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Key points
- Research shows that being autistic can shape a woman's experience of menopause.
- Autism-specific issues might include a lack of social network and difficulties with healthcare providers.
- Challenges with emotional regulation and sensory sensitivity may be particularly heightened during menopause.
- Autistic women often face additional differences with interoception, which can impact their experience.
Many of my clients, ranging from those experiencing perimenopause to those who are post-menopausal, have confronted the challenges of menopause over the years. Many women experience difficulties around menopause, from hot flashes and night sweats to aches and pains, fatigue, and mood swings. But what I hear from my clients—and what is supported by recent research—is that menopause might pose particular challenges for autistic women.1
Why Is Menopause a Challenge for Autistic Women?
There are several reasons why menopause may prove especially problematic for women with autism, including:
1. Problems dealing with appointments and healthcare providers.
Seemingly "simple" tasks, such as making appointments and communicating with healthcare providers, can be extremely difficult for autistic women due to executive function issues and challenges with social communication.
Connecting with my own GP practice, for example, typically involves getting through to a secretary (which often takes about 20 minutes) and explaining the health issue you're experiencing, before being directed to an initial phone call with the GP. Like many autistic people, I struggle with phone calls and find dealing with the unknown steps required to make appointments—like unexpectedly having to deal with more than one person—difficult to manage.
Many of my clients face similar issues when considering accessing health support during menopause. One client said, "It might seem extreme, but I spent years—and I mean years—dealing with horrible symptoms because I just couldn't face dealing with the appointment and then trying to explain my experience to my GP. I just kept limping along until I couldn't take it anymore."
2. Past negative experiences with healthcare providers
Experiencing negative responses from healthcare practitioners when discussing menopause can be a part of any woman's experience—but autistic women may be especially likely to have previous negative experiences with GPs, psychologists, and psychiatrists, a theme that has emerged consistently in research.2
Many of my clients who realised they were autistic later in life experienced negative reactions from their primary healthcare providers when they attempted to explain why they felt they might be autistic. Often, this experience has put them off pursuing support during menopause.
"I just feel it's all too much to explain," my client Ashley told me. "I got nowhere with pursuing an autism diagnosis, so I don't feel I've got a starting point to explain how menopause is affecting me, or why I feel that some of my experience is different to many women."
3. Intensity of symptoms.
Menopause can cause mood swings, increased anxiety, and depression in all women. Yet autistic women are more likely to experience mental health issues and challenges with emotional regulation than most people3 and—like my client Felicia—can find that menopause "tips them over the edge."
Felicia described how she felt she was "going mad": "I'd always struggled to manage my emotions and had anxiety," she told me. "But perimenopause led me to a whole different place. I started self-harming, having meltdowns—which terrified me, my children, and my partner—and reaching a point where I contemplated suicide."
Heightened sensory sensitivity is something that many autistic people experience,4 an experience that is often exacerbated during menopause and similar to what many autistic girls and women experience during menstruation.5 Heightened sensory processing issues during menopause can make certain situations intolerable.
"I've always had sensitivities to noise and light," another client told me. "But everything is ramped up now. I don't feel I can leave the house without sunglasses, and noises such as people eating or people's voices on the radio or television make me want to scream in a way they didn't before."
4. Difficulties with physical symptoms.
Vasomotor symptoms in menopause, including hot flashes and night sweats, can be difficult for all women. However, autistic people are more likely to have pre-existing difficulties with interoception,6 sometimes considered the "eighth sense." Interoception is what allows us to recognise our bodily sensations—including pain, body temperature, hunger, heart rate, and breathing. Some autistic people find pain or physiological sensations that most people might overlook to be unbearable. On the other end of the spectrum, they may miss larger or more significant pains or illnesses.
My client Angela had this experience during menopause. "I felt completely debilitated by the aches and pains I felt," she said. "I became fixated on my aching muscles; it was all I could think about. I tried explaining it and was dismissed for overreacting—but I genuinely think, having spoken to other autistic women, that I was experiencing menopausal symptoms differently."
5. Lack of social network.
Autistic women may have difficulties in making and maintaining relationships and can struggle particularly with groups. They may also have problems discussing subjects that are more confusing or sensitive. As a result, they are more likely to lack a strong social network, which is potentially a source of support for women going through menopause.
Christine told me, "I somehow feel I don't belong in discussions about menopause. I'm not sure my experience is the same as most people's, and I've always found 'women's spaces' difficult, as I find it hard to connect with many women. I've never felt more lonely than I do now."
Finding Solutions
If you are an autistic woman going through menopause, it's important to realise you're not alone—even if, for various reasons, your experience differs from many of the women you come into contact with. Connecting with other autistic women, either online or in person, can help provide a support network.
Writing down what you want to talk about with your healthcare practitioner can also be helpful, instead of relying on trying to communicate more complex needs verbally. If you require further support in making appointments and meeting any of your healthcare needs, including menopausal needs, consider asking a friend or family member to accompany you to appointments.
Finally, it's important to remember that you have a right for your voice to be heard and respected during menopause and for your experience to be taken seriously. To find mental health support near you, visit the Psychology Today Therapy Directory.
In addition to working with autistic women, I founded HypnoMenopause to help women find ways to focus on mental and physical health during this transition.
References
1. Moseley RL, Druce T, Turner-Cobb JM. 'When my autism broke': A qualitative study spotlighting autistic voices on menopause. Autism. 2020 Aug;24(6):1423-1437. doi: 10.1177/1362361319901184. Epub 2020 Jan 31. PMID: 32003226; PMCID: PMC7376624.
2. Moseley RL, Druce T, Turner-Cobb JM. 'When my autism broke': A qualitative study spotlighting autistic voices on menopause. Autism. 2020 Aug;24(6):1423-1437. doi: 10.1177/1362361319901184. Epub 2020 Jan 31. PMID: 32003226; PMCID: PMC7376624.
3. Lai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, Szatmari P, Ameis SH. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019 Oct;6(10):819-829. doi: 10.1016/S2215-0366(19)30289-5. Epub 2019 Aug 22. PMID: 31447415.
4. Marco EJ, Hinkley LB, Hill SS, Nagarajan SS. Sensory processing in autism: a review of neurophysiologic findings. Pediatr Res. 2011 May;69(5 Pt 2):48R-54R. doi: 10.1203/PDR.0b013e3182130c54. PMID: 21289533; PMCID: PMC3086654.
5. Moseley RL, Druce T, Turner-Cobb JM. 'When my autism broke': A qualitative study spotlighting autistic voices on menopause. Autism. 2020 Aug;24(6):1423-1437. doi: 10.1177/1362361319901184. Epub 2020 Jan 31. PMID: 32003226; PMCID: PMC7376624.
6. Bonete S, Molinero C, Ruisanchez D. Emotional Dysfunction and Interoceptive Challenges in Adults with Autism Spectrum Disorders. Behav Sci (Basel). 2023 Apr 5;13(4):312. doi: 10.3390/bs13040312. PMID: 37102826; PMCID: PMC10136046.
