Perimenopause, Menopause, and Autism: An Overlooked Crisis by Julie Bjelland, LMFT

I want to share something important because it touches so many autistic women and other individuals assigned female at birth (AFAB), whether they are currently in perimenopause, menopause, or recovery afterward.

Recent research confirms what many of us have personally experienced: menopause for autistic women is not just a hormonal transition. It is often a profound health crisis that affects every layer of life.

What the Research Tells Us

The 2024 study “A Perfect Storm: Autistic Experiences of Menopause and Midlife” offers some of the clearest evidence we have to date. Researchers interviewed autistic women and found that:

• Menopause amplifies autistic challenges, intensifying sensory overload, emotional struggles, cognitive difficulties, and chronic health issues.

• Autistic traits amplify the experience of menopause, making common symptoms like insomnia, hot flashes, mood swings, and physical discomfort even more severe.

• Flare-ups of chronic health conditions often appear or worsen during menopause.

• Mental health risks sharply increase, including heightened anxiety, depression, and suicidality.

• For many women, the overwhelming physical and emotional distress of menopause prompts them to search for answers and, in doing so, discover for the first time that they are autistic.

These findings align with broader research on the mental health risks faced by autistic women. An extensive 2023 study by the University of Toronto, published in JAMA Network Open, analyzed over 300,000 individuals in Ontario, Canada. It found that autistic women had an 83 percent higher risk of self-harm and a 98 percent higher risk of suicide compared to non-autistic women. These heightened risks were especially linked to co-occurring psychiatric diagnoses such as anxiety and depression.

Taken together, these studies highlight that autistic women are already facing significant mental health vulnerabilities, and menopause can become an especially dangerous period without proper support, awareness, and intervention.

Understanding the Length of Perimenopause

Many women are surprised to learn that perimenopause, the transition phase leading up to menopause, can last anywhere from four to eight years, and for some, up to ten years or longer (according to the North American Menopause Society). During this time, hormonal levels like estrogen fluctuate unpredictably, causing symptoms such as irregular menstrual cycles, hot flashes, brain fog, joint pain, mood swings, and fatigue, often long before menstrual cycles stop completely.

For autistic women, this extended phase can place ongoing strain on sensory regulation, mental health, energy levels, and physical well-being. Recognizing the length of perimenopause is critical because it helps explain why so many women feel depleted, worn down, or deeply unwell for years before they officially reach menopause. It also highlights why early recognition and support are essential.

My Personal Experience

These research findings align closely with my own journey. When I was going through peri-menopause and menopause I experienced severe brain fog, joint and body pain, overwhelming fatigue, emotional strain, and a narrow window of tolerance.  Simple tasks became difficult, and I could feel how unwell my brain and body had become.

I felt dismissed by doctors and was too ill to advocate for myself. At the time, I did not yet know I was autistic, so I could not explain the deeper challenges I was facing or ask for the right kind of support.

Even now, post-menopause, I continue to manage some of the lasting health impacts. I still experience significant fatigue, something I know many other autistic women are struggling with, too. Looking back, I see that I was facing both a physical and mental health crisis. This is why talking about these experiences is so important: sharing our stories and raising awareness. Together, we can help others feel less alone, better understood, and more supported, and maybe even help save precious lives.

What We Need to Know and Share

Autistic women need to know that severe fatigue, sensory overload, brain fog, emotional instability, cognitive slowing, and increased physical pain during perimenopause and menopause are not signs of personal weakness. These are compounded challenges that come from the unique interaction between autism and hormonal shifts.

During this phase, many women also find that their window of tolerance, the emotional and physical capacity they have to handle stress and daily challenges, becomes much narrower. Things they once masked or coped with start to feel unbearable. Their ability to push through or camouflage their struggles may drop sharply, leaving them more vulnerable, exhausted, and overwhelmed.

The Hidden Impact of Medical Trauma

Many autistic women experience medical trauma from years of being dismissed, misunderstood, or misdiagnosed by healthcare providers. This trauma can make it especially difficult to seek help when menopause intensifies health and mental health struggles. Fear of not being believed, past invalidating experiences, sensory overwhelm in clinical settings, or even the stress of making appointments can all become barriers to accessing care. Recognizing the role of medical trauma is essential to understanding why so many autistic women face such steep barriers to support.

We need to raise awareness about these experiences so autistic women can get the care and understanding they deserve.

If You Are Struggling

If you are experiencing thoughts of suicide, self-harm, or feel overwhelmed and unable to cope, please know that you are not alone and help is available. Reaching out can feel hard, but it is a powerful step toward receiving the care and support you need.

Here are global resources you can turn to for immediate help:

• Befrienders Worldwide: Offers confidential support in many countries. Visit befrienders.org to find a helpline near you.

• Suicide Prevention Helpline (USA): Dial or text 988 or visit 988lifeline.org.

• Samaritans (UK and Ireland): Call 116 123 or visit samaritans.org for confidential support.

• Lifeline (Australia): Call 13 11 14 or visit lifeline.org.au.

• Crisis Text Line (Canada, UK, Ireland, USA): Text HOME to 741741 (USA and Canada) or text SHOUT to 85258 (UK) for free, 24/7 support.

If you are in a country not listed here, you can search for local helplines through Befrienders Worldwide or contact your local emergency services if you are in immediate danger.

We also have a practitioners directory here. 

You are valued, you are needed, and you deserve support. Please reach out. ❤️

Additional Resources and Support

Many individuals are discovering their autistic identity during this phase of life or are seeking support from someone who truly understands their experience. I deeply enjoy supporting people through this journey, drawing on both my clinical expertise and lived experience, as well as everything I have learned from specializing in adult-discovered autism and the Sensitive Autistic Phenotype, a presentation often marked by internalized traits, high masking, sensory sensitivity, and deep empathy that is frequently overlooked in traditional diagnostic models.

Here are ways you can access support and explore further:

• Schedule a Discovery Consultation: Available to anyone, anywhere via video, these one-on-one sessions help you explore whether you may be autistic or seek validation of your neurodivergent identity, all in a compassionate, affirming space.

• Book an Autism Assessment: For those ready to pursue a formal diagnosis, I provide comprehensive, neurodiversity-affirming autism assessments available via video. You do not need to be a California resident, but you must be physically located in California at the time of the assessment to receive formal diagnostic documentation.

• Join the Adult-Discovered Autistic Group: This space offers connection, understanding, and validation for those discovering their autistic identity later in life. You can find it inside the Sensitive Empowerment Community, where we gather for meaningful discussions, shared experiences, and support.

• All Autism Resources: You can explore a wide range of supportive resources, including free autism quiz, a guide for understanding autism in women, the course Discovering You’re Autistic as an Adult, insights on the Sensitive Autistic Phenotype, autism articles and podcast episodes, courses to support mental and physical health, the free Autistic Energy Crash Recovery Guide, and more.

You Are Not Alone

To every autistic woman who is struggling during perimenopause, menopause, or recovery afterward: you are not alone. You are not broken, and you are not failing. You are navigating an incredibly complex phase of life that very few people truly understand.

By speaking openly and raising awareness, we can help ensure that future generations of autistic women do not have to face these hardships in isolation. Together, we can build a more compassionate and informed approach to women’s health and well-being.

Why Sharing This Matters

Sharing this article can truly help save lives. Many autistic women are struggling in silence, unaware that the intense challenges they face during perimenopause and menopause are part of a broader pattern and that they are not alone.

By spreading awareness, we can help women understand that what they are going through is not a personal failure or weakness. It is a health and mental health crisis that deserves recognition, support, and tailored care. When women gain access to accurate information, compassionate resources, and communities that understand, they are better able to seek help, advocate for themselves, and feel less isolated in their journey.

Suicide risk among autistic women is a significant concern and a staggering reality that calls for urgent attention. Sharing educational resources like this article can be a life-saving act, offering someone the understanding they need to reach out, find support, and hold on to hope.

Here’s a public link you can share widely:

https://www.juliebjelland.com/hsp-blog/perimenopause-menopause-and-autism-an-overlooked-crisis-by-julie-bjelland-lmft

Please consider passing this along to friends, family members, healthcare providers, and community spaces. Together, we can make sure no woman has to face these challenges alone. ❤️

I’m Julie Bjelland, LMFT

A licensed psychotherapist, author, and the Founder and CEO of Sensitive Empowerment Inc. She specializes in supporting sensitive and neurodivergent individuals, with a focus on adult-discovered autism. Julie’s work includes educational courses, a global online community, autism assessments, and The Sensitive and Neurodivergent Podcast, which reaches listeners in over 189 countries. Her mission is to create a world where differences are celebrated as strengths. Learn more at JulieBjelland.com.

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