The Auti Peri Q&A: Tirzah Miles

"I’m carrying a lot right now: the hormonal shifts, the sensory overload, the unrelenting internal noise—and this lingering fear that I’m becoming a burden to the people I love."

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 environmental, 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.

Fun fact: The Autistic Perimenopause: A Temporary Regression is fuelled by caffeine. If you would like to buy me a coffee, the button above will take you to my page. Thank you! ☕️

Today’s guest is Tirzah Miles (she/her). She writes on Substack at The Sensitive Artist and Healing & Growing.

“Hi, I’m Tirzah. I am a highly sensitive person (HSP) and didn't learn that I was on the autism spectrum until my mid thirties, after my youngest child was diagnosed. My nervous system often responds intensely, whether through muscle tension, breath-holding, racing heart, or difficulty speaking, especially in high-stimulation or anxiety-inducing situations. I’ve learned that preparation, quiet time, and managing sensory input help me navigate these challenges. Since starting signs of perimenopause, I have noticed an uptick in my reactions to stimuli and I’m trying to figure out how to navigate the world with the increase in my heightened anxieties and sensitivities.”

Tirzah lives in Western Pennsylvania, United States.

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What does “autistic perimenopause” mean to you?

I have only in the last several years realized that I was on the spectrum… my 4th child who is now 10 years old was diagnosed with heightened sensitivity and sensory processing disorder at the age of 2.

At that time, I began reading about it and everything related and I realized that there were so many autistic traits that I displayed or identified with. I get very distracted and have difficulty focusing because I have a hard time staying out of my head. I fixate on things and become singularly focused. These things have cause me a lot of difficulty in school and at work.

I probably have AuDHD (autism and ADHD) because when I was about seven years old, teachers put me on Ritalin for my lack of focus. However, I began having seizures so they took me off of it. EEG showed that I had a different type of ADD because I wasn't distracted by outside sources, but inner thoughts.

I info dump too which I’m probably doing right now - lol—sorry!

I did the best I could to live a neurotypical life but I always felt like there was something wrong with me. I have always had awful social anxiety.

I have difficulty following multi-step processes without it being clearly laid out in front of me/step by step.

Driving causes me SIGNIFICANT overwhelm because it’s so much to process all at once… but again I had no idea why it stressed me out until I began learning about it.

Oh and vomiting causes me so much distress, I’ll pass out or close—tunnel vision, cold sweat, ears ring. I had some other sensory issues but they were pretty minor until more recently.

When did your autistic perimenopause symptoms start and what were/are they?

Perimenopause symptoms started about 2-3 years ago. I'm currently 45. I thought I was pregnant more than a couple times before I read that peri symptoms can be the same… sore breasts, fatigue, nausea, etc.

But I’ve noticed other things… horrible brain fog. I sometimes wonder if I have Alzheimer’s.

And exhaustion… especially exhaustion after socializing have been rough for me recently as well.

I have been so easily agitated. Anything that bothered me before upsets me now to the point when I have to shut myself in my room to calm down.

What happened if/when you presented with autistic perimenopause to a healthcare professional?

Frustratingly, my family physician dismissed me very quickly years ago when I told him. He basically said I was too functional to be on the spectrum.

I have recently been debating switching to a female physician. I think a female would be less dismissive… this would probably better for discussing the perimenopausal symptoms too.

What has your treatment protocol been in managing your autistic perimenopause?

I don't currently have any specific medical treatment but I have been needing more quiet time than I used to in order to help me decompress.

How has your everyday life been impacted by autistic perimenopause?

Sounds are more overwhelming, especially when they’re coming from multiple people or sources.

I’ve been more sensitive to touch and almost never want my husband to touch me so that’s been an issue.

I’ve also been more sensitive to tastes, textures, and especially smells.

I spent about ten years caring for other people's kids in my home. By last year around this time, I was feeling overly agitated. All the normal noise, messes and activity level that typical of toddlers and preschoolers suddenly was becoming too much to handle. I ended up switching jobs.

I've been cleaning for the past year. It’s easier on my social anxiety because I'm typically on my own.

My relationships are suffering. I used to be okay doing social things with friends a couple times per month but I dread having to do anything lately. Between working more hours and needing more quiet time, the time spent with my husband and kids has decreased which makes me feel sad and guilty.

Are there things that make or have made your menopause transition especially difficult for you as an autistic person? If so, what kinds of things?

One thing I've noticed that I’m struggling a lot more with recently is my ability to stay on task. I've always struggled with time management and that seems to be worsening… possibly because of perimenopausal brain fog.

Are there things that could make or could have made your menopause transition easier for you as an autistic person? If so, what kinds of things?

More quiet time for reading, etc. seems to help calm my nerves more than anything else. Or even listening to music with headphones.

What supports, resources and services are available to people experiencing autistic perimenopause where you live?

There may be services for autistic perimenopause, but if there are, I'm not aware of them.

What kinds of services, resources or supports would you find most helpful?

Sometimes I think it would be nice to have a home/care aid to help with chores so I can spend time with my kids. By the time I'm getting home from my cleaning jobs, I don't want to do more cleaning.

What is the easiest way for you to access information about autistic menopause?

I have found most of the info I’ve learned about it simply by Googling. There are a lot of helpful videos on YouTube although the ones I’ve watched deal more with autism specifically, not necessarily perimenopause and autism.

I was surprised to realize that I’ve learned a lot more about autism in general, since joining Substack. It seems like there is a community of neurodivergent people on here.☺️

What would you wish for all people to know about autistic perimenopause?

I wish that people knew to be patient, that it takes us a little longer, if we seem snappy, don’t respond with frustration or anger, that actually makes it worse. Offer help by asking what you can do to lighten the burden.

If you see us in a room by ourselves reading, or looking out the window, we are trying to get a few minutes of silence to calm our nerves. We dont want to talk at this time. But it has nothing to do with you.

Is there anything else you’d like to share regarding your autistic experiences of menopause?

In general, lately, I’ve been struggling in a way that feels deeper and more persistent than anything I’ve experienced before. Night sweats wake me up, and often I can’t fall back asleep. I start the day already tired, with a short temper and a constant sense of being on edge—like I’m one interruption away from tears or an outburst.

Focus, always a challenge for me, has become even harder since the onset of perimenopause. My thoughts spin, and it takes real effort to stay grounded. Writing helps—it draws me inward in a deliberate, focused way—but even that requires effort to begin, and it’s hard to return once I’m pulled away.

I’ve long been skilled at masking—appearing “fine” in public or around people I don’t know well. It’s second nature by now, something that helped me survive without even realizing that’s what I was doing. But masking is exhausting.

The more self-aware I’ve become, the more isolating it feels—especially when people don’t realize or believe how hard it is to keep up. Recently, I’ve needed more support, more space, more time—but I worry I’m being seen as lazy or fragile for taking it.

My husband often seems frustrated, despite my efforts to explain. “Just be happy,” he says, as if it were that simple.

Friends offer advice—eat better, move more—but when I don’t feel heard, their words only deepen my anxiety and sense of failure.

I’ve always had certain sensitivities, particularly in social settings, but around age 42 or 43, they became more intense. Now, things that once barely registered—multiple conversations at once, unexpected touch, certain textures or sounds—can feel unbearable. I don’t want to be touched.

I’m more easily overstimulated and more easily overwhelmed. These aren’t new traits, but they’ve sharpened, and they’re harder to manage now.

Only recently have I started to connect the dots: the way hormonal changes in perimenopause are amplifying traits I now understand as autistic. It’s like the buffer I once had has worn thin. I’m slower, more sensitive, and constantly overstimulated.

What I once could mask or push through, I now feel viscerally—and visibly. And still, because I’ve hidden it for so long, I worry that others don’t see the shift or believe the impact.

Aside from my family and a few close friends—those rare people I can be fully myself around—I rarely want to leave the house. Some days, not even my room.

I work three cleaning jobs, which get me out, but thankfully I’m alone most of the time. One involves cleaning vacant apartments, where I can move through my day unmasked. I’m grateful for that.

I’m carrying a lot right now: the hormonal shifts, the sensory overload, the unrelenting internal noise—and this lingering fear that I’m becoming a burden to the people I love.

Understanding how perimenopause intersects with my neurodivergence has helped me make sense of it. I just wish more people knew how deeply these worlds can overlap.

I hope you have 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!

💕