Menopause As an Acquired Neurodiversity: Working with a Different Brain

When women experience perimenopause and menopause, the impact can be wide-reaching and as unique as the person going through it. Women can experience a host of symptoms beyond the most common, like hot flashes and fatigue; declining hormones in menopause can also affect the way the brain functions. A way to further understand this is to explore how menopause can be described as a neurodiverse condition.

 Neurodiversity is an umbrella term referring to the variability in neuro-cognitive development, and encompasses the differences that exist in how individuals process the world in general.

Applied neurodiversity includes conditions like Dyslexia and Dyspraxia, and clinical neurodiversity includes ADHD and Autism; the latter are conditions that form the fundamental way that the brain processes the world. Conditions that develop post-birth are referred to as acquired neurodiversities.

What Is Acquired Neurodiversity?

Acquired neurodiversity comprises conditions that have a permanent impact on the way the brain functions. There are two types of acquired neurodiversity: chronic and transient.

Chronic neurodiversities are pervasive and will have a permanent impact on the way that the brain functions. These include conditions like Chronic Fatigue Syndrome, traumatic brain injuries, fibromyalgia, and Cerebral Palsy. If there is either a permanent change to the brain structure, like after a stroke or other brain injury, or if there is a significant amount of physical processing given over to a condition that affects pain levels or motor function, this will also have an ongoing impact on day-to-day functional thinking.

Transient neurodiversities are ones that pass in and out of a person’s day-to-day experience and will have an impact while they are present. These include conditions like mental health illnesses, the impact of Covid-19, and surprisingly, menopause. For example, depression limits cognitive processing in the same way that stepping on a hose stems the flow of water. Step off the hose, and the water flows again; in a similar way, the brain can function as it once did without the additional pressure or workload that can accompany mental health conditions. The challenge with managing the effects of perimenopause and menopause is that this transition is quite unpredictable. The symptoms can vary widely and can last for a significant time.

What are the symptoms?

The symptoms of the menopause transition that can impact processing are things like trouble with concentration, reduced emotional resilience, sensory sensitivity (especially to noise), memory dropout, brain fog, and issues communicating in ways that may have been easy in the past. The impact of insomnia on a regular basis will also inevitably impact how well the brain functions the next day, as well as affecting physical pain, energy, and mood.

Why is this?

When women are going through the menopause transition, estrogen levels, and therefore the type of estrogen that is produced during child bearing years (estradiol), drops. Estrogen is also key to managing serotonin, which is essential for executive function and emotional resilience. It has been clinically proven that when levels of estradiol drop, the hippocampus, which is the seat of long-term memory, physically shrinks. This doesn't mean that the memories and understanding have diminished; it simply means that the pathway that would normally be used to access these long-term memories has been reduced.

There is a “bridging” process, between the working memory and long-term memory, and it’s this access to these memories which is constantly shifting and changing. The frustrating thing is that it’s unknown when this access will change, and therefore it’s impossible to determine when memory dropouts are going to occur. These dropouts could occur as struggling to remember someone’s name or a particular word mid-conversation or even taking the next step in a familiar process at work. Incidents like this can lead to a severe drop in confidence and in a person’s ability to complete tasks, both in and out of work. Anxiety is also common, as women feel that they can't trust their brains as they once did or that others around them are judging them for what appears to be a lack of capacity. This can be an increased stressor in today's world, when the ability to be reactive is often a marker of competence.

What else is affected? 

Processing Speed: This is defined as the amount of thinking capacity present in any given moment. Fundamentally, it’s the speed at which information is absorbed and processed to a conclusion, whether that is problem-solving or choosing what next to tackle on the to-do list. When any neurodiversity is present, a baseline of processing speed is always taken up by the condition; for example, individuals with dyslexia use 40% of their available processing speed alone on decoding and encoding sounds. This equates to about 25% extra work that the brain is doing all the time. As a result, things like stress, anxiety, and tiredness will have a greater impact on a neurodiverse brain than on a neurotypical brain (a brain without neurodiversity).

Working Memory: This is like the brain’s internal notepad; it isn’t short term memory, nor is it long-term memory, but rather how effectively attention is directed to a task. Typically, poor working memory is a feature of neurodiversity. On the one hand, it makes lateral thinking a strength, but on the other, it can mean that multitasking is a struggle and tracking tasks can be overwhelming. Even familiar processes can feel impossible, coupled with an uneasy sense of not being able to find a starting point.

Stress and Anxiety: It's not unusual to experience high levels of anxiety during the menopause transition. After all, if the body and brain are doing things that are utterly bewildering and unpredictable, it can be very challenging to have a sense of being grounded and to be able to trust that what happens tomorrow will be the same as what happened today. As mentioned, estrogen is also key in the management of serotonin; so if estrogen levels are low or in flux, this will have an impact on mood and the ability to self-regulate. During the menopause transition, there is a huge amount of energy and resources being taken up by the physical and hormonal changes occurring in the body. This takes away from the capacity that might have previously been available for the intellectual and emotional centers.

What if there is already a neurodiverse condition present?

Something that is becoming more evident is the number of women who are going through the menopause transition and are also getting a late-in-life diagnosis for clinical neurodiversities like ADHD. This is in part due to diagnostic bias shifting to a more intersectional space, but it’s also quite possibly due to many women masking (or hiding) the impact of their underlying neurodiversity in their daily lives successfully for many years. What these women find is that once they enter perimenopause, the strategies that might have served them very well for a long time simply don't work as effectively anymore. In this way, acquired neurodiversities can be the perfect tipping point, overloading the system just enough to throw everything out of balance. 

Resources Are Key

At any moment in time, there is a certain number of resources available to use, and these fluctuate according to a variety of internal and external pressures. If this is thought of as a balance of the intellectual, emotional, and physical, there is a finite amount of each at any one time that can be utilized, so these must be both understood and managed. For example, if there are many physical symptoms present, this may minimize the bandwidth for dealing with emotional situations.

Is this a permanent change?

Fortunately, rebalancing hormones can support the system to go through this process more smoothly and with reduced impact on quality of life. HRT (Hormone Replacement Therapy) is a safe and accessible pathway to rebalancing the hormone depletion in the body, bringing a level of control and well-being back into play. Being able to make choices to create a tangible and positive impact on day-to-day functioning can make all the difference in confidence, physical symptoms, and mental health. Managing a myriad and ever-changing combination of symptoms can be daunting, but with consistent dialogue and support, this transition can be navigated successfully. 

Another thing that can help is being more informed on the sort of strategies that can be used to support the shortfall in processing, without always having to rely on others. If this means writing things down, using organization apps and reminders to fill in the gaps, then so be it. Having more self-compassion about having to take more time to complete tasks or asking for help is important – the system is going through a big transition. This isn't a failure, but it can make someone feel extremely vulnerable.

Comparisons about how things used to be are also not helpful; it’s kinder and more productive to focus on what is needed now for support. Understanding what the brain’s capacity is in the moment, whether it's a good day or a bad day/week, and being able to manage the expectations of others, will make all the difference between what feels impossible and achievable. Asking for help can be challenging, but it’s essential. No one should have to spend their menopausal years in distress. 

With the right combination of things in place, including tools and treatment like HRT (if appropriate), it’s possible to start to feel “back to normal” quickly. It’s only now that women are starting to permit themselves to self-advocate in a way that previous generations have not, and women in menopause have the right to discover how to do so effectively, too.

Barth et al, (2016)

Weinburg & Doyle (2017): Neurodiversity at Work

M. Dubol et al, (2021)