Why Perimenopause is a Time When Women Seek Out an Autism Assessment

Originally published in Psychology today by Dr. Claire Jack

Perimenopause and autism

1.     Many women explore autism in their 40s–50s, often during perimenopause, seeking answers.

2.     Autism is often missed in girls and women; awareness is driving more later-life diagnoses.

3.     Perimenopause can intensify sensory issues, emotions and burnout until coping stops working.

4.     Midlife can bring self-focus and confidence, prompting boundaries and neurodivergence exploration.

I was in my late forties when I started considering autism as a possibility for the challenges and difficulties I’d faced throughout my life. And I’m not alone. Anecdotally, the vast majority of my clients are women in their forties and fifties, often going through perimenopause, and starting to explore autism as an explanation for what has – for many – been a long-standing sense of difference without a clear reason. Research shows that autism diagnosis rates in the US rose by up to 175% between 2011 and 20221, with a significant rise in girls and women who are also more likely than males to be diagnosed at a later age. The fact that autism is often missed or misdiagnosed in women and girls when they’re younger is well-documented2, and part of the reason for the significant increase in later-life diagnoses is simply due to women being more aware of autism as something which was missed earlier in their life.

 

Why Perimenopause is a Time When Women Seek Out an Autism Assessment 

Perimenopause makes things harder

Perimenopause is a time of life when many things become more challenging. Hormonal changes, which can have far-reaching physical, cognitive and emotional impacts, mean that it’s more difficult to cope in many ways. For those autistic women who have “got on with it” for most of their lives, despite finding situations extremely challenging, perimenopause is a time when things simply become even harder. This includes heightened sensory sensitivities and emotional volatility3, which are things that might have always been problematic, but which become intolerable during perimenopause. Many of my clients have reached a point of extreme burnout at this point, as the result of continuously pushing through what seem “doable”, but which was taking a considerable toll. Combined, this means that what seemed just about manageable, even if it required a lot of effort, reaches a point where it’s no longer manageable. Which leads to women searching for answers as to “why”.

Women want answers

Midlife is a wake-up call for many of us that we’re not going to be around for ever, and it’s important to live a life that feels more appropriate to who we are. Many of us realise that, to move forwards differently, we need to understand who we are and why we experience things in the way we do. We want answers. And reaching midlife is often the catalyst for seeking those answers.

Cheryl told me, “Nobody sees how hard things have been for me. But I have struggled every day since I was about five. And I want things to be a bit easier going forward. I’m fed up. This is my time to change things”.

Focusing on our needs

For many women, perimenopause is a time when there’s an inner focus and for some women this transitional phase is liberating4. Often, children are reaching teenage years or have left the family home. For some women, there’s a strong realisation that they need to use this new focus to look after themselves, and exploring their experience in more detail – which for some women includes exploring autism in more detail – is a part of that process.

Growing confidence

Menopause can be extremely hard for some women, and can lead to a loss of confidence. For others, it can be a time of greater confidence than they might ever have felt before. It’s from this new, more confident state of mind that they refuse to keep doing things in the same way. They become more confident around setting boundaries, making informed choices and challenging the status quo in their relationships. Once they experience the positive effects of these changes, they often ask the question, “why do I get on better when I do things differently?”. This, in turn, can lead to an exploration of neurodivergence.

Annie told me, “I’ve already made changes. I’ve felt more confident in saying no to thing. I don’t people-please in the same way. I’m slowly feeling a bit better and discovering why that is – and if it’s autism – is important to me”.

They’ve had a lifetime of exploration

By the time my clients come to me, they’ve often spent years trying to find answers for a sense of difference and why things felt so challenging. I can identify with the process of reading self-help books, starting a psychology degree aged 18, having years of therapy and training as a therapist, all to try and establish what was at the root of those huge challenges I faced. After a lifetime questioning, autism is often the one thing that makes sense, and the fact that there’s so much more awareness of women’s autism means that women in mid-life have the opportunity to explore it as an explanation.

As Reika said, “if this isn’t it, I don’t know what else it can be. I just know I’ve looked into everything else and I need answers now”.

It’s never too late to explore autism as an explanation and perimenopause is often a time when women realise the importance of finding answers to a lifetime of difference.

Questions and answers: Why Perimenopause is a Time When Women Seek Out an Autism Assessment

 Is it “just hormones,” or could it be autism?

It can be both. Hormonal changes can amplify traits that were already there, making lifelong patterns more noticeable.

Why would autistic traits feel worse during perimenopause?

Sleep disruption, stress sensitivity, and nervous system changes can reduce your capacity to cope, mask, and recover.

I’ve coped fine until now—does that mean I can’t be autistic?

No. Many women cope through masking, perfectionism, and over-functioning until life demands (and energy levels) shift.

What are common signs that show up more strongly at this stage?Overwhelm, sensory sensitivity, social exhaustion, shutdowns/meltdowns, and executive function struggles often become harder to manage.

Could this be ADHD, anxiety, trauma… instead of autism?

Possibly—and overlap is common. An assessment looks at your whole pattern across your life, not just what’s happening right now.

What if I’m worried I won’t “seem autistic enough” in an assessment?

That worry is very common, especially for maskers. A good assessment explores internal experience and lifelong history, not stereotypes.

Do I need childhood proof or a parent to confirm things?

By the time you're perimenopausal, asking for a parental contribution isn't possible, for many reasons. If you're in a position to provide a parental contribution that can be helpful, but it's certainly not required.

Can perimenopause cause autism?

No. Autism is neurodevelopmental (present from early life). Perimenopause can make it easier to recognise.

What’s the benefit of getting assessed now?

Clarity and validation—plus practical ways to reduce burnout, understand your needs, and advocate for support at work and home.

What if I’m not ready for a full assessment?

You can start with a screening or exploratory step to help you decide what you want next.

References

Grosvenor LP, Croen LA, Lynch FL, et al. Autism Diagnosis Among US Children and Adults, 2011-2022. JAMA Netw Open. 2024;7(10):e2442218. doi:10.1001/jamanetworkopen.2024.42218

Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-diagnosed women with autism spectrum conditions: An investigation of the female autism phenotype. Journal of Autism and Developmental Disorders.

Brady MJ, Jenkins CA, Gamble-Turner JM, Moseley RL, Janse van Rensburg M, Matthews RJ. "A perfect storm": Autistic experiences of menopause and midlife. Autism. 2024 Jun;28(6):1405-1418. doi: 10.1177/13623613241244548. Epub 2024 Apr 15. PMID: 38622794; PMCID: PMC11135000.

Giggins OM, Cullen Smith S, McLysaght A, Doyle J. A robber of joy or a natural transition? a qualitative exploration of women's menopause experiences in Ireland. BMC Womens Health. 2026 Feb 9;26(1):121. doi: 10.1186/s12905-025-04204-1. PMID: 41664109; PMCID: PMC12918476.