Abstract
One day, when life appeared steady and I was making exciting progress in my research career, something shifted so dramatically that it forced me to question my entire reality. The only way I can describe this moment is to say that I had been riding a merry-go-round for years without realizing it, only to be brought to an abrupt and jarring halt. The bright lights and familiar music that had once represented the rhythm of my life faded into the distance, no longer playing for me.
This was the moment everything changed, when I moved from feeling like an accomplished academic to suddenly confronting the complexities of midlife, AuDHD, and burnout. It was sudden, disorientating, and frightening, as if the momentum that had carried me for so long had vanished overnight.
I am a late-diagnosed AuDHDer, and although I had long suspected I might have Attention deficit hyperactivity disorder (ADHD), I was genuinely surprised when I received my autistic diagnosis. AuDHD is the simultaneous co-occurrence of ADHD and autism. ADHD had never felt like a problem; if anything, it had fueled my energy, creativity, and drive. I sought assessment only after my son went through his own diagnostic process, and I found myself nodding and ticking the boxes for autism too. The psychiatrist mentioned that neurodevelopmental conditions often run in families and asked whether I could think of anyone he might have inherited it from. I remembered countless comments from colleagues over the years: “Where do you get all your energy from?” “You’re bonkers to think you can achieve that!” “You’re a perfectionist, do you have obsessive compulsive disorder (OCD)?” and suddenly it clicked. Perhaps it was me. So, I began the long, exhausting journey toward assessment.
While I was waiting, I found myself reflecting on the ways autism had shown up throughout my life, and I began to join the dots between my diagnosis and my younger self. I realized that lining up objects, preferring plain food, hearing sounds that no one else seemed to notice, and feeling nauseous, sweaty, and overwhelmed around new people or unfamiliar environments were not simply signs of anxiety but early autistic traits. These responses were consistent, lifelong and present long before I had the language to understand them. They reflected the way my sensory system processed the world rather than reactions to specific stressful situations. These examples are not exhaustive, but they illustrate how autism was present in my childhood long before I had the framework to recognize it.
As I was beginning to unpick this, my day-to-day experiences began to shift in ways I couldn’t explain. I started to have panic attacks, three so intense that I ended up in A&E, convinced I was having a heart attack. I couldn’t understand why this was happening. Looking back, the triggers were clear: unfamiliar places, large crowds, unpredictability, and the emotional load of raising a neurodivergent family. But at the time, I was confused. Life was good. I had worked successfully in education for 14 years across secondary, sixth form, and higher education. I had run a sports business, recently completed a master’s degree, and was about to get married. I was content. So why was my body suddenly reacting as if I was in danger?
When I finally received my autism diagnosis, everything began to make sense. My anxiety and panic were not random; they were my autistic and ADHD traits colliding with stress, sensory overload, and years of masking. I accepted the diagnosis and became hyperfixated on learning everything I could about AuDHD, eventually making it a focus of my research. But even as I learned more, I did not yet understand how fragile the balance between my internal and external worlds had become.
Life kept stacking challenges on top of each other. Just as I tried to embark on something new, another barrier appeared. I experienced a missed miscarriage, slipped a disc, suffered a period of arthritis that left me unable to walk for a time, and suddenly developed tinnitus. Each issue felt separate, but in hindsight, they were early signs of perimenopause, something I had not yet connected to my experiences. My body was sending signals, but I did not yet know how to interpret them.
A few months later, I was preparing for a research trip of a lifetime. I had been awarded funding to spend a month in China on a research exchange. I was thrilled. But obtaining the visa in London was excruciating. I had two meltdowns in the city, something entirely new for me. I couldn’t understand why. I loved London. I had visited many times. But the noise, crowds, unpredictability, and sensory intensity overwhelmed me. I began to doubt whether I could manage traveling halfway across the world. If I struggled in a familiar city, how would I cope in a completely new cultural environment?
Still, I went. I was determined, optimistic, and excited. International research had always been a dream, and I did not want fear to take that away from me. When I arrived in China, everything intensified. I experienced migraines that I had never experienced before, waves of anxiety so intense I thought I would pass out, dizziness, nausea, nerve pain, and sensory overload. At first, I blamed jet lag. I researched everything I could and discovered that long-haul travel can significantly affect neurodivergent individuals. I had packed every self-regulatory tool I could think of, but nothing helped. My ADHD was eager to explore China, but my autism was overwhelmed by crowds, noise, heat, and cultural unfamiliarity. The region I visited was strictly Hanzu and nobody spoke English. All teaching and research had to be done through a translator, which made it more challenging to communicate, adding to my cognitive load. I tried to pace myself, dipping my toe in, then retreating to my hotel room to regulate by meditation, rest, and yoga. After a week, I began to settle. When my husband joined me 2 weeks later, I felt even more grounded. But when my menstrual cycle began, all the symptoms returned. It was the first time I wondered whether hormones were playing a role.
When I returned home, I expected jet lag. Instead, I experienced debilitating exhaustion that left me bedbound for nearly a month. I assumed it was burnout from the sensory and emotional demands of the trip. But I didn’t bounce back. Every time I felt slightly better and tried to do something, I crashed again for days. I pushed through, believing I just needed to settle back into work. But my symptoms escalated: gastrointestinal issues, dizziness, insomnia, visual disturbances, panic, and daily overwhelm. When I attempted to attend back-to-work training sessions with large groups of people, the accumulation of voices felt unbearable, as if the sound had merged into a rowdy flock of seagulls circling above me. My eyes suddenly became sensitive to the bright lights in every room, and after only a few hours of hearing and seeing in that environment, I would develop an instant migraine. At the time, I put this down to being autistic and overwhelmed, but I later learned that declining estrogen can heighten both sound and light sensitivity. Combined with low progesterone, which usually helps keep the nervous system calm, it meant I had almost no internal buffer left. What I experienced in those rooms was not just sensory overload; it was my entire hormonal and neurodivergent system struggling to cope.
My doctor suspected a complex interplay of burnout, AuDHD, and hormonal disruption caused by perimenopause. It was the perfect storm. Hearing that frightened me, but it also validated the chaos I was experiencing. My body was not betraying me; it was overwhelmed.
Embarrassed by my symptoms, I masked through them to remain professional over a 6-month period. I now realize how much harm that caused. I ignored exhaustion, headaches, and executive overload. I taught while experiencing panic attacks, nerve pain, sweating, breathlessness, and the sensation of passing out, yet no one knew. I had become so skilled at masking that even in crisis, I appeared fine. That level of concealment came at a cost. It eroded my sense of safety, identity, and trust in my own body.
I began confiding in colleagues, but many struggled to understand. Some said, “you never used to be like this,” or suggested taking antidepressants. They meant no harm, but their responses reinforced my fear that I had changed, that I was no longer myself. On one of my last days before taking an extended leave, I broke down in my office. I felt desperate, exhausted, and afraid. I had gone from being a driven, enthusiastic academic to someone I barely recognized. My sense of identity, professional and personal, felt shattered. I grieved the version of myself I had been, the one who could juggle everything without falling apart.
I began hormone replacement therapy (HRT), which was its own journey. I learned I have a sensitive nervous system and progesterone sensitivity, and I had to try multiple treatments before finding one that worked. I also sought help from a psychologist. Their words shook me: they were concerned about my health and well-being and said I was experiencing a psychological collapse. Hearing that terrified me, but it was also the moment I realized something had to change. My system simply could not keep up with the strain I was placing on it. I needed time, real time, to recover from deep, cumulative burnout.
Stopping felt like failure. But once I stepped off the merry-go-round, everything caught up with me. My back injury returned. My exhaustion deepened. I felt helpless. Recovery has not been linear. The relationship between hormones, burnout, and AuDHD is complex, with overlapping symptoms that influence each other. It has felt like unraveling a can of worms. Yet in that unraveling, I began to understand myself in a new way. I realized how long I had been pushing, striving, and masking without recognizing the toll it was taking.
Being still has taught me something profound. I have begun to reposition my thinking about what matters. Peace, quiet, and happiness now outweigh my relentless drive for achievement. I have learned about the impact of hormones on brain function, why menopause often hits earlier and harder for neurodivergent women, and how burnout in midlife can be catastrophic when unrecognized. This has become a new area of research interest, one born from lived experience rather than academic curiosity. Understanding myself has become part of my healing.
I wish I had known sooner. I wish someone had told me that masking competence, ignoring early signs, and pushing through would only lead to collapse. I wish I had understood the interplay between hormones and neurodivergence. I wish I had known how to advocate for myself. But I also know that many neurodivergent women reach this point without warning, without language, and without support. If sharing my story helps even one person recognize the signs earlier, then this experience has meaning.
During this period, I encountered a number of responses that, although not intended to be hurtful, were deeply unhelpful. Comments such as “I sailed through perimenopause without any symptoms,” “aren’t you too young to be taking HRT,” “at least you’re not terminally ill,” or “are you sure you can’t do that, it will only take an hour” minimized what I was experiencing. These remarks did not come from a place of malice but they revealed a significant lack of understanding about perimenopause, neurodivergence, and burnout. Even when I tried to explain what was happening to me, I often felt unheard, both in professional settings and at home.
For any non-autistic readers, I encourage you to really listen when someone describes symptoms like these and to take their words seriously. Autistic women often mask distress until they reach the breaking point, so when we say we cannot do something, it is not a negotiation or a lack of effort. It is a genuine limitation of capacity. Please resist the urge to push for explanations or to persuade someone to attend events or complete tasks when they have already said they are unable to do so. Respecting boundaries is a form of support.
Early recognition and understanding can prevent symptoms from escalating. While it is encouraging that some workplaces and institutions are beginning to implement policies around neurodivergence and perimenopause, these should be seen as a starting point rather than a complete solution. I urge readers to continue learning beyond formal policies, as there is now a growing body of accessible literature that can help deepen understanding and improve support for autistic women navigating this stage of life.
Autistic burnout does not only affect late-diagnosed women in midlife; it can happen to any autistic person at any stage of life. Henceforth, my advice to the autistic reader is this: do not ignore the early warning signs. Do not mask your struggles to appear competent. Do not assume you must push through because you always have. Your body will tell you when it is overwhelmed; listen to it. Recognizing your limits is not a weakness. It is wisdom, and it might just save you from falling off your own merry-go-round.