Hi, I’m Sam (she/her). A late diagnosed neurodivergent woman, a tenacious midlife struggler, and an advocate for people in autistic perimenopause here at The Autistic Perimenopause: A Temporary Regression AKA The Auti Peri.
I am delighted to be the host of The Auti Peri Q&A Series!
In this series, I host a Q&A interview with a fellow autistic person about their experience of the menopause transition.
Everyone’s experience of the autistic menopausal transition is different. I aim to elevate the voices, lived experiences and reflections of autistic people’s menopausal transition.
Autistic perimenopause is a highly individual, dynamic and sometimes prolonged life stage caused by reproductive hormonal fluctuations. As autistics can be highly sensitive to bodily and environemntal, we may experience fluctuations as physical, psychological and cognitive symptoms.
Academic research into auti peri is in it’s early stages, yet it is a matter or urgency that we bust the social taboo and get used to talking about this.
Today’s guest is Ang, “A late-identified adult dedicated to helping you feel seen, heard, and delightfully more yourself. Stop by and take a look around. It’s better on this side of the weird.” Ang lives in New York, USA and writes Adulthood… with a chance of autism on Substack.
Hi, I’m Angela Walker, aka Autistic Ang. A few years ago at 38, I discovered I’m autistic, and it changed everything. Life up to that point was a lonely, confusing journey, but learning about my neurodivergence finally made it all make sense.
Before this realization, I was barely holding it together—emotionally, professionally, and personally. Everything felt like it was falling apart: my mood, my marriage, my work. I was constantly overwhelmed and in the dark about why.
Then came that pivotal moment: the realization that I’m autistic. Suddenly, I felt like I belonged. My perspective shifted, and for the first time in a long time, I truly wanted to live.
Now, my purpose is to help other late-identified autistics feel seen and understood—something many of us went without for far too long.
To me, “autistic perimenopause” means navigating two overlapping storms at once. On one side, there’s the physical and emotional chaos of perimenopause—hot flashes, mood swings, brain fog—but autism makes everything louder and harder to untangle.
Sensory sensitivities go into overdrive, emotional shifts feel even more intense, and the lack of awareness about how these two experiences intersect can leave you feeling lost.
For me, it was confusing because I didn’t even know perimenopause was a thing. I thought it was just my autistic brain reacting to stress or overstimulation.
In reality, my body was going through changes I didn’t understand, and autism amplified every moment of it.
When did your autistic perimenopause symptoms start and what were they?
Looking back, I was definitely in perimenopause for over a year before it even crossed my mind.
At first, I just thought I was stressed or “off.” I had random bouts of hot flashes that felt like my body was trying to roast itself from the inside out. My POTS symptoms flared too. At the time, I knew about my autism but didn’t know that POTS even existed.
Basically I’d stand up and feel like a noodle with a heartbeat. Then my heart sped up and I’d nearly faint.
Emotionally, I went from feeling fine to snapping over the tiniest thing (like someone chewing too loud) or crying at commercials. My sleep took a hit, and brain fog made me feel like I was misplacing not just my keys but half my thoughts.
What happened if/when you presented with autistic perimenopause to a healthcare professional?
I didn’t see a healthcare professional specifically for perimenopause because, at the time, I didn’t even realize I was in it. I chalked up all the symptoms to stress or unrelated health quirks.
It wasn’t until I had surgery to remove a 19-pound benign cyst attached to one of my ovaries that things started to make sense. The sheer size of the cyst raised questions for me later: Could it have disrupted my hormones and triggered perimenopause earlier than expected? Unfortunately, no one in healthcare raised that possibility or made the connection.
Not to mention, how does one not notice a bowling ball in their stomach? By not paying attention to their body! Here I thought I was improving my mind/body connection and that maybe I was just gaining weight or something, though in hindsight, what was I thinking?
After the surgery, I was thrust straight into menopause because the ovary with the cyst was removed as well as all the other bits. I started on 1 mg of estrogen right away, but it wasn’t enough. The symptoms—especially the hot flashes and how they made my POTS worse—continued to wreak havoc on my body. I eventually had to advocate for myself to increase the dose to 2 mg, which finally gave me some relief.
What stands out to me is how little attention was given to my autism during this process. Doctors treated the hormonal side of things but didn’t acknowledge or explore how autism might have amplified my experience or shaped my symptoms.
It was frustrating to feel like I had to figure out the bigger picture on my own—connecting the dots between the cyst, perimenopause, autism, and menopause with no road map or support from the medical system.
What was your treatment protocol for managing your autistic menopause? (Medical/lifestyle/alternative therapies etc.)
After the cyst was removed and I was thrown headfirst into menopause, the initial plan was to start me on 1 mg of estrogen. That was it—just a basic, one-size-fits-all approach to hormone replacement therapy. At first, I went along with it because I didn’t know any better, but my body made it clear pretty quickly that this wasn’t cutting it. The hot flashes, for example, weren’t just annoying—they were like full-body sensory assaults, triggering my POTS symptoms and leaving me drenched, overwhelmed, and drained. It felt like I was walking around in a body that wasn’t mine anymore.
About a year into this mess, I finally advocated for myself and got the estrogen dose bumped up to 2 mg. And I got a script for Zofran because I was vomiting a few times a week, usually during anything that required extra movement (mowing, hiking in hot temps, etc.). That made a big difference! The hot flashes eased up, and my POTS symptoms became more manageable.
But it wasn’t just the medication—I had to get creative with how I managed my day-to-day life. I invested in all the cooling gadgets I could find: a bedside fan, cooling pillows, even portable fans for when I was out and about. I also had to be even more mindful than usual regarding staying hydrated and keeping my blood pressure stable (essential for POTS), which often felt like a full-time job.
Mentally, I leaned on mindfulness techniques because they gave me something to focus on when my brain felt like it was glitching. Journaling helped too, especially for sorting through the brain fog and emotional ups and downs. It wasn’t perfect, but it was the closest thing I had to a plan.
How was your everyday life impacted by autistic perimenopause (your caring/employment responsibilities, hobbies, mental health, relationships, etc.)?
Perimenopause crept in like a sneaky thief, stealing my focus, energy, and patience. At the time, I didn’t even know what was going on, so I just tried to push through.
Brain fog made work so much harder—I’d lose track of conversations, misplace documents, or completely forget tasks.
The sensory overload from hot flashes, combined with my usual autistic sensitivities, made even simple social interactions difficult. I started avoiding people more because I didn’t have the energy to mask my discomfort or explain why I was suddenly a sweaty, irritable mess.
Hobbies went out the window for a while, which was hard because those are usually my way of recharging.
And my relationships? Umm . . . let’s just say they were tested! I’d snap at my wife over the smallest things, then feel terrible about it later. It was like my emotions had no filter, and I couldn’t figure out how to turn the volume down.
Mentally, I felt like I was drowning—overwhelmed, underprepared, and completely out of control.
Were there things that made your menopause transition especially difficult for you as an autistic person? If so, what kinds of things?
The sensory overload from hot flashes and other physical symptoms was a nightmare. Imagine already being sensitive to heat, smells, and textures and then throwing hormone-induced chaos into the mix. It was like my body was a house of cards, and menopause came in like a gust of wind.
Executive dysfunction was another massive challenge. The brain fog and lack of focus made it so hard to keep up with appointments, manage daily tasks, or even remember what I was supposed to be doing. And since autism often makes it hard to adapt to sudden change, the whole experience felt like a nonstop ambush.
No one explained what was happening, and there was no guide to help me navigate it all as an autistic person.
Were there things that could have made your menopause transition easier for you as an autistic person? If so, what kinds of things?
Yes—so many things could’ve helped.
First off, a healthcare provider who understood the intersection of autism and menopause would’ve been amazing. If someone had acknowledged that my sensory sensitivities, emotional regulation issues, and executive dysfunction might be heightened by menopause, I wouldn’t have felt so lost.
Practical advice tailored to autistic needs would’ve been a game-changer too. For example, tips on managing sensory triggers during hot flashes, strategies for dealing with brain fog, or even just reassurance that what I was going through was normal for someone like me.
Emotional support would’ve gone a long way. Just having someone say, “I see you, and I know this is extra hard for you,” would’ve meant everything.
What supports, resources, and services are/were available to people experiencing autistic perimenopause where you live?
To be blunt, there weren’t (and still aren’t) any specific resources for autistic people going through perimenopause or menopause where I live (Central New York, U.S.). Most of the information I found was either about menopause in general or autism in general—nothing that addressed how the two might overlap.
I felt like I was on my own, piecing together information from forums, blogs, and random internet rabbit holes . . . until, of course, I stumbled upon The Autistic Perimenopause: A Temporary Regression around the beginning of 2024. Sam gave me the understanding I so desperately needed. Instead of looking back and judging myself for missing every friggin sign of perimenopause, I’ve now reframed a bunch of stuff.
While I’m not in perimenopause anymore, I find so much value in her newsletter. It’s made me feel seen, and it’s the best resource, hands-down, that I’ve come across regarding this issue.
What kinds of services, resources, or supports would you have found most helpful?
A tailored support group for autistic people dealing with menopause would’ve been super helpful. A place where I could share experiences and get advice from others who truly understood. I also would’ve appreciated practical guides that address things like sensory challenges during menopause, how to manage executive dysfunction when your brain feels like it’s in molasses, and how to communicate your needs to healthcare providers.
Another big one is better training for doctors. If my providers had even a basic understanding of how autism could impact my experience of menopause, it would’ve saved me so much frustration.
What is the easiest way for you to access information about autistic menopause?
Online communities have been the most helpful for me. Hearing from other autistic people who’ve gone through this makes me feel less alone, and their personal tips and tricks are often more practical than anything I’ve found on mainstream health websites.
I’d also love to see more articles or books specifically about autistic menopause written by people who’ve lived it.
What would you wish for all people to know about autistic perimenopause?
It’s not just perimenopause, and it’s not just autism—it’s the unique overlap of both.
The sensory, emotional, and cognitive challenges we deal with as autistic people don’t go away during menopause; they often get louder and harder to manage.
I wish people wouldn’t dismiss our experiences as “normal.” What’s normal for one person is unbearable for an autistic person.
Is there anything else you’d like to share regarding your autistic experiences of menopause?
If I could share one thing about perimenopause and menopause, it’s this: learn to lean into what your body is telling you. Your gut feelings, those little nudges, that sense that something’s not quite right—they matter, even if the people around you don’t seem to get it.
I’ve had so many moments where I felt completely off-kilter but couldn’t explain why. The hot flashes, the brain fog, the mood swings—they were their own circus. But add sensory overload and a brain that loves to analyze everything (hello, autism!), and it felt like I was swimming in chaos without an end in sight.
It’s hard to keep asking for help when you’re running on empty, I know. But it’s worth it.
If something feels wrong, don’t ignore it. Speak up. If a treatment isn’t helping, keep searching for answers. You deserve more than a dismissive “this is normal”—because what’s “normal” for someone else could be crushing for you. No one else has the full picture of what you’re going through, so let yourself be the authority on you.
Surgical menopause was, without a doubt, the best thing that ever happened to me.
These days, I feel genuinely happy—like a weight I didn’t even realize I was carrying is just gone. Before? Let’s just say I wanted to go full Godzilla and smash my way through anything and anyone that crossed my path.
The rage, the chaos, the unpredictability—it’s gone! In its place is a calm I never thought I’d find.
Life isn’t perfect, but for the first time in my entire life, it feels manageable . . . and even joyful.
I hope you enjoyed this Q&A. If you would like to be featured as part of this series, please message me. I’d love to share your story!
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Thank you so much for taking the time to do a Q&A with me on this! I appreciate your interest and thoughtful questions. Very grateful for the opportunity to share my story with your audience 😊
Thank you so much for taking the time to do a Q&A with me on this! I appreciate your interest and thoughtful questions. Very grateful for the opportunity to share my story with your audience 😊
So good to know we're not the only ones 💖