You’re Not Getting Worse: Why Menopause Makes Masking Impossible (and that’s okay)

PLEASE PIN THIS IMAGE – Menopause and neurodivergent masking go together like Bigfoot and a summer fairy picnic.

Autistic or ADHD traits seeming to get more intense after 40? Menopause and neurodivergent masking don’t mix. Read on for why this happens, and what you can do to feel better.

My story of menopause and neurodivergent masking colliding.

As I wiped my eyes and took deep breaths, I stood from the chair in the shed. Good thing for this finished-out shed; our house was way too small for me to have a bawling fit in.

As I trudged back to the house, the anger and despair still pinged inside, but not nearly as hotly as it had been. I ignored my husband as I went about doing whatever it was I had to do. After about a half hour, the emotions settled, then dissipated altogether.

What had I been mad with him about again? Oh, yeah. Some innocent thing he said that I took totally the wrong way. As usual, perimenopause was kicking me in the rear end.

What I wouldn’t realize for almost another decade was that hormones weren’t the direct cause.

Feel like you’re “losing it”?

Are you a neurodivergent woman in your 40s or 50s who’s wondering if the term “insane asylum” was invented for people like you? If so, you’re probably also wondering if somehow, your autism or ADHD is getting worse.

The good news is: it’s not.

The not-so-awesome news is: you’re running out of the neurological resources that made masking possible.

You know those meltdowns that come out of nowhere (like in my above story)? How your senses seem to be constantly in overdrive? And social situations suddenly seem impossible, when before they “just” used to be exhausting?

Those are signs that your brain can no longer sustain the enormous cognitive load of appearing neurotypical.

It will no longer allow you to mask.

What is neurodivergent masking?

Neurodivergent masking is when you suppress your natural neurodivergent tendencies in order to fit into neurotypical social environments. At midlife, you’re probably doing most of it on autopilot.

What does masking look like for autistic women or women with ADHD?

Forcing eye contact when it feels uncomfortable.
Scripting conversations in advance.
Suppressing stimming behaviors.
Monitoring your tone, facial expressions, and body language constantly.
Pushing through sensory discomfort without accommodating for them.

Masking is exhausting. It requires tremendous executive function – which we’re already short on – and emotional regulation.

It requires specific neurochemicals in our brains.

Which we are also already short on.

And then comes menopause…

The estrogen-brain connection nobody told you about.

A scant few health care providers know what I’m about to reveal:

Estrogen is a neuroactive hormone.

In other words, it doesn’t just affect your reproductive system, but also fundamentally shapes how your brain functions.

Estrogen influences:

Serotonin production and receptor sensitivity. That leads to mood regulation and impulse control.
Dopamine pathways. Dopamine is what helps you feel motivated to do something and rewarded when you finish the something. It’s also essential for proper executive functioning.
GABA (Gamma-aminobutyric acid) activity, which is your brain’s primary calming process.
Neuroplasticity, which is your brain’s ability to adapt and regulate itself.
Mitochondrial function, necessary for energy production in brain cells.

(Here’s a comprehensive scientific review of how estrogen affects the brain.)

So, guess what happens when estrogen levels drop during perimenopause and later?

Yep, you got it. All of these systems become less stable. For neurotypical women, this results as brain fog, mood swings, or memory issues.

For neurodivergent women who were already managing differences in these systems, the impact is exponentially more significant.

Why menopause dismantles your masking ability.

Put succinctly, masking requires all of those brain neurotransmitters and systems mentioned above. Less estrogen means less production of the chemicals and less efficient working of the systems. That leads to an inability to mask. That includes the following.

Executive function collapse.

Executive function is your ability to plan, organize, switch tasks, and inhibit impulses. It relies heavily on dopamine and norepinephrine.

Estrogen helps to regulate both.

Without enough estrogen, your executive function goes kaput. You can’t:

Monitor and adjust your behavior in real time.
Suppress your natural responses to uncomfortable stimuli.
Follow the complex social scripts you memorized decades ago.
Maintain the mental checklist of “acceptable” behaviors (which you don’t give a flying fig about anyway because your dopamine has flown the coop).

Sensory overwhelm intensifies.

Estrogen helps to control how intense your nervous system experiences sensory input. Therefore, when estrogen levels drop, your highly sensitive self feels even more sensitive.

The fluorescent lights you tolerated for decades suddenly feel like ice picks in your retinas. The clothing textures that you didn’t mind become intolerable, seemingly overnight.

Though you feel more sensitive, in actuality your nervous system has lost one of its key regulating hormones.

Emotional regulation becomes nearly impossible.

GABA is like your brain’s brake pedal for intense emotion. When estrogen declines, it becomes less effective.

Meanwhile, your stress response system becomes more reactive for the same reason. This combination means that:

Smaller triggers create bigger reactions.
Recovery time from emotional dysregulation lengthens.
The gap between “I’m fine” and “I’m completely overwhelmed” shrinks to nothing.

When you’ve spent your life using cognitive control to manage emotional responses, losing that control feels catastrophic. You have to understand that it’s not a personal failure, but a neurochemical reality.

Go ahead and tell your husband, “It’s not my fault!” You have my permission.

Because it’s the truth.

The crash point: when masking becomes impossible.

Many neurodivergent women describe a moment when masking simply stops working. You might:

Have a meltdown at work for the first time.
Suddenly be unable to tolerate social situations that you previously managed.
Stop returning messages because the mental effort feels impossible.
Withdraw from activities and relationships that require masking.
Yell at someone you’re barely acquainted with for letting a brush pile fire get out of hand and burn two of your trees that border your property and the one he’s managing.

(Not that the last one happened to me or anything. I’m just pulling it out of thin air.)

This is not you turning into a bad or anti-social person. Blame it all on your brain. Without enough estrogen, it refuses to produce the neurochemicals that made masking possible in the first place.

This can sort of be good news.

I ain’t gonna sugar-coat nothin’ here, darling: it really sucks to not feel motivated to do anything, and to not feel that dopamine kick when you finally get up and do something. The guilt you carry all day after screaming at your husband for a miniscule infraction is no fun.

And I don’t know about you, but I miss those immediate little jolts of happiness at beauty and success with little tasks that used to come without trying.

But for those of us who are neurodivergent, the cloud comes with a silver lining. That is, our brains are telling us to stop trying to accommodate the neurotypical systems and ways of being.

Menopause can be a catalyst for unmasking. It can be the kickstart you need for finally living in a way that honors your nervous system rather than constantly overriding it.

What does unmasking in menopause look like?

Setting boundaries you couldn’t enforce before.
Leaving situations when you’re overwhelmed instead of pushing through.
Stimming openly because you need the regulation.
Asking for accommodations without apologizing.
Choosing authenticity over acceptance.

I most certainly am not trying to downplay the challenges of menopause. It’s a bear, both for lifelong neurodivergent women and women experiencing transient neurodiversity, thanks to their estrogen packing its bags and leaving. The physical symptoms can be debilitating. The emotional turbulence can send both you and your loved ones reeling.

But within this difficulty is an opportunity to build a life that works with your neurodivergence instead of against it.

What can help.

Hormone replacement therapy.

HRT gives you a boost of estrogen that can alleviate much, or most, of the issues I brought up earlier. However, it can cause digestive distress to some sensitive women. If that happens to you, the next solution might work better.

Progesterone cream.

Progesterone cream is available both over-the-counter and medically prescribed.

Once absorbed into your skin and sent through your system, the progesterone in creams at some point arrives to the brain. There, it’s quickly metabolized into a neurosteroid called allopregnanolone. This chemical helps to control the GABA receptor, thereby boosting its activity. So, allopregnanolone (say that ten times fast) helps prevent you from experiencing the effects of an overstimulated nervous system. (Here’s one study that discusses that science.)

For neurodivergent people, sensory sensitivities and the feeling of “overwhelm” are often linked to a nervous system that is either in a state of hyper-arousal, or not being well controlled by the GABA activity. The calming effect of progesterone’s metabolite can raise the threshold for sensory stimuli, making you less reactive to… well, everything.

The neurosteroid also provides anti-anxiety and mood-stabilizing effects. In turn, your executive function works better because your brain isn’t dealing with emotional dysregulation.

Finally, progesterone is a mild sedative. Since it helps you sleep better, it helps your executive function, focus, and emotional regulation the following day. (This study explains it in detail.)

While low levels of estrogen can still cause issues, it’s possible that your body may need the calming counterbalance of progesterone even more.

My sensitivities and executive function were WAAAAAY worse before I started using progesterone cream. The introductory story for this post? Yeah. My pre-progesterone cream days.

I say this as a fellow ND, postmenopausal woman, not as a medical pro: if you’re struggling, and you haven’t tried it yet, consider giving it a shot. Get your hormone levels tested first to make sure your progesterone is low, just in case.

All right. Onto two non-hormone-intervention ways that can help your sudden inability to mask.

Accommodate yourself.

Reduce sensory input; for example, use noise-canceling headphones or earplugs, wear sunglasses indoors, and wear comfortable clothing.
Simplify your environment and commitments.
Build in recovery time after social or cognitive demands.
Communicate your needs directly instead of trying to hide them.

Reframe the narrative.

If you’ve been thinking that your autism or ADHD has been getting worse, or that you’re falling apart, it’s time to gently but tightly swaddle that thought, tuck it into a basket, and set it in the River of Unhelpful Thoughts to let the current carry it away.

Instead, begin to tell yourself that you’re experiencing a neurological transition while neurodivergent. Remind yourself that your new limitations aren’t character flaws, but information about what your nervous system needs at this stage in your life.

Moving forward: permission to be different.

You don’t have to rebuild the mask that is crumbling. Or has crumbled.

In fact, the attempt to rebuild it will likely have dire psychological and emotional – therefore physiological – consequences.

The transition away from working to fit into a neurotypical world is difficult and disorienting. If you’re like me, you’ll grieve the old you who could power through and make life look easy.

But on the other side is something many (undiagnosed) neurodivergent people spend their whole lives searching for: permission to finally, fully, be themselves.

You’re not getting worse. You’re getting real.

And that’s not just okay.

It might be exactly what you’ve needed all along.

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What resonates the most with you in this article? Have any tips for the rest of us? Feel free to share them in the comments!