Why do we need to pay particular attention to autistic people’s experiences of menstruation?

Menstruation is a topic that is rarely discussed openly – and the culture of silence, discomfort and shame surrounding it could mean that we fail to consider how the physical realities of periods are likely to affect autistic people. We know that autistic people often have sensory processing differences – and periods are, in their essence, physical processes that affect most of the senses. Similarly, hormonal changes can affect autistic people’s emotional processing, exacerbate any existing mental health difficulties and amplify sensory sensitivities. The need to keep track of when to have sanitary products ready, or knowing (and remembering) when those need changing, can be very difficult for autistic people, who are more likely to experience differences with what we call executive functioning (meaning skills like remembering, planning, prioritising and organising). It is also important to note that autistic people assigned female at birth who do not identify with their gender as assigned at birth may find periods particularly distressing.

Sensory processing

Autistic people are often impacted strongly by the physical sensations provoked by the environment, such as: loud noises; how touch or certain fabrics feel on the skin; temperature changes; how food tastes, smells and looks. However, all of those examples are, at least in theory, things that the autistic person and those around them might have a degree of control over – they might be able to change them. Menstruation and the accompanying physical sensations, on the other hand, are usually completely outside of the control of the individual and, to complicate matters further, they are also produced by and within their own body, making them inescapable. Examples of sensations that are likely to be particularly distressing for autistic people are:

• The sensation of the menstrual blood flow.
• The feel of sanitary products.
• The smell of the blood.
• Stomach cramp. For those with conditions such as endometriosis, the pain associated with menstruation can be particularly debilitating.
• Bloating and having to readjust to constant body shape changes and pain in different parts of the body, depending on where you are in your cycle.

Emotional regulation

The hormonal changes associated with the various stages of the menstrual cycle can be unpredictable – they can lead to intense emotional reactions and heightened sensations, and may affect all aspects of the autistic person’s life. Examples of how hormonal changes during menstruation may affect autistic people’s emotional experiences include:

• Experiencing emotions more intensely.
• Being more sensitive to negative emotions.
• Reacting more impulsively than usual.
• Being in distress due to heightened sensory sensitivity and needing space and a calm, low-demand environment.
• Feeling a loss of control and needing more structure and routines in order to create a sense of control and safety.
• Greater difficulty in coping with stress.
• Social relationships are experienced as more exhausting.
• Heightened sensitivity to body changes and image, with implications for self-esteem.

Executive functioning

In simple terms, executive functioning skills refer to our ability to carry out complex tasks, remember information, retain our focus and plan, prioritise and organise. Those skills are particularly important when it comes to responding to the needs of your body during menstruation, and autistic people often experience difficulties with different areas of executive functioning. But what are the executive functioning demands of periods?

• Keeping track of your own cycle regularly and remembering when your next period might start (and those can be highly irregular for some people, causing further anxiety and distress).
• Knowing when to take painkillers and purchasing those in advance.
• Making sure that you have the sanitary products you need, in the necessary quantity, available at the right time.
• Struggling to focus on or complete school- or work-related tasks, as the physical, emotional and organisational demands of periods are overwhelming.

Menstruation shouldn’t be seen as a taboo topic for us to shy away from discussing – periods are a normal part of the human experience, but also one that can be profoundly distressing, particularly for people with sensory processing needs. It is, therefore, important that autistic people’s experiences of menstruation are considered routinely, with sensitivity to the individual’s unique profile of needs, and without shame or discomfort.