Midlife women are increasingly presenting to primary care with worsening anxiety, burnout, brain fog, emotional volatility, and treatment-resistant depression. For many, perimenopause is not the onset of a new psychiatric condition — but the unmasking of lifelong, undiagnosed ADHD and autism.

Drawing on data from over 400 AuDHD women, this talk explores how gender bias, masking, and outdated diagnostic models contribute to missed diagnoses in primary care. Survey findings reveal that 73.8% of women had their symptoms dismissed or misattributed, and over half were diagnosed with other conditions first.

We examine the neurobiology underpinning symptom escalation in perimenopause, including the interaction between estrogen and dopamine pathways central to ADHD. As estrogen declines, executive dysfunction, emotional dysregulation, and sensory sensitivity may intensify — often leading to misdiagnosis as anxiety, bipolar disorder, or personality disorder.

This session equips GPs and healthcare professionals to:

• Recognise high-masking presentations of ADHD and autism in midlife women
• Differentiate neurodivergent burnout from primary mood disorders
• Understand the neuroendocrine mechanisms influencing symptom changes in menopause
• Adjust assessment and prescribing practices with a hormone-informed lens

By reframing menopause as a neurological inflection point rather than a psychiatric collapse, clinicians can transform outcomes for a generation of women who have been misunderstood for decades.