What is menstruation?

Menstruation, or getting your ‘period’, is a regular experience for most people with a vagina during a long part of their lives. It is the part of the menstrual cycle when someone bleeds from their vagina for around 2-7 days; this is normal and does not mean you are injured or hurt. 

For most, a period happens every 28 days or so, but it is common for periods to range from every 21 to 40 days. The length of a person’s menstrual cycle can vary each month, with some people finding that their cycle is more or less predictable than others. 

It is likely that a person will get their first period in late childhood or early teenage years. Periods usually stop when the person is in their late forties or early fifties, during a time called the menopause. 

You can watch a short video that explains in detail what happens during the menstrual cycle on the NHS website (the video is at the bottom of the page). 

Autism and menstruation

Research suggests that autistic people who menstruate may be more likely to experience: 

• increased sensory sensitivities, including:

      -  sensitivity to the smell and sight of menstrual blood 

      -  the body or skin feeling more sensitive in general 

      -  sensory overload occurring more frequently just before and during menstruation 

• increased emotions and challenges with emotional self-regulation (the ability to calm yourself down) 
• increased executive function difficulties (finding it difficult to focus, for example)
• excessive menstruation symptoms, including unusually painful periods and heavy menstrual bleeding. 

It is important to consult your doctor if your periods are excessively heavy, long and/or are accompanied by PMS (premenstrual syndrome) symptoms, such as mood swings and difficulty sleeping, that are affecting your daily life. 

Challenges associated with menstruation can impact autistic people in various ways, including: 

• confusion due to the lack of clear, detailed information about menstruation and the common use of slang terms and euphemisms  

• feeling worried about disruption to routine, for example: 

      -  changes in showering and toileting routines

      -  having to wear period products 

      -  having to use public toilets

      -  difficulties coping with change and uncertainty relating to the period – each period can be different and can also                   change due to age, stress or childbirth

• challenges caused by executive function difficulties, including:

      -  difficulty learning the sequence of changing a sanitary pad or tampon 

      -  difficulty remembering to change a sanitary pad or tampon    

• intensified emotions and elevated levels of stress, anxiety and/or depression before and during periods, leading to an increased likelihood of meltdowns 

• difficulties identifying and/or communicating symptoms of premenstrual syndrome (PMS)

      -  if a person has difficulty communicating their emotions, emotional symptoms (due to PMS) can lead to                                       distressed behaviour. 

Ways to support autistic people with challenges around menstruation

Autistic people can need time to adjust to and understand changes, so it is important to start early with preparing for menstruation. Clear descriptions and explanations of what is going to happen when their period starts (with reference to the relevant anatomy) and what they need to do to manage it, will help to avoid confusion and unnecessary stress. 

The information should be delivered in a format that is most suited to the individual, which could include using visual strategies (like demonstrations or illustrations), social stories, books, pictures and videos. Avoid using euphemisms and slang terms when talking about periods, as they can be confusing and worrying. 

Some ways to prepare and support autistic people with menstruation include:

• explain and/or show them where to buy and how to use different menstrual products 

      -  you could use a pen to colour in the area of the underwear where a pad should be placed 

• explain menstrual hygiene, such as when to change used menstrual products and how often to wash 

• help them to set a schedule and/or reminders for changing used products

• show them how to use an app or a calendar to keep track of their period and plan for when it is due 

• help them to find a person they can go to if they start their period at school

• if they find communal toilets distressing, discuss with their school the possibility of access to an alternative. 

Strategies for self-management

It is best to have guidance from someone who can help you to understand, plan for and manage your period at the beginning. Everyone is different and as you learn more about your own period, you may find that there are strategies for self-management that are unique to you. Here are some suggestions that may help:

• carry spare underwear and period products with you at all times, or at least for several days or a week before you expect to get your period 

• keep spare underwear and period products in places you visit often, like your place of work or the home of a family member 

• use a period tracking app to understand your cycle better and get reminders of when your period is likely to start

• set alerts or reminders during your period to remind you to change period products and when to wash, which may be more often than usual 

• talk to your doctor about using hormonal contraception known as ‘the pill’, which may help to make your menstrual cycle more predictable and reduce PMS symptoms 

• keep a diary, or use a period tracking app, to track your emotions during your cycle. This can help you to recognise and understand when, how and why your emotions may change because of your period. 

Insight from autistic people