Menopause Masking: What It Is (and Why It Looks Like You’re “Fine” Until You’re Not)
- Kiesa Kelly
- 3 days ago
- 8 min read
Last reviewed: 02/12/2026
Reviewed by: Dr. Kiesa Kelly
If you’ve ever thought, “Everyone thinks I’m doing great, but I’m barely holding it together,” you’re not alone. Menopause masking can describe that exact experience: appearing capable and composed on the outside while your internal effort (and recovery time) keeps climbing.
In this article, you’ll learn:
What “menopause masking” means and why it can feel so invisible.
Why masking often increases for midlife women (even the highly competent ones).
How perimenopause/menopause symptoms can reduce your “buffer” for social performance.
Signs that masking is turning into burnout, especially for ADHD/autistic/AuDHD women.
What support can help, including options for Tennessee + telehealth care.
What “Menopause Masking” Means (In Plain Language)
“Menopause masking” is not a formal medical diagnosis. It’s a plain-language way to talk about what happens when midlife hormone changes and life demands collide with the pressure to keep functioning, keep smiling, and keep up appearances.
💡 Key takeaway: Masking is often a survival skill that helped you succeed for years, but it can become unsustainable when your nervous system loses its spare capacity.[1,7]
Masking = performing wellness while spending extra energy
Masking is the gap between what people see and what it costs you. It can look like being “high functioning,” “so organized,” or “always the strong one,” while you’re internally over-monitoring, self-correcting, and suppressing discomfort to match expectations.[7]
For many women, masking also includes “making it look easy”:
Staying pleasant when you’re overstimulated.
Over-preparing so you won’t forget something.
Hiding fatigue, irritability, or tears until you’re alone.
Why midlife is when the mask often slips
Perimenopause and menopause can bring sleep disruption, mood shifts, hot flashes/night sweats, and subjective cognitive complaints (often called “brain fog”).[1–3] Even when symptoms are mild, the cumulative effect can reduce the energy you used to rely on for social performance, executive functioning, and emotional regulation.[1–3]
Why this is about capacity, not character
Masking is not a moral issue. If your ability to “hold it together” changes in midlife, it doesn’t mean you’ve become lazy, dramatic, or less competent. It usually means your capacity has changed, and the same demands now cost more.[1–3]
💡 Key takeaway: When the mask slips, it’s often a signal to adjust the load, not a reason to blame yourself.[1]
Why Masking Often Increases for Midlife Women
Masking tends to rise when responsibilities rise. Midlife can be a season of peak demand, and many women respond by tightening their systems and pushing harder.
Roles and visibility: work, parenting, caregiving, leadership
Midlife often includes more visibility at work (leadership, client-facing roles, higher stakes), while also carrying family logistics, aging-parent caregiving, and emotional labor at home. When the calendar is full and the margin is thin, masking becomes the glue that keeps everything from showing.
Practical example: You can run a meeting flawlessly, then spend the next six hours unable to do “simple” tasks because your brain and body are in recovery mode.
Social expectations and “don’t be difficult” conditioning
Many women were taught, explicitly or implicitly, to be accommodating and low-maintenance. That conditioning can turn menopause/perimenopause symptoms into something you “hide well,” even when your body is asking for support.
The perfectionism–people-pleasing loop
Perfectionism and people-pleasing can be a form of risk management: “If I do it perfectly, no one will be disappointed, and I won’t be judged.” The problem is that perfectionism is expensive, especially when your physical and cognitive buffer is shrinking.
💡 Key takeaway: Perfectionism can look like competence, but it often functions like a stress response when you don’t feel safe to need support.
How Menopause/Perimenopause Can Make Masking Harder
Menopause doesn’t create character flaws. It can change sleep, stress reactivity, and cognition in ways that make social performance and executive load harder to sustain.[1–3]
Sleep disruption + hot flashes + stress reactivity
Sleep disruption is common in the menopause transition, and vasomotor symptoms (hot flashes/night sweats) can add repeated nighttime awakenings.[1,4] When sleep quality drops, everything you use to mask with becomes less available: patience, word-finding, planning, and emotional regulation.[1]
Brain fog/executive strain reduces “buffer”
Research reviews describe that perimenopause is commonly associated with subjective cognitive difficulties and can affect areas like attention, working memory, processing speed, and verbal learning for some people.[1–3] When your executive “buffer” is lower, you may need more scaffolding to do tasks you used to do automatically.
Practical example: You’ve always been the person who tracks birthdays, permissions slips, and deadlines in your head, and suddenly you need lists, reminders, and recovery time to do what used to be effortless.
Sensory thresholds shift (noise/heat/clothing)
Many people report changes in sensory tolerance in midlife: heat feels unbearable, crowded rooms feel louder, and certain fabrics or waistbands feel intolerable. If you’re autistic, ADHD, or AuDHD, those shifts can amplify sensory overload and make masking in public more draining.[1,7]
💡 Key takeaway: When your body is working harder to regulate temperature, sleep, and stress, you have fewer resources left for social performance.[1,4]
Signs of Menopause Masking (Even If You Don’t Call It That)
Masking is often easier to spot by its after-effects than by what happens in the room.
Over-prepping, scripting, recovering in private
Common signs include:
Rehearsing what you’ll say (even for “easy” conversations).
Writing detailed notes so you won’t lose your train of thought.
Needing a long decompression window after social or work demands.
“Fine” on the outside, shutdown on the inside
Some people describe a split-screen experience: outwardly friendly and competent, inwardly numb, detached, or close to tears. Others experience shutdown at home: minimal speech, irritability, or a strong need to be alone after being “on” all day.
The “effort cost” keeps rising
A helpful question is: “Is the effort required to maintain my life increasing faster than my capacity to recover?” If yes, you may be moving from coping into burnout territory.
💡 Key takeaway: If you’re spending more time recovering than living, your system is asking for a different plan.
Masking vs Coping vs Burnout
Not all “trying hard” is the same. The difference matters because the solution changes.
Healthy skills vs survival strategies
Coping skills are supportive and sustainable: planning, boundaries, asking for help, pacing, and using tools that reduce friction. Masking is often a survival strategy: it helps you get through the moment, but it can increase long-term depletion when it requires suppressing needs and tolerating overload.[7]
Burnout indicators: skill loss, narrowed capacity, irritability
Autistic masking burnout and ADHD masking burnout are commonly described as a pattern where the load stays high but the ability to compensate drops. People may notice “skill loss” (things that used to be easy become hard), narrowed tolerance for change, more sensory overwhelm, and more irritability or shutdown.[7]
If you relate to “high masking ADHD women” or “autism masking women,” midlife may be the first time the strategy stops working because the hormonal and sleep-related buffer has changed.[1,5–7]
When it looks like anxiety/depression (and when it isn’t)
Menopause transition is associated with changes in mood and sleep, and those can overlap with anxiety and depression symptoms.[1] Burnout can also look like anxiety or depression on the surface.
Common misconceptions to let go of:
“If I can do my job, I can’t be struggling.” You can function and still be depleted.
“If I’m melting down/shutting down, I must be immature.” Stress responses are not character flaws.
“If menopause is the cause, it’s ‘just hormones,’ so it doesn’t matter.” Hormones can meaningfully affect sleep, cognition, and stress physiology.[1–3]
💡 Key takeaway: Burnout isn’t failure; it’s an overload signal that your support level needs to match your reality.
What Helps (Support-Level, Not DIY Treatment)
This section is about support and accommodations, not self-diagnosis or at-home treatment. If symptoms are severe or rapidly worsening, a medical and mental health evaluation is important.
Shift from willpower to accommodations
Willpower is a finite resource. Accommodations are structural.
Examples that often help:
Fewer back-to-back meetings, more transition time.
Written agendas and follow-up notes.
Visual reminders and simplified routines.
Sensory supports (cooling tools, quieter spaces, predictable clothing).
If executive strain is a major issue, executive function coaching can help you build systems that reduce decision fatigue without shaming your brain.
Reduce social/decision load without shame
A small reduction in social demand can create a big improvement in recovery. Consider experimenting with:
“One social thing per day” (or per weekend).
Default meals, default workouts, default outfits.
Delegating invisible labor (calendar management, scheduling, household admin).
If sleep is part of the picture, support like CBT-I can be a high-impact starting point; see ScienceWorks’ insomnia services.
Build recovery time like a medical necessity
Recovery is not optional for a nervous system under chronic load. Treat decompression time as a health need, not a reward you earn.
A simple, non-glamorous strategy: schedule a daily “sensory low tide” window (dim lights, low noise, no conversation, predictable activities) and protect it the way you’d protect a medical appointment.
💡 Key takeaway: The goal isn’t to “stop needing breaks”; it’s to stop living in a state where breaks are never enough.
When to Seek Assessment or Support
If midlife changes are revealing long-standing patterns, an evaluation can help you separate “this is menopause” from “this is how my brain has always worked, and menopause lowered my compensation.”[1,5,6]
ADHD/autism/AuDHD clues across the lifespan
Some people first recognize ADHD, autism, or AuDHD in perimenopause because overlapping symptoms become harder to compensate for (attention, organization, emotional regulation, sensory tolerance).[5,6] If you’ve always worked twice as hard to look “together,” menopause may be exposing the cost.
If you’re curious, screening tools can be a gentle first step (not a diagnosis), such as the ASRS ADHD screener and the AQ-10 autism screener.
What a neurodiversity-affirming evaluation explores
A neurodiversity-affirming evaluation typically looks at:
Your developmental history and lifelong patterns (not just current stress).
Strengths, supports, and contexts that change symptoms.
Overlap with anxiety, trauma, sleep issues, and perimenopause factors.
If you’re considering assessment, learn more about ScienceWorks’ psychological assessments and how an individualized, collaborative process works.
Options for Tennessee + telehealth care
If you’re physically located in Tennessee, ScienceWorks offers ADHD and autism assessment through secure telehealth, which can be especially helpful if sensory load, fatigue, or scheduling barriers make in-person care harder.[8] You can also explore specialized therapy for support with stress, burnout, and co-occurring concerns.
If you want help sorting through next steps, you can reach out through the ScienceWorks contact page.
About the Author
Dr. Kiesa Kelly is a licensed psychologist and the owner of ScienceWorks Behavioral Healthcare. She earned her PhD in Clinical Psychology with a concentration in Neuropsychology and has over 20 years of experience in psychological assessment.
At ScienceWorks, Dr. Kelly provides neurodiversity-affirming care for adults and teens, including assessment and therapy support for ADHD, autism, OCD, insomnia, and trauma. Learn more about her work at Dr. Kiesa Kelly’s bio.
References
Williams M, Maki PM. A review of cognitive, sleep, and mood changes in the menopausal transition: beyond vasomotor symptoms. Obstet Gynecol. 2025 May 22;146(3):350-359. PubMed | DOI
Metcalf CA, Duffy KA, Page CE, Novick AM. Cognitive problems in perimenopause: a review of recent evidence. Curr Psychiatry Rep. 2023 Oct;25(10):501-511. PubMed | DOI
Conde DM, Verdade RC, Valadares ALR, Mella LFB, Pedro AO, Costa-Paiva L. Menopause and cognitive impairment: a narrative review of current knowledge. World J Psychiatry. 2021 Aug 19;11(8):412-428. PubMed | DOI
The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. PubMed | DOI
Smári UJ, Valdimarsdottir UA, Wynchank D, de Jong M, Aspelund T, et al. Perimenopausal symptoms in women with and without ADHD: a population-based cohort study. Eur Psychiatry. 2025 Sep 4;68(1):e133. PubMed | DOI
Osianlis E, Thomas EHX, Jenkins LM, Gurvich C. ADHD and sex hormones in females: a systematic review. J Atten Disord. 2025 Jul;29(9):706-723. PubMed | DOI
Perry E, Mandy W, Hull L, Cage E. Understanding camouflaging as a response to autism-related stigma: a social identity theory approach. J Autism Dev Disord. 2022 Feb;52(2):800-810. Epub 2021 Mar 31. PubMed | DOI
ScienceWorks Behavioral Healthcare. ADHD and autism assessments for adults and older teens in Tennessee. Published Nov 26, 2025. Accessed Feb 12, 2026. scienceworkshealth.com
Disclaimer
This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis, or treatment. If you have new, severe, or worsening symptoms, or concerns about safety, please seek help from a qualified healthcare professional or emergency services as appropriate.
