light earthquake” with a local epicentre that measured 4.4 magnitude. Did I move? No. The fact that I live in a tsunami zone on the west coast of Aotearoa New Zealand is alarming (see what I did there?), because my reaction time to everything is exceptionally slow. Suggesting that I have my “mechanical conveniences” taken away so that I need to wash, rinse and wring my family’s laundry by hand is ludicrous. We would be forced to become naturists. And yes, I jumped on the kitchen garden bandwagon like many others during Covid lockdowns. But that’s all dead now, and, if I don’t start moving naturally soon, perhaps I will be too. 2) Know your purposeThe Okinawans call it Ikigai and the Nicoyans call it plan de vida; for both, it translates to “why I wake up in the morning.” Knowing your sense of purpose is worth up to 7 years of extra life expectancy.Ha ha, is this one a joke? I have only just discovered my own neurodivergence and everything I thought to be true is lies. I don’t know who I am, or why I am. And I am supposed to have it all figured out? I wake up in the morning because it’s what I do every day, not because I want to. But if I know why I wake up I get to do it for seven extra years? That sounds exhausting. Dan Buettner said on the Zoe podcas

Hi, I’m Sam (she/her). A late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression AKA The Auti Peri.I am delighted to be the host of The Auti Peri Q&A Series! In this series, I host a Q&A interview with a fellow autistic person about their experience of the menopause transition.💕 Thank you for reading The Autistic Perimenopause! 💕If my work is valuable to you and you can afford to, please consider upgrading to a paid subscription.Annual paid subscriptions cost US $46.60/ NZ $80/UK £35.90 (ish) per year.Monthly paid subscriptions cost US $4.66/NZ $8/UK £3.59 (ish) per month. YAY! This is the tenth Auti Peri Q&A interview! 🎉Thanks so much to all my awesome previous guests! Here are their insightful Q&A interviews: Autistic Ang, Tamsin Chennell, Allegra Chapman, Julie M Green, Nicola Bal, Elly Marie, Jen deHaan and Patrice Riley.There are lots more fantastic Q&A guests to come! If you would like to be featured as part of this Q&A series, please message me. I’d love to share your story!Today I am putting myself in the hot seat and sharing my own responses to The Auti Peri Q&A - Sam Galloway - creator of The Autistic Perimenopause: A Temporary Regression. Originally from London in the UK, I currently live on the Kāpiti Coast of Aotearoa New Zealand with my husband, our two kids and two ragdoll cats. Harry is pictured with me below, the divine feline that he is! 😻Grab a cuppa, put your feet up and have a read. As you may expect, I have a lot to say on this subject! But I will try not to take up too much of your time… 🤞🎧What does “autistic perimenopause” mean to you?In my personal experience, symptoms of the menopause transition have been very extreme. They began at an earlier age (mid 30s) for me compared to the average, which isn’t uncommon for autistic people. I don’t know why some autistic people may start perimenopause younger than non-autistics. Some autistics are hypersensitive to internal changes, including the effects of hormonal fluctuations on our body and mind. We also may be aware of their effect sooner, before they become more frequent/severe. Changes can be unbearable and adversely affect my functioning and capacity to cope with everyday demands. Until I had a Mirena inserted, my sensory overload was increased in perimenopause with random menstrual and back pain, headaches, joint pain, skin dryness, dry eyes, spontaneous bleeding, and general unpredictability around my health, mood and wellbeing. Fortunately my experience of severely debilitating symptoms in my menopause transition is not the case for all autistics.Up until midlife, I was mostly able to channel my energy and intellect into socially masking and compensating for my constant, numerous challenges. When autistic perimenopause started, everything fell apart. I had masked so well and for so long that I had no idea I was even autistic before perimenopause began. I had always had a general inkling that I was different from everyone else, but for no discernible reason. The gap between my peers and I widened when life as I knew it became unbearable in the early stages of my autistic perimenopause. I was so emotionally and sensorially dysregulated, that it became impossible - and undesirable - to continue masking. As is the case for many late diagnosed females, seeking diagnostic assessments for our own children in this life phase is often the catalyst for self-diagnosing our own neurodivergence. I happened upon signs of female autism after researching the topic regarding my kids, and saw how it made sense of my own life until that point. So midlife is often extremely complex for neurodivergent women.Many consider it liberating, but I am not yet at that point.The shame and confusion caused by our unconscious and involuntary masking can present with increased meltdowns, shutdowns and regression in our communication and skills. Imagine brain fog, but instead of wondering why you walked into the room, you may wonder why you exist in this realm, and why you have had to evade social rejection your entire life. Imagine a hot flush, but instead of unbearable sweating and discomfort, you become hysterical and no longer want to be inside your own skin. Imagine not knowing why you feel the way you do, but instead of seeing your own GP and starting HRT, you are referred to adult mental health and think you are losing your mind. Mental health services do not necessarily comprehend the link between neurodivergence, mental health and hormones, so many end up misdiagnosed and given psychiatric drugs and therapies that do not improve symptoms. Hormonal mood issues require hormonal treatment (HRT/MHT), as the root cause needs to be addressed before symptoms can be alleviated.When we don’t understand ourselves, and doctors don’t understand autism or menopause, we are unsupported and may feel hopeless. The risk of death by suicide is three times higher in autistic women than in non-autistic women in midlife. This should be a known crisis point. Although we are at the very early stages of academic research into autistic perimenopause, I believe that severe menopausal depression should necessitate an autism assessment, since the link between neurodivergent suicidality and fluctuations in reproductive hormones is so strong. It is an enormous disservice to autistic women that there are major data voids in autistic perimenopause, and also that there is not enough specialised (or any?) support for us. Medical systems are patriarchal, misogynistic and ableist. It is frightening to be going through this transition with no emotional or practical support.When did your autistic perimenopause symptoms start and what were/are they?My first symptom was dry eyes. I had recently emigrated to Aotearoa New Zealand from the UK and was unsure whether it was hayfever from the new-to-me native Kiwi flora pollen. It didn’t feel like hayfever though; instead my eyes were burning and felt sunburnt. My two homeschooled sons were under 5 at the time, and I had to drive them to activities every day. In agony, I regularly had to pull the car over and would cry tearlessly several times a day. The optician reassured me that it was nothing sinister, but when it continued with repeated regular application of over the counter lubricating eye drops, I had a private referral to an eye specialist.As homeschooling mothers often do, I have to take both children along with me to all my medical appointments. When I eventually saw an eye specialist she told me, “I am not calling you old, because I am the same age as you, but this is because of your age”. This was the first occasion where perimenopause was missed, and all because I was 37 - too young to be “menopausal”, surely? INow I despair when I reflect back on that time. This was only around 2018, and both a medical specialist and I had no idea that perimenopause could start in our mid-late thirties. How many women my age had been referred to her and been told “it’s because of your age” without being told that it is actually a symptom of fluctuating/low oestrogen?The most we are told about dryness as a symptom in perimenopause and menopause is about dry vaginas! Dry eyes are not an uncommon perimenopausal symptom, yet continued medical misogyny and unintentional gaslighting fails to give us the proper diagnoses in midlife, or when nearing midlife.Women are often socialised to be so frightened to admit their age to others. Perhaps the eye specialist may have felt that she was bravely broaching the social taboo of menopause whilst sparing my feelings and pride? When I think back to what might have been, I wish I had been empowered and informed by instead being told “this is a common symptom of perimenopause, and hormonal symptoms require hormonal treatments”. Eye drops are great, and I have to still use them constantly, it is practically a stim these days! But what I needed was an oestrogen buffer from that point in my life onwards, as that could have been preventative of developing other uncomfortable symptoms as a result of perimenopause.Dry eyes was a distressing and disconcerting symptom, and is one I continue to have despite HRT. It is a cause of, and can result from, chronic sensory overload. This was not helped by the life changes resulting from uprooting across the world with my husband and kids. All the societal expectations of being a woman “managing” a household whilst appearing willing and grateful were too much for me when my capacity was already so drastically reduced by fluctuating hormones, and continuing to spiral.As my little boys were growing up, I noticed their neurodivergent traits. Whilst researching this, I happened across a YouTube video presentation by Professor Tony Attwood into the female presentation of autism, and totally related to everything. I immediately self-diagnosed. I was privately diagnosed autistic and then ADHD before my fortieth birthday, and before either of my children had reached the top of the public mental health waiting list. Late-diagnosed autism is increasingly common as The Lost Generation of female autistics are slowly becoming identified later in life. In midlife, our masks are impossible to maintain, our basic self-care skills may regress and we have very limited energy. This can lead to increased sensory meltdowns, emotional dysregulation and episodes of The Rage. Our regressions can be mistaken for general burnout, but autistic burnout and autistic perimenopause are wholly different beasts. I know I repeat it a lot, but autistic women are three times more likely than non-autistics to die from suicide in our midlife years. Appropriate support and health care are essential, but services are uninformed and lacking skills in working with autistic women.It was at the time of my neurodivergent uncovering that I needed a periodontal gum graft, which was a harrowing experience given

“Hello this is Sam Galloway from The Autistic Perimenopause: A Temporary Regression in New Zealand.I'm currently inside a blanket fort I've built myself.I'm hoping my cats and kids don't try and come and take it off me while I'm recording.We are just going into Autumn here in New Zealand which is fantastic because I've been boiling and hot flushing all the long summer so it's nice and dark here in the evenings which is good.Suits my mood.I hope wherever you are in the world it's bright and cheery. Goodness knows we need it. ☀️Today I just wanted to talk through my neurodivergent perimenopausal discovery timeline which is just an explanation of how I came to self identify as autistic, ADHD, highly anxious, and also recognise that I was in, still am, in perimenopause.”Listen for more! 💕🎧 ▶️Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️💕 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

Hi, I’m Sam! Late Diagnosed Neurodivergent, Tenacious Midlife Struggler, and Autistic Perimenopausal Advocate.Welcome if you’re new to The Autistic Perimenopause: A Temporary Regression! Thanks for being here if you are already a regular reader. My mission is to support you during your neurodivergent menopause transition by providing:* Information* Validation* RegulationYou are not alone 💕I’m so glad you are here. If you feel seen and heard by my writing, please consider upgrading to a paid subscription. Paid subscribers support continuous publishing of lived experiences of autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression 💕TL;DR3 top tips for starting to identify our support needs:* Take up space and make your voice heard.* Accept and lean into fluctuating capacity.* Identify triggers/people/environments/tasks that you actively avoid. Poll results show that 72% of respondents don’t yet know what their needs are, 85% lack a safe support community/network, and 97% are not getting enough support in autistic perimenopause and beyond.No wonder we are so vulnerable to deteriorating mental health in midlife. Is it because we have masked our entire lives, hiding our needs even from ourselves?Those of us socialised as female have been discouraged from showing and meeting our needs, and instead being of service to others at all times. Is it any wonder we show our confusion and rage when demand made on our energy outweighs our capacity?💕Poll results are in, and it is worse than I had expected. But let’s not lose hope! We will work it all out together over time. Huge thanks to the 39 respondents so far to the recent poll (one of them was me so I am now patting myself on the back!). Due to my distinct lack of tech skills and foresight, the poll is open forever, so feel free to vote any time! You can find the poll in this post. Scroll to the poll! 👇Poll ResultsHere are the results (as of 12/3/2025):What do the numbers show us? This may be the least scientific data analyis ever, so strap yourself in. I am super grateful and shocked to have surpassed one thousand subscribers strong in the past week! Thank you to everyone who has given me your time, I know and appreciate how precious and finite it is. 💐 💝 😘There were already 39 respondents when I recorded the video to discuss the findings and my reflections. Ethics, biases, moral grounding of my research etc.? There will be no statistical analysis on these small numbers, but I think we can use them as representative of a small snapshot of engaged members of this community. If nothing else, the results suggest that those who were able to respond are definitely in need of support. We will work through all of this and figure out what supports we need and how to get them. It can’t be a rushed job, and it is not my intention to resolve all the entrenched trauma and hyperindependence behaviours so many of us have developed in life as coping mechanisms. Let’s be clear, I am not qualified to do any of that work with you (sorry!). I wish I could do more, but I am committed to do what I can and share what I have learnt the hard way…Let’s start with a complete mindset shift so that we can give ourselves the self-compassion required to do this work. My belief is that we are all in need of more support than we are currently receiving as we transtion through autistic perimenopause and beyond. So, without further ado, and for those who can not tolerate the Windy Welly background noise in the video (I am sorry, I tried to reduce it post-edit but it refused to be silenced), here are my take aways from the results.💕What are the foundations to getting support in autistic perimenopause?* Accept that nobody is supposed to be totally independent, and interdependence is in our DNA (fact check this spurious claim later, Sam).* Grieve for our missed opportunities and the struggles we have survived thus far. * Accept our neurodivergent self-identification/formal diagnosis.* Voluntarily unmask at home to learn what is is to be authentically you.* Identify your sensory preferences and requirements.* Set up your home for regulation and emotional safety. * Notice what chores or tasks you actively avoid. Accept that these may overwhelm you. Can they be delegated or dropped altogether? (Hair washing is a lifelong trigger of mine. When I experience functioning regressions, I get my hair professionally washed and dried at a salon. It is quick. and I don’t have to get my face/ears wet.)* Release unnecessary demands, toxic people and avoid your triggers as much as possible.* Barter/exchange favours from your safe people. (During periods of intense perimenopausal insomnia, a friend has taken my child to homeschool meets for me. In return, I deep cleaned her bathroom. Not because she expected anything in return, but I felt I owed her, and it was a useful and manageable task that elicited joyous hyperfocus on my part. Dopamine all ‘round!)And self-compassion goes without saying here!Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️Radical self-acceptance is our goal. It isn’t easy, but try to remember one, some or all of the following recommendations…* Autistic perimenopause is a life phase that exacerbates the asynchronous nature of our neurodivergence. We are in a state of constant flux, while our hormones go absolutely haywire. Your capacity is likely to reduce. Don’t be frightened, this is temporary. Accept the regressions. They will pass. * Avoid overexplaining your struggle to the people in your life who will not accept your differences. If you feel unsafe around them, trust your gut. Shame on them for not believing you nor supporting you enough. * Know that there are other people who are just like you. I am proud to be one of them! There are many things I can not do now that I used to be able to, or would highly mask to look like I could do them. Now I refuse to even try. Does that make me a failure? No. So if you can’t do things now that you previously could, please know that you are not a failure either. * If other people are judging you for showing that you have needs, that is their problem. If they aren’t already supporting you, and have no intention of doing so, do you really want or need them in your life anymore?* Perfectionism is impossible, and it isn’t fair to expect it from ourselves.* Respect your need for recovery time and accept social hangovers after you have pushed through and done hard things. * Plan time to regulate at home alone as much as you can/need to. * Do you have a chronic illness, premenstrual dysphoric disorder (PMDD) or another co-occuring condition? Can you predict when you are going to regress/be dysregulated? Anticipate those phases and ensure you have blocked off enough rest time for yourself. Incorporate pacing into your schedule in advance, rather than retrospectively. If you already have access to supports, book them in for those times you know you will need them. * Stop trying to do all the things you find the hardest in life. This workbook could help you:I hope this helps, please let me know in the comments to what extent you are already embracing and accepting your own needs. Has this post offered any insights? What do you think would be beneficial in helping ourselves through this difficult phase of accepting that we always had support needs, that they went unmet, and that now we owe it to ourselves to redress the balance? 🥰 Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe

The world can feel like a sensory onslaught and drive us rapidly from regulated to the verge of a meltdown in the right wrong conditions. I am so sorry if the background noise of this video also drives you into sensory overload. Rather than cause harm, my goal is to share how Sensory Processing Disorder (SPD) can take a regular everyday situation, and turn it into a sensory nightmare for anyone who has SPD. There are triggers everywhere. Sensory Processing Disorder is:* A common co-occuring condition for neurodivergent people, that turns this world into a total misery-inducing, tormentous ordeal. Unless you are lucky enough to altogether avoid wherever other people are in general, and crowds of people specifically. * The reason noise cancelling headphones were invented. * What Occupational Therapists are legendary at supporting people with. I was wrong - not all autistic people have SPD, as I said in the video. I am sure I heard that somewhere, but I can not back that up with research despite scrolling for hours to attempt to do so. The best I found was that 90-95% of autistics have SPD. I was fairly distressed and highly masking whilst filming this video, and was pretty hasting in suggesting that my kids and I are medicated to go out into the world. Whilst this isn’t necessarily the case - and I did not have the capacity to explain myself very articulately - I do use medications as part of my toolkit to cope with this world, and to be able to function within it. Although the extent to which I function day to day is debatable! Apologies for not returning to the pool to re-shoot the video and provide correct data, but I never want to go back ever again. Of course, I will have to go back next week for the next sensory onslaught my kids’ swimming lessons.Do you have SPD? Let us all know in the comments!There is a free online self-test linked below that could suggest whether or not you too are blessed with this condition. To know for sure though, you will need to see a qualified practitioner for an assessment. Whilst a range of professionals may be qualified to assess you, I would recommend seeing an Occupational Therapist who is neurodivergent, has SPD or at the very least has a strong interest in these areas. They can work alongside you to design a sensory diet that supports your needs and sensory preferences. It has nothing to do with food though! I will cover this in another article soon. (Please remind me when I inevitably forget…)ADDitude Magazine online: Symptoms - Signs of Sensory Processing Disorder (SPD) in AdultsSelf-test - Sensory Processing Disorder: Adult Symptom Test for SPDTreatment - How to Treat Sensory Processing DisorderFun fact: Sam Galloway is an AuDHDer who self-medicates using coffee! If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️Podcast episodes about adult SPD:There is a quick three question poll for autistic perimenopausal people asking about your current support needs:Please come on over to this post to fill in the poll. It will only take one minute but will help our community. There are 25 responses so far, thanks so much to those people! I think we will all be surprised at the results so far. They show we have a lot of work to do as a community to identify our support needs and access a network that will support us accordingly. I hate the idea that we are all struggling and suffering alone. Here’s the post, just open the link and scroll down to the poll..! Easy peasy, please and thank you. 😊 What People Are Saying 🥰💕 Thanks so much for starting this Substack. I'm in early perimenopause and a neurodivergent Mom. All the unknown is hard around here and this journey is no different. I love bringing together the voices of lived experiences and so appreciate that you're sharing yours and building this community. Thank you.💕 I find such relief when I hear my email go off and look down and see that it’s from you. You bring me comfort every single time I receive an email. I get to learn about myself and how to help myself. You are my guide and I am so very sure you are the guide of so many. Please please hear me when I say thank you for saving my life. Forever and always grateful.Come and enjoy The Auti Peri Q&A Series, where you can read about other autistic midlifers whose sensory processing issues have or still are impacting their daily life. Let’s all commiserate together…I would love to share your story! Please message me on Substack or email me back if you would like to be involved in the Q&A series. Get full access to The Autistic Perimenopause: A Temporary Regression at samgallowayaudhd.substack.com/subscribe