Most people know that hormones, such as oestrogen and progesterone, change throughout the menstrual cycle, but fewer realise how much these fluctuations can affect mental health. Changes in hormone levels can influence mood and energy for many reasons, including the physical discomfort of cramps or fatigue, emotional strain, social tension, and direct effects on brain chemistry. For example, oestrogen can reduce dopamine activity in the brain, which may influence mood and mental wellbeing (Brock, Rouse et al., 2016).
Research in the general population shows that the days leading up to and during menstruation can be linked with increased symptoms of depression, anxiety, mania, and even higher risks of self-harm or substance use (Carrol et al., 2016; Handy et al., 2022; Miller et al., 2001). These patterns highlight how closely connected hormonal changes and mental health can be.
Given these effects, it makes sense to ask how menstruation and other reproductive changes, such as the first period or menopause, affect people with neurodevelopmental conditions such as autism. Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that involves differences in social communication, sensory processing, and adaptability to change. These differences may shape how autistic individuals experience both the physical and emotional aspects of menstruation.
Despite this, research on hormonal and menstrual health in autistic people is still very limited. Autistic women and gender diverse people have often been left out of studies, which means their experiences and needs are less understood (D’Mello et al., 2022; Grove et al., 2024). The small amount of research that does exist suggests that autistic individuals may face unique challenges, including higher rates of menstrual pain or irregularities, mental health difficulties, and the added impact of stigma (Steward et al., 2018). Understanding these experiences through a biopsychosocial and cultural lens that considers biology, psychology, and social context together is an important step towards better and more inclusive healthcare.
Autistic women and gender-diverse people may experience distinct and under-researched biopsychosocial challenges related to menstruation and reproductive health.
Methods
A scoping review was conducted using PRISMA extension guidelines to map existing research on autism and menstruation. Systematic searches of Medline/PubMed (September 2024–May 2025) identified English-language studies published since 1980 involving autistic individuals. After independent screening and full-text review, 45 studies were included, mostly from the USA and UK, covering qualitative, quantitative, and mixed methods. Data were extracted on study characteristics, populations, mental health outcomes, menstrual disorders, and healthcare use. Iterative screening, reference checks, and citation tracking ensured thorough coverage, and findings were synthesised thematically to identify key patterns and gaps in the current evidence base.
Results
The review included 45 studies published between 2004 and 2025, with most being published after 2020, reflecting a growing but still limited interest in menstrual health among autistic individuals. Most studies originated from the USA and the UK and used a mix of qualitative, quantitative, and mixed methods. Three main themes emerged: mental health impacts of menstruation, menstrual disorders, and menstrual management and healthcare access.
Many studies reported that autistic individuals experience noticeable changes in mood, behaviour, and sensory sensitivity around menstruation. While some findings were mixed, the majority pointed to increased distress, aggression, repetitive behaviour, and difficulties with emotional regulation, particularly in those with intellectual disabilities. Case reports highlighted severe mood deterioration, self-injury, and suicidal thoughts linked to menstruation. Sensory overload and challenges with menstrual hygiene were also common. Reported rates of premenstrual dysphoric disorder varied widely, suggesting the need for more precise assessment methods. Research on menopause in autism, though limited, showed similar trends, with autistic individuals reporting heightened anxiety, depression, sensory sensitivities, and difficulties with social communication during perimenopause and menopause.
Studies consistently documented higher rates of menstrual disorders, including dysmenorrhoea, menorrhagia, amenorrhoea, and irregular cycles, among autistic individuals. These difficulties may be influenced by differences in sensory processing, interoception, and communication. Many autistic people may struggle to describe pain or discomfort, leading to under-recognition of distress and delayed care.
Menstrual management varied widely. Some autistic individuals managed independently, while others needed support with hygiene routines. Educational strategies such as visual aids, social stories, and step-by-step skill-building techniques were effective. Involving parents and tailoring education to individual sensory and cognitive needs improved outcomes.
Healthcare disparities were clear in the review. Autistic individuals were less likely than non-autistic peers to access gynaecological care or use hormonal contraception, despite high levels of menstrual distress. Barriers included a lack of professional awareness, communication challenges, stigma, and limited understanding of autistic specific healthcare needs. Reports also highlighted the influence of neuronormative and misogynistic assumptions within medical settings, which can dismiss autistic communication styles, minimise sensory needs, and downplay the concerns of women and gender diverse people. Positive outcomes were seen when hormonal treatments were tailored to individual preferences, although side effects could be significant.
These findings suggest that menstruation and menopause can intensify challenges already faced by autistic individuals, reinforcing the need for reproductive healthcare that is inclusive, sensory aware, and trauma-informed. Healthcare professionals require training that addresses communication differences, acknowledges the impact of neuronormativity and misogyny, and promotes respectful, accessible dialogue. Addressing these gaps could significantly improve both mental health and quality of life for autistic people.
The review indicates that autistic individuals experience high rates of menstrual and menopausal difficulties affecting mental health, sensory processing, and daily functioning.
Conclusions
The review concludes that although research on menstrual health in autistic individuals is still limited, the available evidence raises important concerns. Autistic people appear to face a range of challenges related to menstruation, including mental health difficulties, menstrual disorders, sensory distress, and unmet support needs. Placing these findings within a bio, psycho, socio and cultural framework highlights that menstrual experiences are shaped by interactions between the individual and their environment, and that autistic people may be particularly vulnerable to negative experiences. The review stresses the need for greater awareness, more inclusive support, and further research to address current gaps and improve menstrual healthcare and overall quality of life for autistic individuals.
Autistic individuals face significant barriers to appropriate care, underscoring the need for inclusive, autism-informed, and equitable reproductive healthcare.
Strengths and limitations
This scoping review offers new insights into an area that has received limited research attention so far. It provides the most comprehensive overview to date of research on menstrual experiences among autistic individuals, drawing together evidence across the lifespan from menarche to menopause. The use of PRISMA extension guidelines strengthens the transparency and rigour of the methodology, while the inclusion of qualitative, quantitative and mixed method studies allows a broad range of experiences to be captured.
Importantly, the review included studies involving both formally diagnosed autistic individuals and those who self-identify as autistic, reflecting real world barriers to diagnosis and ensuring that lived experiences were not excluded. The identification of clear key areas, including mental health impacts, menstrual disorders, and healthcare access, offers a useful framework for clinicians and researchers.
However, the review also has notable limitations, many of which reflect gaps in the wider evidence base. Although publications were eligible from 1980 onwards, the final sample included only studies published between 2004 and 2025, highlighting how only recently this topic has received research attention. Much of the evidence is based on small samples, case reports, or studies from the USA and UK, which limits generalisability. There was also substantial variation in study populations and methods, contributing to inconsistent findings, particularly around the prevalence of premenstrual dysphoric disorder. In addition, the review did not assess whether included studies used co-produced approaches. As the paper itself notes, involving autistic individuals through patient and public involvement or lived experience advisory panels is increasingly recognised as important. The absence of this perspective may mean that some findings reflect clinical or researcher priorities rather than the needs and concerns of autistic people themselves. Finally, the rapidly evolving nature of the field means that results are only current up to May 2025, and future research may quickly extend or revise these conclusions.
This is an under-researched field with limitations in the existing evidence base, underscoring the urgency for co-produced and methodologically consistent further research.
Implications for practice
Autistic individuals often experience heightened anxiety, mood changes, compulsive behaviours, and sensory overload during their periods. Up to 80% of post-menarchal autistic individuals report wanting hormonal management to help regulate their menstrual cycles, while co-occurring conditions such as anxiety or obsessive-compulsive disorder can make menstruation even more challenging.
These changes may be misunderstood as general behavioural issues if menstrual factors are not considered. Healthcare providers should recognise these unique needs and offer support that is personalised, respectful, and accessible. Education for autistic individuals and their carers is essential, and sensory sensitivities should be considered when selecting menstrual products. Clinicians should also consider hormonal treatments where appropriate, and use assessment tools that work for individuals with varying communication abilities.
Collaborative approaches involving gynaecologists, psychiatrists, and other professionals can help autistic individuals manage their menstrual health safely and with dignity. By understanding the combined impact of biological, psychological, social, and cultural factors, healthcare providers can reduce stigma, improve care, and enhance quality of life for autistic people experiencing menstruation. Ensuring menstrual health is managed with knowledge, safety, and respect is a fundamental right, and addressing these needs can make a meaningful difference to both mental health and day-to-day wellbeing.
Autistic individuals need a personalised, multidisciplinary, and respectful care that recognises menstruation as a key factor in their wellbeing.
Statement of interests
Steve Calvosa has no conflicts of interest to declare.
Edited by
Dr Dafni Katsampa
Links
Primary Paper
Skommer J, Gunesh K. Autism, menstruation and mental health- a scoping review and a call to action. Front Glob Womens Health. 2025 Jun 25;6:1531934. doi:10.3389/fgwh.2025.1531934.
Other References
Brock R, Rowse G, Slade P. Relationships between paranoid thinking, self-esteem and the menstrual cycle. Arch Womens Ment Health. (2016) 19(2):271–9. doi: 10.1007/ s00737-015-0558-4
Carroll HA, Lustyk MK, Larimer ME. The relationship between alcohol consumption and menstrual cycle: a review of the literature. Arch Womens Ment Health. (2015) 18(6):773–81. doi: 10.1007/s00737-015-0568-2
Handy AB, Greenfield SF, Yonkers KA, Payne LA. Psychiatric symptoms across the menstrual cycle in adult women: a comprehensive review. Harv Rev Psychiatry. (2022) 30(2):100–17. doi: 10.1097/HRP.0000000000000329
Miller MN, Miller BE. Premenstrual exacerbations of mood disorders. Psychopharmacol Bull. (2001) 35(3):135–49.
D’Mello AM, Frosch IR, Li CE, Cardinaux AL, Gabrieli JDE. Exclusion of females in autism research: empirical evidence for a “leaky” recruitment-to-research pipeline. Autism Res. (2022) 15(10):1929–40. doi: 10.1002/aur.2795
Grove R, Clapham H, Moodie T, Gurrin S, Hall G. ‘Nothing about US, without US’: research priorities for autistic girls, women and gender diverse people in Australia. J Autism Dev Disord. (2024) 55:2522–38. doi: 10.1007/s10803-024-06330-5
Steward, R., Crane, L., Mairi Roy, E., Remington, A. & Pellicano, E., 2018. “Life is Much More Difficult to Manage During Periods”: Autistic Experiences of Menstruation. Journal of Autism and Developmental Disorders, 48, pp. 4287-4292.
