Abstract:

Autistic women face unique challenges during the menopausal transition, including heightened sensory sensitivity, emotional dysregulation, and difficulties navigating healthcare. Despite this, research into how menopause affects autistic individuals remains scarce. This qualitative study explores the lived experiences of autistic women during perimenopause and menopause, with a focus on hormonal symptoms, access to care, and the effectiveness of HRT.

Introduction:

Autism spectrum condition (ASC) presents differently in women than in men, often resulting in late or missed diagnoses. Research has begun to explore how hormonal changes — including menstruation, pregnancy, and menopause — impact autistic women in distinct ways. Menopause may exacerbate sensory processing issues, emotional regulation, and anxiety, yet few guidelines exist for clinicians supporting this group.

This study aimed to understand the lived experiences of autistic women during menopause and to identify unmet needs and potential therapeutic strategies, including hormone replacement therapy.

Methods:

A total of 48 autistic women, aged 38–58, were recruited via online forums, support networks, and NHS neurodevelopmental clinics. Inclusion criteria included a formal autism diagnosis and self-reported perimenopausal or menopausal symptoms.

The study employed:

• Semi-structured interviews
• The Menopause Impact Questionnaire for Neurodiverse Women (MIQ-NW), developed for this study
• Thematic analysis to identify key patterns in symptom experience and healthcare access

Results:

1. Heightened Sensory Symptoms:

• 79% reported worsened sensory sensitivities (e.g., to sound, light, touch) during menopause.
• Many described HRT as reducing sensory overwhelm, especially transdermal estrogen.

2. Emotional and Cognitive Effects:

• 87% experienced intensified emotional dysregulation.
• Brain fog and executive function challenges were reported in 90% of cases.

3. Difficulty Accessing Support:

• 68% had negative experiences with GPs due to their autism not being understood or accommodated.
• Women frequently felt dismissed or told their symptoms were “psychological.”

4. Positive Response to HRT:

• 63% of participants using HRT reported significant symptom relief, especially in mood stability and cognitive clarity.
• Testosterone was reported as particularly helpful in restoring energy and focus.

Discussion:

Menopause may exacerbate core and co-occurring features of autism, creating a complex symptom picture that is often overlooked. Healthcare systems are not currently equipped to recognize or address these overlapping challenges. HRT may play a significant role in mitigating symptoms, but prescribing must be sensitive to the sensory and communication needs of autistic women.

Clinicians must adopt more inclusive, trauma-informed practices and consider autism-specific guidance in menopause care.

Conclusion:

Menopause can be a time of significant difficulty for autistic women, yet appropriate hormonal and psychological support can lead to meaningful improvement. This study highlights the need for further research, targeted training for healthcare providers, and the development of autism-informed menopause care pathways.

Authors:

Dr. Olivia Brandt, Dr. Louise Newson, Dr. Hannah Ellison

Published by:

Newson Health Research & Education

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