Alternative Therapies, Managing Symptoms, Mental Health, Menopause Advice, Perimenopause, Post Menopause, Wellbeing
7 Mar 2025
For decades, neurodivergent conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) were primarily studied and diagnosed in men. This male-centric perspective has led to countless women receiving late diagnoses—or missing them altogether—despite struggling with symptoms throughout their lives. The delayed recognition of ADHD and autism in women is not merely a failure of awareness but a complex interplay of gender biases, masking behaviours, and the profound influence of hormonal fluctuations.
The Underdiagnosis of ADHD and Autism in Women
Historically, ADHD and autism were believed to predominantly affect boys, largely because diagnostic criteria were based on male presentations of these conditions. Girls often present differently, displaying less overt hyperactivity and more internalised symptoms, such as inattentiveness, anxiety, and social difficulties.
Many neurodivergent women unconsciously learn to mask their symptoms from an early age. They develop coping mechanisms to fit into social and professional environments, mimicking neurotypical behaviours at the cost of significant emotional exhaustion. This masking leads clinicians, teachers, and even family members to overlook the true challenges these women face, delaying diagnosis until adulthood or, in many cases, leaving them undiagnosed altogether.
The Role of Hormones in Neurodivergence
Hormones play a pivotal role in how neurodivergence manifests in women, particularly in relation to ADHD and autism. Fluctuations in oestrogen and progesterone levels across the menstrual cycle, pregnancy, postpartum, perimenopause, and menopause can significantly impact cognitive function, emotional regulation, and sensory sensitivity.
Menstrual Cycle and Neurodivergence
Throughout the menstrual cycle, oestrogen levels rise and fall, influencing dopamine availability in the brain. Since ADHD is closely linked to dopamine function, the hormonal shifts that occur during different phases of the menstrual cycle can lead to noticeable changes in ADHD symptoms. Many women with ADHD report heightened difficulties with focus, emotional regulation, and executive function in the luteal phase (the period before menstruation) when oestrogen drops and progesterone rises.
For autistic women, hormonal fluctuations can exacerbate sensory sensitivities, emotional overwhelm, and social exhaustion. This often results in increased burnout during certain phases of the cycle, making day-to-day functioning more challenging.
Pregnancy and Postpartum Challenges
Pregnancy introduces significant hormonal fluctuations, and while some neurodivergent women experience temporary improvements in symptoms due to high oestrogen levels, the postpartum period can be particularly challenging. The sharp drop in oestrogen and dopamine after childbirth can trigger increased ADHD symptoms, sensory overload, and mood instability, sometimes leading to postpartum anxiety or depression. Many neurodivergent women struggle with the expectations of motherhood while also managing the internal chaos of their neurodivergence, often without adequate support.
Perimenopause and Menopause
Perimenopause and menopause represent one of the most significant yet under recognised periods of difficulty for neurodivergent women. The gradual decline of oestrogen during this time directly impacts dopamine regulation, leading to worsening ADHD symptoms such as brain fog, forgetfulness, and reduced focus. For autistic women, sensory sensitivities, social anxiety, and executive function difficulties can intensify. This often coincides with increased stress from life transitions, such as career changes, aging parents, or children leaving home, compounding the struggle.
Why Are So Many Women Diagnosed Late?
There are several key reasons why women with ADHD and autism are often diagnosed later in life:
Gender Bias in Diagnostic Criteria – Most diagnostic tools are based on male presentations of ADHD and autism, leading to missed or misdiagnosed cases in women.
Social Masking – Women are adept at camouflaging their symptoms, making it difficult for professionals and even themselves to recognise their neurodivergence.
Hormonal Influence – The impact of fluctuating hormones on symptoms means that many women don’t recognise their neurodivergence until they reach perimenopause, when oestrogen levels drop significantly.
Cultural and Societal Expectations – Women are often expected to be organised, emotionally regulated, and socially adept. When they struggle in these areas, they may attribute their difficulties to personal failings rather than neurodivergence.
Comorbid Conditions – Many neurodivergent women are first diagnosed with anxiety, depression, or borderline personality disorder before their underlying ADHD or autism is recognised.
The Importance of Proper Recognition and Support
Recognising the unique ways neurodivergence presents in women is critical for timely diagnosis and appropriate support. Women who are diagnosed later in life often experience a sense of relief and validation, finally understanding why they have struggled for so long. With a proper diagnosis, they can access tailored strategies, workplace accommodations, and medical interventions that improve their quality of life.
Healthcare professionals must become more aware of the gender differences in neurodivergence and consider the impact of hormones when assessing symptoms. Additionally, workplaces and educational institutions need to adopt more inclusive policies that acknowledge and support the needs of neurodivergent women.
The late diagnosis of ADHD and autism in women is a significant issue that affects their mental health, career progression, and overall well-being. As awareness grows and diagnostic criteria evolve, it is crucial to integrate a more gender-sensitive approach that accounts for hormonal fluctuations, social masking, and the distinct ways neurodivergence presents in women. By doing so, we can create a more supportive and inclusive world where neurodivergent women no longer have to suffer in silence.