The Autistic Perimenopause

About The Autistic Perimenopause

Fiercely advocating to raise awareness on temporary fluctuations and regressions in capacity during our neurodivergent menopause transition. A safe space for our community to unmask, co-regulate, and share knowledge to self-advocate. samgallowayaudhd.substack.com (https://samgallowayaudhd.substack.com?utm_medium=podcast)

Publisher

Sam Galloway

Category

health & fitness · society & culture

Language

en

Explicit

No

First episode

27 Apr 2024

Latest episode

18 Sept 2026

Latest episodes

52 episodes in the feed.

1. 

   18 Sept 2026

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

   Moving Beyond the Natural vs Medical Menopause Divide What happens when “natural” and “medical” become identities rather than options? In this conversation, Kate Codrington and I explore the pressure to have the “right” kind of menopause, and what happens when our beliefs about menopause care start to become rules we feel we have to follow. We talk about: the natural vs medical menopause divide why “natural” can become an identity rather than simply a preference the shame or sense of betrayal that can arise when we need medical support why menopause shouldn't become an identity test the pressure to cope without medical intervention the problem with replacing one rigid system with another self-advocacy when you don't know which path to take why Kate says “there's no rush” moving beyond the constant “is it this or that?” Kate's question: “Does this intervention make me feel more of myself or does it take something away?” why our menopause needs can change over time the importance of personalised and individualised menopause care the reality that access to menopause treatment options isn't equal for everyone One of the things I loved most about this conversation was the recognition that there doesn't have to be one fixed answer. As Kate puts it: “The lack of path sends us into a flat spin and then we grab hold of one thing or the other thing in a panicked kind of way.” Perhaps the answer isn't to find the correct menopause ideology. Perhaps it's to slow down, gather information, pay attention to ourselves, and ask what we need now. If you're listening rather than reading, come over to the post and tell us: Have you experienced the natural vs medical menopause divide? And has your approach changed as your menopause has changed? Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe (https://samgallowayaudhd.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

2. 

   27 Aug 2026

   🎧 Dear Menopause: Thank You for Saving My Life

   One year ago, Sam Galloway entered surgical menopause following a hysterectomy and oophorectomy. After years of debilitating perimenopause, she expected menopause to be another battle. Instead, hormonal stability brought unexpected gifts: stability, certainty, clarity and the beginnings of cognitive recalibration. In this deeply personal follow-up to “Dear Perimenopause: F**k You”, Sam reflects on the first year of surgical menopause, neurodivergence, sensory overload, mood stability, cognitive changes, self-advocacy and what it means to stop trying to become the person you were before perimenopause. This is not a story about menopause being universally positive. It is one neurodivergent woman's story about finding unexpected relief after years of hormonal chaos. Content note: This episode discusses suicidal ideation, reproductive loss, miscarriage, ectopic pregnancy, medical trauma and mental health. Hello and welcome to Divergent Menopause (https://samgallowayaudhd.substack.com/?utm_campaign=profile_chips), previously known as The Autistic Perimenopause: A Temporary Regression. I am Sam Galloway (she/her) (https://substack.com/@samgallowaynz), an autistic ADHDer (AuDHDer), and a surgical menopause survivor. I write Divergent Menopause to share what many of us are never told until we have to find out the hard way. Thanks for joining me on this wild midlife ride! 🎢 Dear Menopause, One year ago today we became acquainted with each other when I emerged from my elective gynaecological surgery that gifted you to me. Even though I told my doctor last month that I think the honeymoon period between you and I has now worn off, I am still utterly enamoured by you! Happy First Anniversary to us! If you hadn’t arrived when you did, I am not sure I would still be here. Not only have yo usaved my life, but you have given me so many precious gifts that, now combined, vastly improve my quality of life. Stability. Thank you, Menopause, for the gift of stability. During the surgery, my uterus, cervix, one remaining Fallopian tube and - best of all - my ovaries were all removed. Yes, you are a medical and surgical Menopause and I know that many people see that as a bad thing, but I think you are The Best Thing that could have happened to me. Before we made things permanent between us, I had dallied with you. My hormone blockers induced a temporary, reversible chemical menopause was a great trial, but nothing else even comes close to you. Temporary ovarian suppression gave me some relief of my turbulent perimenopausal pre-menstrual dysphoria disorder (PMDD), but when you came along after my surgery I knew you were the real deal. My dear Menopause, you have stabilised my mood so that I am no longer at the mercy of my hellish hormonal flux. No more “good week” versus “bad week”, and no more rapid mood de-escalation. No more waiting to find out just how low I will go, this time. It is no exaggeration to tell you that you have saved my life. No more intrusive thoughts nor threats of harming myself or my family. No more suicidal ideation. My mental health and mood stability are at an all time high. Well, my mood itself is not at an all time high, but nor would I want it to be. Instead it stays within a narrower range of “safe” for the first time in my life. Does that feel boring sometimes? Yes, a bit. But it’s about time my ovarian hormones weren’t running the show. Certainty. Thank you, Menopause, for the gift of certainty. One of the worst things about Perimenopause for me (and there were so many horrendous things to choose from!) was the chronic uncertainty. It spiked my anxiety just wondering how long it was going to take. Would I be one of the lucky ones who has a shorter 8 year perimenopause, or would my transition have taken a lengthier 14 years? There was no way of ever knowing. It was a waiting game, and, as a neurodivergent ADHD woman with absolutely no sense of the passage of time, it had already felt like a lifetime of peri had consumed me. How I hated the changes that were occurring during The Change. I never knew what whack-a-mole symptom was going to ruin my day next. The sheer horror of having no control over my symptoms was abhorrent to me. My Autism makes me want to call the shots, or at least have a copy of the manual memorised. But there is no manual for neurodivergent perimenopause. No manual either for neurodivergence, nor for the menopause transition. What a sick joke to put us through all this prolonged uncertainty without a roadmap nor with the reassurance that we would survive the journey. My dear Menopause, you gave me the roadmap. All signs were pointing to you by the end. If my exhausting self-advocacy for my elective hysterectomy and oophorectomy (ovary/ies removal) hadn’t gone to plan, I had no hope of continuing on that road for the long haul. The certainty you have given me is multi-layered. The relief from being certain that I will no longer experience menstrual bleeding is enormous. Sensory overload came with every bleed I had ever had, and that s**t accumulated beyond belief over my three decades of menstruation. No more menstrual cramps ever. Now whenever I get a pelvic twinge, I can be pretty confident that I will find relief in using the bathroom - that my bladder or bowel is the culprit and that my lagging interoception won’t lead to me sitting on the sofa in a puddle of blood because Taskmaster hasn’t finished yet. As for the blood itself - the always shocking vibrancy, the smell, and its viscosity as it pooled then poured - I can’t even… Every perimenopausal bleed triggered me. After my five pregnancies, all planned and wanted, with only two children to show for it, every bleed I had in my thirties took me straight back in my mind to a time when I was losing a baby. Two early miscarriages and an ectopic pregnancy. When I met you, Menopause, it was my second major gynaecological surgery. Both saved my life. One ended a pregnancy, the other ended my fertility. I know that so many women are saddened by the loss of their fertility when you reach them, Menopause, regardless of their status as parents or not. But I needed you. You healed me from the medical trauma that had come before you. The first time I had woken up after in recovery, my abdomen covered in freshly sutured incisions where the laparoscopic camera and surgical tools had shortly before accessed my innards, I was screaming at the nurses to give me my baby back. Thus I was heavily sedated in my secede surgery when you arrived, Menopause, and I was glad of it. There was no question that I had wanted my reproductive organs removed, because it gave me the certainty of never losing a baby or a pregnancy again. Clarity. Thank you, Menopause, for the gift of clarity. The certainty you gifted me was accompanied by the clarity that the way I could see things from then on, no longer tainted by the highs and lows of my ovarian hormones. No more uterus after surgery meant no more progesterone needed to maintain the health of my uterine lining which meant no more progesterone intolerance which meant no more suicidal ideation. Yes, I could rephrase that dreadful sentence but now I have the clarity that what is left of my lifetime is short. My finite time and precious energy therefore hold greater value, and I need to stop wasting it with my formerly pedantic ways. Although I still do not sense the passing of time (Menopause, you have not cured my neurodivergence as I gratefully knew you would not), I now fully grasp the value of it. And that is why I still spend hours on the sofa watching Taskmaster and building LEGO sets. Not because I am in too much pain to move and need something else to focus on, which was the case over a year ago, but because I have now survived Perimenopause and, in my mighty wisdom and clarity, I know that the mighty Taskmaster Greg Davies and his assistant little Alex Horne are worthy of my valuable time and attention. Knowing where to spend and invest my time now is only half the story though. My dear Menopause, you now tell me when we are rapidly approaching a waste of our time, and we swerve it together. (Although, alas, my doom scrolling habit has not yet evaded me…) These days it is so much easier to ignore the b******t that surrounds us. Your gift of clarity comes with a wonderful capacity to moderate my tolerance for others. Namely, I have lowered my tolerance threshold so we can avoid anyone who doesn’t like this unmasked Menopausal version of me. Conversely, your presence brings with you an improvement of my rational responsiveness. I am less likely to meltdown, shutdown or become mute during times of stress and confrontation. My responses are more deliberate, and I can take a pause before I speak. My impulsivity is better moderated and, as and when I lose my s**t, I know it was deserved and not just a hormonal reaction. Recalibration. Thank you, Menopause, for the gift of recalibration. Perimenopause absolutely tore my highly masked undiagnosed neurodivergent self to shreds. I was already struggling to function in this world, when peri was established I was in tatters. No part of me was untouched by the hormonal flux. I regressed significantly, losing independence and self-care skills, reduced mobility, disengagement from everyone around me. It was jarring and terrifying, and many times I felt as though I was losing my mind. My cognitive regressions felt enormous, although they went largely unnoticed by others. Perhaps a combination of my residual masking capacity and the fact that most of my intellect was experienced in my inner world and had gone unseen for so long, I no longer felt like the same person anymore. My sensory calibration was wrecked, and I had no energy left to pretend everything was fine. And so I hid away at home, and kept my disturbing difficulties to myself. There I could control the sensory inputs and just about cope with them. It shrunk my world beyond belief. After surgery, the constant uniformity of my hormone levels caused my brain and body to operate on a steadier trajectory. In this last year I have been able to adjust to the constancy, giving my drained brain a chance to recalibrate. Although slight, the small regains to my cognition and information processing feel vast. I am beginning to picture where I left things again. When I use a multi-storey car park now, my vehicle is no longer inadvertently abandoned as I can visualise where I left it. When I am hungry, I can now visualise what is in the fridge, freezer and pantry, and make an informed decision to eat chocolate for lunch (even though I am supposed to be mainlining protein these days). I can remember how many pumps of oestrogen gel I applied in the morning and where, and whether or not I have taken my medication. I can’t remember the punchlines in the Taskmaster banter, but we can’t expect miracles. There are 21 series and counting that have already been aired so far. Plus I love finding jokes funny every time I hear them! My dear Menopause, this recalibration is perhaps the greatest of gifts. I am not chasing the version of myself I was before Perimenopause stepped into the scene and tried to throttle me. She was thin but thought she was fat, and she was depressed and thought that was acceptable. She naively thought that one day she could chase her Masters degree with a tasty PhD. Ha! I wouldn’t even have the attention span to fill in the application form these days, never mind test one hypothesis for years on end and defend a thesis. Yawn. (Not really, I would f*****g LOVE to do a PhD. Sigh…) But having a glimmer of hope that my perimenopause-induced cognitive and information processing regressions may now be reversing is inspiring. Shortly after my surgery, during my blissful month in bed where I could do nothing but manage my pain relief schedule, sleep off the general anaesthetic and build LEGO (Concorde, Botanical Gardens and Tuxedo Cat sets!) whilst obviously watching Taskmaster repeats, I renamed my publication and community. Previously The Autistic Menopause: A Temporary Regression, I held on to the hope that my regressions were indeed temporary. Divergent Menopause (https://samgallowayaudhd.substack.com/) was birthed from my still raw pelvic bowl, honouring both my transition from perimenopause to surgical Menopause, and becoming inclusive of all my neurodivergence and my neurokin. Time has dragged on rapidly this past year whilst I waited to see if my brain would regain lost and lagging skills. It hasn’t fully, but I know now with clarity and certainty that my hormonal stability is nurturing my menopausal recalibration. Today holds enormous significance to me, but I know it is still very early days in my Menopause. Please know that I am grateful for the gifts of stability, certainty, clarity and recalibration(ity) that all compound to enhance my quality of life. I am looking forward to spending the rest of our lives together, Menopause. Cheers, Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe (https://samgallowayaudhd.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

3. 

   20 Aug 2026

   Dear Perimenopause: F**k You

   In this episode of Divergent Menopause, Sam Galloway reads her brutally honest “f**k you” letter to perimenopause. A decade of rage, grief, chronic pain, cognitive changes, suicidal ideation and medical uncertainty, ending with the decision that finally changed everything: surgical menopause. This is not a tidy menopause success story. It's a story about surviving a menopause transition that nearly broke her, and finding something unexpected on the other side. Why write a “f**k you” letter? It is so cathartic to rage onto the page all of that pent up anger, frustration and grief caused by a certain person or event. You can get all those things you wish you had said, the ones that are still keeping you up at night, out of your system which can feel like an enormous relief and release. I would not recommend sending it to the person though! You don’t want to invite more emotional harm or rekindle past conflict into your world. Some people like to ceremoniously burn their “f**k you” letters so that they are never discovered or read by anyone else. Take good care of yourself in the process, if it doesn’t feel like a helpful tool for you, or the right time to write a “f**k you” letter, it’s best avoided. This one flowed for me though! Let me know in the comments if you have ever written a “f**k you” letter. If so, did you found the process therapeutic, triggering or something else? Dear Perimenopause, I love to hate you. You were the bane of my assistance for too long, and still you are all I can talk about. Everyone is sick of hearing about you. When you first showed up, I knew it was inevitable. You arrived much sooner than I expected, and nobody believed me when I said you were here. Apparently I was too young for you or some b******t. You clearly didn’t give a f**k that I was in my mid 30s with two tiny kids, acclimatising to life in a new hemisphere. I thought I’d fallen on my feet arriving here in Aotearoa New Zealand in 2016, but out of nowhere you crept up on me, tripped me up, kicked me to the ground and shat all over me. Thanks for that, Perimenopause. I honestly thought I would eventually learn to live with you, but you wanted me dead. Now I see right through you. You are a dangerous and insidious silent killer. You choose the most vulnerable victims. Yes, Perimenopause, I know there are many people who love you, but they don’t know you like I do. They are the lucky ones. Why couldn’t I have had the version of you that other people revere? You’re supposed to be transformative, illuminating and empowering. What the f**k did I ever do to you to deserve this? The first sign of you was the burning inflicted upon my eyes. They were dry as f**k. The pain was so intense that I mistook you for sunburn, for hayfever, for eye cancer even. You frightened the life out of me. I had to pay to see an eye specialist. Do you know you’ve cost me a f*****g fortune in healthcare over the years, Perimenopause? Anyway, the eye specialist told me that my eyes were dry because of my age (whatever that means) at only aged 36 or so. My eyes are still dry nearly a decade later, and I apply lubricating eye drops all the time. All The Time. You cause me to cry tearlessly, you still put my family at risk when my eyes drive out and throb whilst driving, and you have stopped me from painlessly watching my children grow up. Perimenopause, you cost me their childhoods. My boys are now 14 and 11, and they still often ask me, “Why are you so grumpy, Mummy?” Every time, I blame you. Yes, you, Perimenopause. You have stolen years from me that I’ll never get back. You stopped me from being the calm mother I was born to be, and morphed me into this depleted, shambolic husk of my former self. Did you know I used to be a nursery/kindergarten teacher before I homeschooled my own kids? Together my students and I explored this magnificent world with curiosity and joy. But then you came along and turned me into hateful, shameful woman who frequently dissociates from those I hold most dear just to make it through each day. Until I met you for myself, I knew nothing about you, except that people avoided talking about you for some reason. When I was a child, you were only mentioned in hushed whispers and euphemisms like “women’s problems” and “the change”. I think it’s because they were scared of you, and too many people still are. Your medical demands have cost me the money I could have spent exploring this not-so-magnificent-anymore world with my own children: shaping their futures and building them up. Instead because of you, Perimenopause, I can’t even even sit on a f*****g bike saddle and explore our neighbourhood with them because you, you f*****g b***h, have lacerated my vulva and shrunken my labia, thus rendering me unable to rest for long, unless sat crosslegged on a soft sofa cushion, TV remote in hand, with Taskmaster playing on repeat. Perimenopause, you have shrunken my world (and my labia). And what the actual f**k have you done to my metabolism?! First you wrecked my sleep, spiked my cortisol, and turned my appetite up to 11. Now I can only stay awake when aided by sugar by day, yet I can’t sleep at night. That doesn’t even make sense. Why don’t you make any f*****g sense?! All this sugar you’re making me eat has fucked me sideways. Whilst I am consuming it I can feel my vagina turning thrushy, and my boobs get itchy. You really are getting on my tits. I feel like I’m a size of a house. One of those red brick suburban outer London houses that my husband and I were lucky enough to buy when we were newlyweds. The type of house you can extend out the back and up into the loft space to make extra room. Rather than expand the house, we left London, before moving back to his home of Aotearoa New Zealand. Regarding my metaphorical house of a body (please forgive me, Peri, if I am none too articulate, only you have completely fucked over my cognition, my working memory and my vocabulary, you beastly b***h) and my actual house: I am now residing inside a house I cannot manage to upkeep without a dedicated team of support workers, because you’ve brought so many compounding and devastating regressions to my ability to function as a parent. And just when I was getting used to my cognitively reduced, yet physically expansive self, and feeling like I could accept myself under the Health at Every Size paradigm, the zeitgeist turned on me. Now, thanks to advances in weight loss medications and their widespread popularity, we are back in the heroin chic years that I thought were behind me. Every time I even look at a chocolate biscuit now, I can hear the tiny top model Kate Moss telling me that “nothing taste as good as skinny feels” and hey presto, Perimenopause, you push me off the disordered eating cliff with both hands, laughing at me as I crash up on the rocks. Just like your little sister Puberty did back in the 1990s, when Kate Moss was huge (culturally, not in size nor stature). Do you know what was the worst thing was about you? You gave me chronic uncertainty. I had no idea how long I would be suffering from you. How bad things might get. No idea how much more I could take. My mood was in constant flux. Chronic pain, energy depletion, rage. You frightened the life out of me and I see you are still busy doing it to others. What about everyone else who is suffering like I did? Why do you show us some of us no mercy? How do you decide who will be your next victim and whose life you will give meaning to? How are you still so unknown to people, Perimenopause? Why don’t doctors see you for what you really are? Healthcare professionals should be warning us about you. We should all see you coming. You should be declaring your arrival, red flags in hand. Yes, Perimenopause, I do know that many other people see your advent as a sacred rite of passage. And I agree that you are an inevitable life stage for those of us who are fortunate enough to survive beyond our youth. But my experience also tells me that you are far from benign. You can be lethal. The mood crashes and suicidal ideation you brought pushed me to my limits, yet I refused to become a statistic. I would not let you win. Because of you, I have had my entire reproductive system removed. I elected to undergo major surgery, consenting to the risk of medical complications or possible death, to end your hold over me. One of us had to go. I fought so hard for what was my only chance left at life. Drastic measures were crucial, and I was running out of time and options. The suicidal ideation you gifted me showed no reprieve so, Perimenopause, your termination was necessary. You had to be stopped! So to get rid of you once and for all, almost one year ago to this day, both my ovaries, my one remaining fallopian tube, my cervix and my uterus were surgically excised. And do you know what? It’s the best thing I’ve ever done! Now that I’m rid of you though, I’m stuck with your big sister for life. Menopause, dear Menopause. Early, surgical Menopause, to be precise. Compared to you, I love and adore her! Yes, you gave me my neurodivergent understanding of myself, Perimenopause. And for that I am grateful. But for everything else you burdened me with, you can go f**k yourself. You shall never darken my door again. Stay away from my friends. Perimenopause is dead! Long live Menopause! Cheers, If this letter spoke to you… You don’t have to agree with every word I’ve written here. You don’t even have to like perimenopause as much as some people seem to. But if you’ve ever needed somewhere to put the rage, grief, confusion or sheer f*****g exhaustion of navigating menopause in a neurodivergent body, I hope Divergent Menopause can be that place. Everything here remains free to read and listen to. If you’d like to help me keep making it, you can become a paid patron or founding patron. You’re not paying to unlock the work but you’re helping me continue to make it. 💐 And if you can’t pay, that’s absolutely okay. Read. Listen. Share. Comment. Tell someone who needs it. That all helps too. Thanks! 💕 Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe (https://samgallowayaudhd.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4)

Who has been a guest on The Autistic Perimenopause

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• SONIA VOLDSETH
• Allegra Chapman
• Kim Pitts
• Amanda Hanna
• Samantha Galloway

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