Neurodiversity and Hormones - Part 3: Hormones Across the Lifespan

This blog is written by Creased Puddle's Specialist Neurodiversity Consultant Dr Alice Siberry . If you've missed part one and two of this series, you can read the series on our blog here.

Hormonal shifts don’t end after puberty (see our previous blog!), and for many neurodivergent people, they continue to play a powerful (and often invisible) role throughout a person’s life.  

Whether it’s the monthly rhythm of a menstrual cycle, the seismic changes of pregnancy and postpartum or the quieter but equally intense journey of perimenopause, hormones shape how we feel, function and experience the world. And yet, these intersections are still missing from most conversations about neurodivergence.

The missing conversation

There’s growing anecdotal evidence, and some emerging research, that hormonal changes can amplify or alter neurodivergent traits, but for the most part, these experiences remain underexplored and under supported.  

Why?  

Because we’ve often treated neurodivergence and hormonal health as two separate topics, when, for many people, they’re deeply intertwined.  

It may be helpful to briefly revisit the basics, though it was more fully explained in our previous blog on the importance of this conversation (Part 1). Though hormones impact everyone, the greatest impact appears to be on those assigned female at birth, who have both sex and reproductive hormones estrogen and progesterone, as well as small amounts of testosterone. These hormones reset every 28 days (unlike the main hormone for those assigned male at birth, testosterone, which resets every day).  

Sex hormones are known to help with the production and distribution of dopamine (which support executive functioning), acetylcholine (which assists with memory) and serotonin (which regulates mood). Neurodivergent people are likely to have differing levels of neurotransmitters, which could in part, be explained by hormone regulation.  

The typical menstrual cycle looks like:  

Day 1-7 is where the uterus lining is shed, and typically the person bleeds. In this phase, estrogen and progesterone levels are at their lowest.  

Day 7-16 is where the uterus lining begins to build back up, ready for an egg to be released. During this time, estrogen rises in preparation.  

Day 17-26 is when an egg is released, known as ovulation. At this time, estrogen is high and then rapidly drops, followed by a steady incline in progesterone. At this time, the uterus prepares to either support pregnancy or break down the egg for menstruation.  

Day 27 onwards is the final stages, known as the luteal phase, where if no pregnancy occurs, progesterone and estrogen drop signalling to the body it is time for menstruation to happen. This is the time where many will experience PMS (premenstrual symptoms), such as mood swings, fatigue, irritability and low mood.  

 However, this isn’t just about “mood swings” or “PMS”. It’s about:  

• Sudden drops in executive functioning during certain cycle phases  
• PMDD (Premenstrual Dysphoric Disorder) being misdiagnosed as personality disorders or mental illness  
• Overstimulation, sensory overwhelm, and emotional intensity increasing around ovulation or menstruation.  
• Underdiagnosis of gynaecological medical challenges such as endometriosis.  
• Postpartum identity shifts leading to increased risk of neurodivergent burnout.  
• Perimenopause unmasking previously hidden or masked traits, often leading to later-in-life diagnosis.  

Neurodivergence and PMDD

PMDD is a severe form of premenstrual distress that affects mood, cognition, and behaviour. It’s not just PMS, it’s extremely debilitating and it’s increasing recognised as more common among autistic and ADHD people (Dorani et al., 2021). Though figures are not accurate, it has been reported that PMS may occur in up to 48% of people who menstruate, while PMDD only occurs in 3-9%. This is disproportionate in ADHDers and autistic people, with up to 92% of autistic females and 46% of ADHDers reportedly experiencing PMDD. It is likely that sensitivity to hormones and reduced dopamine levels are part of the explanation though more research is needed.  

There are lots of problems when it comes to support for PMDD:  

• PMDD is hard to diagnose. 
• Neurodivergent people may already struggle with interoception (noticing internal changes), so it can be even harder to track symptoms.  
• The cyclical nature of PMDD is often misunderstood as emotional instability, feeing into stereotypes, especially for people assigned female at birth.  
• Hormonal interventions like birth control and SSRIs (anti-depressants) are the only known treatments at present, and they can have unpredictable effects on neurodivergent bodies.  

Only more research and understanding will lead to better care pathways, and as part of this, it is essential to include the experience of neurodivergent people.

Pregnancy, postpartum and the neurodivergent experience

Pregnancy is another point of major hormonal upheaval. During pregnancy, estrogen and progesterone levels increase. For some, it can bring relief, a quieting of certain symptoms, the increase in estrogen can actually really help the brain, despite the impact of growing a human being on the body! For others, this experience can be destabilising, leading to “pregnancy brain”, which refers to pregnancy-related challenges in cognitive functioning.  

Once birth happens, it is typical for estrogen and progesterone to flood, leaving people to experience really low levels, and appears to disproportionate lead to post-natal depression in neurodivergent parents (Pohl et al., 2020). Neuroimaging has also shown that reductions in grey matter (which allows for processing of sensory information, learning, speech and cognition) endures for years after pregnancy (Servin-Barthet et al., 2025). On top of this, you have a newborn, which as a neurodivergent parent can mean:  

• New sensory demands
• Sleep deprivation (already a struggle for many neurodivergent people)  
• Executive load and emotional regulation at an all-time high  
• Loss of structure, routine and control  
• Identity shifts that unearth or amplify previously masked traits  

There are many reports that neurodivergent people don’t feel seen during this period. Their struggles are chalked up to “new parent overwhelm”, when in reality, their needs are complex and layered and often routed in hormonal imbalance.

Perimenopause and (re)diagnosis

For some, perimenopause is the moment things start the click. This appears to be where the most research about the neurodivergent experience of hormones exists. Although the average ago of menopause is 51 years old, menopause can actually happen any time from the 30s to the mid-50s or later. During the perimenopause, the supply of eggs in a women’s ovaries diminishes and ovulation becomes irregular. At the same time, the production of estrogen and progesterone decreases, slowly over months.

An ADDitude survey of nearly 5000 females revealed that 93% of respondents aged 45 years or older experienced elevated and aggravated ADHD characteristics in perimenopause. They reported:  

• Worsening sensory issues  
• Increased brain fog and memory lapses  
• Emotional volatility and shutdown  
• A growing sense of disconnection or struggle with masking  

Estrogen is known to ‘mask’ dopamine, and when it finally is no longer at its peak, many start questioning, “could I have always had ADHD?” For those assigned female at birth, perimenopause often becomes a point of discovery, not because their neurodivergence didn’t exist before, but because it’s no longer to push through or hide it.  

So, what now?

We need to stop treating hormones as an afterthought or separation from neurodiversity in conversations about support.  

That means listening to lived experiences, validating people’s shifting traits and needs throughout life and training clinicians, educators and employers to understand the impact of hormonal fluctuations on things like attention, sensory processing, mood and energy. When we create more inclusive, informed support for neurodivergent people at all life stages, we can continue to get the best out of everyone.

Get in touch with us about how we can support you explore the impact of hormones and neurodivergence:  

• Training and awareness courses 
• Workplace Needs Assessments  
• Neurodiversity coaching  
• Neurodiversity consulting
• Become a Level 4 Workplace Needs Assessor

You can receive the next blog post straight to your inbox by subscribing to our newsletter.

References  

ADDitude Magazine (2025) We Demand Attention on the Benefits and Risks of Hormonal Contraception and Hormone Replacement Therapy for Women with ADHD. Available at: https://www.additudemag.com/hrt-hormone-replacement-therapy-birth-control-pill-adhd/#:~:text=An%20ADDitude%20survey%20of%20nearly,in%20perimenopause%20and%2For%20menopause.  

Dorani, F., Bijlenga, D., Beekman, A. T. F., van Someren, E. J. W., Kooij, J. J. S. (2021) Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research.