No Longer a Question Mark After the Period: Autism and Menopause

1. Introduction

People born with uteruses will go through menopause once their ovaries stop producing the hormones involved in menstrual periods. People may have irregular periods for years leading up to menopause, but a person is only considered to be in menopause once they’ve gone a full calendar year since their last menstrual period.  A person may still be fertile for up to 2 years following their last menstrual cycle.  During perimenopause and menopause, a person may experience a variety of physical and mental changes (typically around 50 years of age).  Each person experiences these changes differently, but it can be helpful to know in advance that they may occur.  This can be especially true for Autistic people who like to know what to expect and how to prepare for it.

Photo Credit : Centre for Ageing Better on Pexels

The onset of perimenopause (the name given to the menopause transition) as well as the severity of symptoms are determined by several factors. These include genetics, smoking/drug use, overall health, reproductive health, osteoporosis as well as social determinants². 

It can be important to remember that menopause is a natural occurring process for those who have a uterus.  The changes it brings can be minimized and managed with awareness and education.  It is not our intention to pathologize this naturally occurring season of life, but to provide information to help you to feel more comfortable if you experience any of the physical or emotional changes we will discuss.

 

Throughout this toolkit, you will hear from our autistic contributor about her experiences and advice regarding menopause. Terri Robson is an experienced individual that has worked as a social worker, trainer, educational and motivational speaker, advocate, and consultant in the field of human services. Her goal is to contribute to her community in some small way. Terri is also an autistic advocate who is determined to share her life experiences with others. She considers herself a non-ableist “Aspie”.

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2. Signs, Symptoms and Expected Changes (physical and mental)

Perimenopause is marked by large fluctuations in hormones of a person with a uterus.

Among the most well-known changes that many people experience during perimenopause are hot flashes (also referred to as “hot flushes”), night sweats, and rapid changes in mood. Please see the appendix or click here for a more comprehensive list. Terri reports the most notable of her symptoms as: “Less control over [my] mood (little things would set me off), temperature swings, as well as new and different triggers.” Another common symptom is related to insomnia, including difficulty getting to sleep and/or waking early and being unable to get back to sleep. Previous research has found that sleep challenges occur at higher rates for autistic people of any age compared to their neurotypical peers³. These sleep challenges can be experienced by Autistic people of any gender and throughout the lifespan.

Photo Credit : Karolina Grabowska on Pexels

When asked what some things are that Terri wishes she knew about perimenopause and menopause before their onsets, she offered up: “I wish I knew when it was going to start, as in, what age. It was quite a surprise! When the hot flashes and mood swings would occur, I think I could have been more aware and prepared for potential triggers had I been able to plan. Knowing how long it would last (would also have been helpful), Because I got quite varied reports from others. Some people told me 1 to 2 years; and another said hers lasted 18 years! Yikes! Thank kind of freaked me out!”

In addition to hot flashes and mood changes that are often reported, there are physical changes to expect. Due to the loss of estrogen during the transition to menopause, changes to the vagina and vulva that typically occur due include⁴ :

• Reduction in blood flow to the genitals
• Collagen decrease which creates a greater fragility and lack of elasticity to the genital tissue 
• A possible subtle change in smell may be detected 
• The vagina shrinks in size
• The vagina can become more dry 
• The clitoris shrinks and the amount of erectile tissue does too 
• The labia minora decreases in size while the labia majora can get flatter giving the appearance of being bigger

Photo Credit : Maksim Goncharenok on Pexels

The combination of all these changes can create the experience of sex being uncomfortable or even painful for some people. One way to go about addressing complications due to these physical changes in the vagina is with hormone therapy. This intervention typically works 50% of the time. The type of hormone therapy that has been found to be the most effective is vaginal estrogen. There are several applications available for vaginal estrogen. These include⁵: 

• Creams
• Vaginal rings
• Vaginal Tablets
• Vaginal Suppositories

Oral dosage was historically the most common one used; however, oral estrogen is now only suggested if it is being used for things other than just specifically vaginal issues⁶.

• For some people with uteruses, medical intervention is what brings on their menopausal changes. This is referred to as medical menopause. Examples of what may require medical menopause are medical interventions such as:
• hysterectomies (removal of the uterus)
• ovarian surgery (like the removal of cysts for example)
• uterine artery embolization (a treatment used for fibroids)

Some medications can also bring on the onset of menopause. These medications include⁸:

• Aromatase inhibitors (used in situations where someone is diagnosed with a hormonally responsive breast cancer)
• Tamoxifen (same as above)
• GNRH agonists (used in situations where someone is diagnosed with a hormonally responsive breast cancer but who also has fibroids or benign tumors of the uterus and/or endometrial cells)

The timing of a person’s final period is a complex interplay of genetics, environment, and social factors. The best predictor of one’s final period is when your sibling with a uterus’s onset of menopause was (even more so than your parent’s). Of note is that smoking reduces the age of menopausal onset by approximately two years⁹. When asked how long it took between the onset of her first symptoms of perimenopause and when she entered menopause Terri said: “I think it was between 2.5 and 3 years”.

Changes in strength, size and shape of your body are to be expected. Loss of muscle mass during the menopause transition is why people tend to feel as though their metabolism has slowed down. Muscles take up a lot of our daily energy consumption and losing muscle mass means we do not burn calories as efficiently¹⁰.

Photo Credit : Andres Ayrton on Pexels

Another reason for the noticeable shape changes that accompany menopause is linked to body fat changes. There are 2 types of body fat¹¹:

• Subcutaneous fat, which is fat found just under the skin that you can grab or pinch and comprises 90%-95% of body fat for people with uteruses.
• Visceral fat is the fat found inside the belly that surrounds vital organs and comprises 5% of body fat for people with uteruses.

After the menopause transition is complete, the visceral fat in our body makes up approximately 20% of our body fat, an increase of 15%! This change brings on a whole new set of particular concerns. These include¹¹:

• Reduction in insulin sensitivity
• Increased inflammation resulting in other physical problems
• Fatty acids released will increase cholesterol and triglycerides
• Negative impacts on the liver
• Increased levels of testosterone and estrogen (sleep difficulties and skin issues may be consequences of these hormonal fluctuations)

Sleep disturbances in addition to insomnia are also noteworthy symptom of perimenopause and affect roughly half of people with uteruses³. These disturbances typically present as waking up in the night or experiencing hot flashes/night sweats. 

In addition to the physical changes of perimenopause and menopause, psychological changes might also occur_. These changes can include cognitive, social, emotional, and sensory issues, including an increased risk of dysregulation. Other ways that mental health can take a hit during the menopause transition include¹²:

• Amplification of stress (everyday stressors such as money or work-home balance etc. have a stronger impact)
• Depression
• Anxiety 

Terri describes menopause impacting her mood and mental health as: “It made my moods more extreme. I didn’t really have a support system as no one I knew was going through it at the same time. And let’s face it, there were times I had no clue what was going on (especially in the beginning)”.

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3. Common Autistic-Specific Challenges and Barriers During Menopause

Autistic people with uteruses unfortunately have not been included in much research about menopause and the time leading up to menopause. In fact, the first study looking at the interplay of these two factors was published in 2020! Part of this results from the fact that historically, autism was seen as mainly affecting people who were assigned male at birth¹³. In addition, less medical research in general has been done on people with uteruses compared to those assigned male at birth^14.

Photo Credit : Nati on Pexels

Since communication can be a challenge for some autistic people, the ability to describe sensations, experiences, and body changes to their healthcare professionals may be a challenge during perimenopause or menopause¹². Even those Autistic who have the ability to communicate with spoken words may find it difficult or impossible to share their very personal, physical symptoms with their doctor.  When they call the doctor’s office for an appointment, the office staff may ask for the reason for the appointment, and the person may stumble to find a response, or find themselves to be mute in such a situation.   They may struggle to articulate the symptoms they have been experiencing once in a doctor’s office, be unable to describe the depth and intensity of what they are experiencing.  They may leave the office with a remedy that they don’t want to take or to use but could not advocate for themselves in seeking an alternative.  Autistic people in general may have difficulty with addressing conflict and may perceive a disagreement with the doctor as conflict.

Autistic people might not obviously show signs of the effects of menopause in the same way as neurotypical people. For instance, feeling pain or being in distress may look quite different in autistic people²⁶. It is also possible to mistake symptoms of menopause for traits associated with autism²⁶. A medical professional may assume that an Autistic person’s sensory processing differences explain the change instead of that symptom being attributed to menopause. This can result in autistic people hesitating before seeking help or treatment as they may feel like they will not be heard or taken seriously¹⁵.

Photo Credit : Karolina Grabowska on Pexels

Those who lack education on what to expect during the menopause transition may struggle with the symptoms and assume they are doing something wrong (e.g., I am gaining weight because I am not eating healthy enough). They may think night sweats can be attributed to the weighted blanket they’ve used for years or descend into negative self-talk as though it is a personal shortcoming that they are experiencing an increase in emotional outbursts. Autistic people are more likely to be gentle with themselves if they have a full understanding of what to expect during menopause¹⁶. Terri suggests that when speaking to medical professionals about menopause (and even friends and family for that matter) that it is best to “be honest with how you feel and what you are going through. No one can help unless they know what is going on.”

While it is easy to encourage Autistic people to be open and thorough in sharing symptoms and concerns with their doctor, we understand that this can be a challenge. Having a support person to help with the steps necessary to communicate vital information to the doctor can be invaluable.  The Autistic person can take that support person with them to the doctor’s appointment, use the resources in this guide to assist with language that describes symptoms, or provide a checklist to the doctor as a starting point for conversation.  Asking for help to prepare a scripted introduction to your issues can also be very helpful.   An Autistic person may not knowhow to respond to the question, ‘What brings you here today?’ when there may be many symptoms to share.

Additional studies are needed to explore the unique interplay of autism and menopause because¹²:

1. Menopause has been shown to amplify pre-existing sensory sensitivities experienced by an Autistic person. This may make it more difficult for someone to stay within their window of tolerance thus resulting in more frequent and/or intense meltdowns^12 . Terri reports her experience of this as: “My tactile and sound sensitivities got worse. That was really difficult for me as those 2 sensitivities feel over-stimulated a lot to start with”.
2. There is a lack of experts in the healthcare professions who have experience with the challenges faced by Autistic people going through menopausal changes¹² .
3. The few studies that have been done on menopausal symptoms in Autistic people show higher levels of depression as well as increased sensory sensitivity and emotional regulation challenges¹⁴.
4. Autistic people with uteruses are already vulnerable to issues affecting mental health and during the menopausal transition, Autistic people report even more challenges. This difficulty is mostly felt in areas such as: planning, emotional regulation, managing changes, sensory sensitivities, socializing and communicating¹² .

Photo Credit : Ketut Subiyanto on Pexels

When asked what Terri thinks is of particular importance for someone with autism to prepare themselves for, Terri responded: “Prepare yourself for the changes that will occur to your body and state of mind. Do as much reading as you can, information is your friend. Knowing what occurs during this time of our lives, can help us prepare for what lies ahead”.

Menopause is an unavoidable hormonal event that impacts people with uteruses once they have come to the end of their years of fertility. While many people with uteruses suffer from a lack of information about this major hormonal event, Autistic people have the added challenges related to the compounding of their unique set of circumstances and how those interplay with the menopausal transition. Further research is necessary in this area. Terri offers these words of encouragement: “It is good to keep in mind that the symptoms will end at some point”.

It can also be good to remember that once menopause has taken root and fertility is no longer a concern, it brings with it many benefits. These include freedom from the monthly menstrual cycle, which might mean a release from monthly cramping, concerns over becoming pregnant, the expense of pads, tampons, or cups, and from a physical event that might interfere with enjoyment of physical activities.

This toolkit was intended fill some of those knowledge gaps surrounding menopause and to provide suggestions and support to Autistic people and those who care for them in this stage of life. For further reading and for PDFs that can be of use in preparation for and during the menopause transition, please continue on to the sections of this toolkit titled “Finding support and Checklists” and “Resources for Caregivers”.

Some final thoughts from our contributor Terri: “If you have someone to talk to, even a peer, I believe it can help. You can put your fears and concerns out there and they don’t seem as big.” She goes on to tell us: “Read as much as you can about menopause in general, so you know what to expect” and she suggests: “try to remember that it will end at some point”.

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4.  Finding support and Checklists

4.1 Things to do to help manage symptoms during the menopause transition:

Photo Credit : Marcus Aurelius on Pexels

1. Exercise (Even just going for a walk will have a positive impact on you)
• It is important in countering muscle mass decline and weight gain by replacing and repairing muscle cells^17.
• Weightlifting is particularly important to help avoid osteoporosis (thinning bones) that is common following menopause.
• Hormonally, exercise is important because it creates endorphins and endorphins make you feel good!
  - It also decreases the hormonal levels of adrenaline, cortisol and other hormones that are part of the body’s response to stress.
2. Practice good sleep hygiene. This includes paying attention to¹⁸:
• Create a sleep schedule. Set a bedtime and wake up time ( click here for a template to help you keep track)
• Avoid napping.
• Avoid anxiety provoking things before bed.
• Avoid stimuli before bed (NO SCREENS FOR AT LEASE ONE HOUR BEFORE BED!)
• Reserve bed specifically for sleep and sex (not for watching tv, playing on phone, endless scrolling, snacking)
• Avoid looking at the time if you wake up in the night. Instead, try reading until it tires you out enough to sleep again.
3. Take note of changes that are occurring^18.
4. Talk to a doctor or therapist about changes that could be related to menopause^19.
5. Keep track through a diary of the frequency of hot flashes experienced as well as what was going on right before it’s onset
   - such as where you were and what you were doing.
6. Avoiding known as triggers for hot flashes such as stress, caffeine, alcohol, or hot weather can have a positive impact^20.
7. If experiencing night sweats is an issue, use and wear thin materials^21.
8. If experiencing mental fog is an issue, try to do some new things such as puzzles^22.
9. Reach out to family and community if unpleasant psychological states such as increased anxiety or depression is experienced^23.
10. Consider joining an online menopause or perimenopause support group on Facebook
11. Eat well²⁴:
• Foods that are known to be good for your day-to-day health are also best for hormone health.
  - Whole grains, lots of fruits and vegetables, 25 grams of dietary fibre/day reduce processed foods
  - Omega-3 fatty acid (eat fish and seafood).
• If you are not already taking a multivitamin, talk to your doctor about increasing your calcium, magnesium, and/or vitamin D intake.
  - Calcium and magnesium are especially important for bone health and preventing osteoporosis.

Photo Credit : Nadin Sh on Pexels

 

4.2 Menopause symptoms which make it essential to contact a doctor: 

Abnormal bleeding, which would be any of the following^19,25:

• Having to change saturated menstrual products every hour or less over a period of several hours. 
• If any clots discharged are larger than a quarter 
• If a heavy period lasts longer than 7 days
• If you have any bleeding after the menopause transition is complete (2 years after your last period)
• If you are having to stay home from work or withdraw from leisure activities because of blood flow

 

4.3 Questions to consider asking your doctor. 

As we age, family doctors may order more routine tests and screenings.  Some of the questions below are not concerns directly related to menopause but to the age of the patient (such as a mammogram or a colonoscopy).  Family doctors tend to recommend annual pap tests, and mammograms for those between the ages of 50 and 74, and colonoscopies after age 50 (or 10 years earlier if a relative has had colorectal cancer).  

1. Is hormone therapy right for me?
   a) If so, which do you recommend?

b) Is there a chance of a negative interactions with other medications I am currently on?
2. Should I have a blood test?
3. Should I have a pap smear?
4. Should I have a mammogram?
5. Should I have a colonoscopy?
6. Should I have a bone density test?
7. What can I do to support my bone health?
8. Should I have a depression screening?
9. Are there any sleep aids they might recommend? (This is if you are experiencing sleep disturbances). 
10. What are your suggestions for vaginal dryness I am experiencing?
11. Could the symptoms I told you about be caused by something other than menopause?
12. What should I consider worthy of seeking out medical attention for in relation to my menopause transition?
13. What tests and/or interventions are covered by my provincial health insurance plan? Which would I have to pay for out-of-pocket?

( Click here for a PDF version to print out and take with you to an appointment)

 

4.4 Perimenopause/menopause symptoms worth reporting to a doctor should they apply to you.

1. More tired than usual
2. Irritable
3. Hot flashes and night sweats
4. Heart Palpitations
5. An increase in headaches/migraines
6. Joint pain
7. Muscle aches
8. Weight gain
9. Change in body shape
10. Change in skin condition (dryer/itchy etc.)
11. Decreased libido 
12. Discomfort/pain/itching during sex
13. Vaginal dryness
14. Changes in period (length/flow volume)
15. Breast tenderness
16. Exhaustion
17. Bloating 
18. Changes in digestion
19. Trouble sleeping
20. Urinary Incontinence (can range from leaking urine by accident to having a newly overactive bladder)
21. Hair loss/thinning hair
22. Trouble sleeping
23. Memory loss/forgetfulness/difficulty concentrating
24. Brittle nails
25. Brain fog
26. Increased growth of facial hair

There could be other changes you noticed that you think your doctor should know about.  

 

( Click here for a PDF version to print out and take with you to an appointment)

 

4.5 Sample Letter to bring to your appointment should you be concerned about verbal communication while with a medical professional.

 

Dr. Dr.   __________________.

 

As an Autistic person, I am sometimes unable to express my concerns verbally, especially in moments I find stressful.  As a result, I’d like to begin our appointment with this written communication. However, I may be able to speak as our appointment progresses.

I have been experiencing symptoms that I think might be related to menopause or perimenopause.  These symptoms are indicated on the list I have provided along with this note.  I am most concerned about (list symptom or symptoms that are causing you the most concern).  Please help me understand these issues and how I can address resolve them.

Sincerely,

_______________________________

 

( Click here for a PDF version to print out and take with you to an appointment)

 

4.6 When to Seek Psychological Help

If your symptoms are significant enough that they are interfering with your everyday life, it is time to seek help. Terri suggests: “Be honest with how you feel and what you are going through. No one can help unless they know about what is going on”.

Photo Credit : Marcus Aurelius on Pexels

Keep in mind that menopause can correlate with other life changes that can affect your emotional state and mental health.  If you have children, they may be moving out of the house or going off to post-secondary education away from home.  This can leave a parent wondering about the new role they have in life as ‘an empty nester” someone whose kids have left home.  It is also mid-life, a time when people in general step back to evaluate where they are in life; where they have been and where they want or wanted to go.  All of these can have an impact on a person’s well-being and mental health.

• Increased levels of anxiety
• More frequent panic attacks or meltdowns
• Feeling more nervous than usual
• Feeling more worried than usual
• Over-thinking more than usual
• Muscle tension
• Increased lack of concentration
• Feelings of depression:
• Hopelessness
• Lack of motivation
• Irritability
• Not sleeping or desire to sleep far more than normal
• Suicidal thoughts
• Mental Fog
• Mood swings that are increased in volume or intensity
• Need help managing emotional regulation (especially around sensory triggers)

 

( Click here for a PDF version to print out and take with you to an appointment)

 

4.7 Scripts

Sometimes the first steps towards help are the hardest to take. If you would like to see a doctor but are nervous about what to say on a phone call with their office, you can use these scripts to take that important first step.

 

Making a medical appointment for menopause symptoms:

I’d like to make an appointment with Dr.________________ to discuss menopause symptoms.

I would prefer an appointment (give day of the week and best time of day). 

 

Making  a medical appointment  for urgent menopause or perimenopause issues:

I’d like to make an appointment with Dr. ___________________ to address issues related to (examples: very heavy menstrual bleeding,  painful intercourse, severe sleep deprivation, inability to manage my emotions).  Could I get your earliest ( morning? afternoon?) appointment on  one of these days (example: Monday, Wednesday, or Friday)?

 

( Click here for a PDF version to print out and take with you to an appointment)

 

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5. Support Programs I can Reach Out To If I am Struggling

5.1 National programs

The Canadian Mental Health Association

Provides resources, suggestions and has a crisis line as well as crisis intervention through texting. ( https://cmha.ca)

talksuicide.ca at 1-833-456-4566

or text 45645 (4 pm-midnight ET)

 

Wellness Together Canada

To connect with a mental health professional one-on-one:

• call 1-888-668-6810 or text WELLNESS to 686868 for youth
• call 1-866-585-0445 or text WELLNESS to 741741 for adults

You can also visit Wellness Together Canada to access different levels of support, including:

• one-on-one counselling
• credible articles and information
• self-guided courses and programs
• peer support and coaching

 

5.2 For First Nations, Inuit, and Métis Peoples

Hope for Wellness Help Line

Call 1-855-242-3310 (toll-free) or connect to the online Hope for Wellness chat.

Available 24 hours a day, 7 days a week to First Nations, Inuit, and Métis Peoples seeking emotional support, crisis intervention, or referrals to community-based services.

Support is available in English and French and, by request, in Cree, Ojibway, and Inuktitut.

 

5.3 For youth and young adults

Kids Help Phone

Call 1-800-668-6868 (toll-free) or text CONNECT to 686868. Available 24 hours a day, 7 days a week to Canadians aged 5 to 29 who want confidential and anonymous care from trained responders.

Visit the Kids Help Phone website for online chat support or to access online resources for children and youth.

 

5.4 Other resources

Consider finding a therapist with autism-specific expertise who can help to identify strength-based ways to address next steps along the life path.

Your local non-profit autism agency may be able to provide a list of such experts or seek recommendations from your own autism network to find such a professional.

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6. Resources for caregivers

6.1 Advocacy

This is one of the most important roles you can play for someone you care for, especially if they have communication challenges. Please remember that even the most chatty and eloquent Autistics may experience situational mutism and your advocacy can be a great help.  One way to ensure to be involved in a health/mental health appointment is to sign a “consent for release of information” for the person for whom you are caring for.

It is important to ask the person if you can help.  They may feel as though they are offending you if they say ‘no’, so make it clear that you support whatever response they provide, and that you are there for them down the road if they change their mind.

Photo Credit : Centre for Ageing Better on Pexels

Because menopause occurs during adulthood, medical confidentiality might mean that you are turned away at the examination room door. This kind of document will give the doctor permission to share information with you and allow you to be part of the conversation. These forms are useful in all clinical settings, not just medical, but psychological as well. It would likely be stressful and frustrating to get to an appointment and not be able to speak on behalf of the person you are caring for who is perhaps minimally or nonspeaking. You can call the clinical office before the appointment and ask about the use of this type of document in their clinic.

If you are preparing someone you are caring for an appointment and they are nonreading and/or nonspeaking, Click here for a visual aid in identifying perimenopause symptoms.

 

6.2 Collect Data

Doctors are better able to support patients if they can see data or observations about symptoms over a period of time. This allows them to look for patterns that can help them understand what is happening. It is beneficial to go to appointments with documented information about you or for the person you are caring for. This can be especially important should that person be minimally or nonspeaking. Having “data” recorded might be the best indicator of changes.

Is this person having more autistic meltdowns? What is different about them and at what frequency are these things happening? ( Click here for a pdf chart you can print and use to collect data on behaviour changes)

Is their sleep disrupted? What does that look like and at what frequency? ( Click here for a pdf chart you can print and use to collect data on changes in sleep pattern)

 

Photo Credit : cottonbro studio on Pexels

 

6.3 A final word on data collection

Data collection can seem daunting to some.  Not everyone has the time to do this, so don’t let it deter you from assisting if you do not have data.  Share what you know, and what your Autistic loved one has shared with you.

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7. References

1. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 320.
2. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 50-51.
3. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 210.
4. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 163-164.
5. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 171.
6. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 170.
7. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 55.
8. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 59.
9. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 60.
10. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 72-73.
11. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 79-80.
12. Moseley, R.L., Druce, T., & Turner-Cobb, Julie M. (2020). ‘When my autism broke’: A qualitative study spotlighting autistic voices on menopause. Autism, 24(6), 1423. https://pubmed.ncbi.nlm.nih.gov/32003226/
13. Groenman, A.P., Torenvliet, C., Radhoe, T. A., Agelink van Rentergem, J. A., & Geurts, H. M. (2022). Mentruation and menopause in autistic adults: Periods of importance? Autism, 26(6), 1563-1572. https://pubmed.ncbi.nlm.nih.gov/34825585/
14. Groenman, A. (2022, April 27). Menstruation and menopause in autistic people. National Autistic Society. https://www.autism.org.uk/advice-and-guidance/professional-practice/menopause-menstruation
15. Moseley, R.L., Druce, T., & Turner-Cobb, Julie M. (2020). ‘When my autism broke’: A qualitative study spotlighting autistic voices on menopause. Autism, 24(6), 1423. https://pubmed.ncbi.nlm.nih.gov/32003226/
16. Moseley, R.L., Druce, T., & Turner-Cobb, Julie M. (2020). ‘When my autism broke’: A qualitative study spotlighting autistic voices on menopause. Autism, 24(6), 1428. https://pubmed.ncbi.nlm.nih.gov/32003226/
17. Moseley, R.L., Druce, T., & Turner-Cobb, Julie M. (2020). ‘When my autism broke’: A qualitative study spotlighting autistic voices on menopause. Autism, 24(6), 1430. https://pubmed.ncbi.nlm.nih.gov/32003226/
18. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 77.
19. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 207-208.
20. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 330-331.
21. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 99.
22. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 105.
23. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 152.
24. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 153.
25. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 257.
26. Dr. Jen Gunter, The Menopause Manifesto: Own Your Health with Facts and Feminism (Toronto: Penguin Random House, 2021), 115-116.
27. Bogdanova, O. V., Bogdanov, V. B., Pizano, A., Bouvard, M., Cazalets, J. R., Mellen, N., & Amestoy, A. (2022). The Current View on the Paradox of Pain in Autism Spectrum Disorders. Frontiers in Psychiatry, 13, 910824.

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8. Appendix 

Expected Changes During Perimenopause/Menopause

□ Hot flushes/flashes (can be used interchangeably)
□ More tired than usual
□ Irritable
□ Night Sweats
□ Heart Palpitations
□ An increase in headaches/migraines
□ Joint pain
□ Muscle aches
□ Weight gain
□ Change in body shape
□ Change in skin condition (dryer/itchy etc.)
□ Decreased libido
□ Discomfort/pain/itching during sex
□ Vaginal dryness
□ Changes in period (length/flow volume)
□ Breast tenderness
□ Exhaustion
□ Bloating
□ Changes in digestion
□ Trouble sleeping
□ Bladder Incontinence
□ Hair loss/thinning hair
□ Trouble sleeping
□ Memory loss
□ Brittle nails
□ Brain fog
□ Osteoporosis
□ Increased growth of facial hair

 

( Click here for a PDF version to print out and take with you to an appointment)

 

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