ADHD (Attention Deficit Hyperactivity Disorder) and autism spectrum disorders (ASD) are neuro-developmental conditions that can affect individuals across the lifespan, including women. 
These conditions are characterised by distinct patterns in behaviour, communication, interaction, and cognitive functioning. While historically these diagnoses have been more commonly identified in men and boys, increasing awareness and understanding have highlighted that women and girls are also significantly affected, often with unique presentation and challenges. 

ADHD and autism in women 

ADHD in women often presents differently than in men. Women with ADHD may experience more inattentiveness, internal restlessness, and disorganisation, rather than the more overt hyperactivity and impulsivity often seen in boys. These differences can make ADHD in women less noticeable to parents, teachers, and even healthcare professionals, leading to under diagnosis. 
Autism in women and girls often manifests as differences in social communication and interaction, along with restricted, repetitive patterns of behaviour, interests, or activities. Women and girls with autism might be better at masking or camouflaging their difficulties, making their struggles less apparent to others. 
This ability to mask, while helping them to navigate social situations, can delay diagnosis and lead to internal stress, anxiety, and depression. 

Why do women get a late diagnosis? 

Many women with ADHD or autism are diagnosed late, often in adulthood, for several reasons: 
Stereotypes and Bias: There's a historical bias toward identifying these conditions primarily in boys, based on more visible and disruptive behaviours, leading to a lack of awareness and understanding of how they present in girls and women. 
Masking and Compensation: Women are often more adept at masking symptoms or developing compensatory strategies to manage their difficulties, which can hide the underlying condition. 
Comorbidity: ADHD and autism in women are often accompanied by other conditions like anxiety, depression, and eating disorders, which can complicate the clinical picture and lead to misdiagnosis. 

Why do symptoms worsen during menopause? 

The hormonal changes during menopause can exacerbate symptoms of ADHD and autism. 
Oestrogen, in particular, plays a crucial role in brain function, and its fluctuation can impact mood, memory, and cognitive function, worsening the symptoms of these neuro-developmental conditions. 

Hormone Replacement Therapy (HRT) and other supports 

HRT can be beneficial for some women during menopause, including those with ADHD or autism, by stabilising hormone levels and potentially mitigating some of the exacerbated symptoms related to these conditions. However, the decision to use HRT should be made on an individual basis, considering the potential benefits and risks. 

Additional strategies to help women during this time 

Education: Learning about how ADHD and autism intersect with menopause can empower women to seek appropriate support and accommodations. 
Structured Support: Therapy, including cognitive behavioural therapy (CBT), can help in developing strategies to manage symptoms more effectively. 
Medication: For ADHD, medication might be adjusted during menopause under medical guidance to better manage symptoms. 
Lifestyle Changes: Regular physical activity, a balanced diet, and sufficient sleep can help manage symptoms of both menopause and ADHD/autism. 
Social Support: Connecting with others going through similar experiences, through support groups or online communities, can provide emotional support and practical advice. 
For women navigating ADHD or autism during menopause, a comprehensive approach that includes medical, psychological, and lifestyle interventions can offer significant relief and improve quality of life. It can be a lonely time especially at menopause when symptoms can worsen significantly, and it may be a shock to have a diagnosis of ADHD or autism whilst trying to navigate through menopause. 
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