How does PMDD impact people with autism?

Premenstrual dysphoric disorder (PMDD) is a condition similar to premenstrual syndrome (PMS) that can affect women and people with female reproductive organs. However, PMDD symptoms are more severe than PMS symptoms. 

People with PMDD typically experience intense irritability, depression, and anxiety during the luteal phase (the one to two weeks before their menstrual period starts). These symptoms can be debilitating and cause significant interruptions in their ability to function. However, symptoms usually subside two to three days after a person’s period begins. 

Among the general population, PMDD affects approximately 5% of women of childbearing age. But it appears to be more prevalent among people with autism. While estimates vary, one study found that as many as 92% of menstruating people with autism live with PMDD. 

Are periods worse for autistic people?

Menstruation can affect different people in different ways. For some, it causes severe discomfort that interferes with their ability to work, attend school, and socialize. Other people have milder menstrual symptoms that don’t significantly impact their quality of life. 

There’s some evidence to suggest that severe menstrual symptoms may be more common in autistic people. Research shows that autistic people are more likely to experience painful, heavy periods, menstrual hygiene issues, and mood and behavior changes due to premenstrual syndrome (PMS). 

In addition, since this population is more likely to have PMDD, they may be more likely to experience the following symptoms during their luteal phase:

• Difficulty with concentration and focus
• Feeling sad or hopeless
• Panic attacks
• Increased anxiety
• Frequent crying
• Mood swings
• Fatigue
• Angry outbursts that may affect other people
• Irritability
• Loss of interest in activities and relationships
• Sleep disturbances
• Food cravings and/or binges
• Feeling a loss of control
• Physical symptoms, like cramps, bloating, breast soreness, headaches, and other unexplained aches and pains
• Thoughts of suicide*

As you review this list of symptoms, keep in mind that you can have PMDD without being autistic. But if your menstrual cycle is seriously impacting your well-being and ability to function, be sure to talk to your doctor. 

Many people — especially people assigned female at birth — aren’t diagnosed with autism until later in life because they don’t show some of the most well-known signs. For some, receiving a PMDD diagnosis can open the door to other evaluations that can help them better understand the full picture of their mental and physical health.

*A note on safety: PMDD carries an increased risk of suicidality. If you’re having thoughts of harming yourself, don’t hesitate to ask for help. You can contact the National Suicide and Crisis Lifeline by dialing 988 from any phone. Their counselors will provide confidential support and resources to help keep you safe. 

How does PMDD affect autism symptoms?

Having PMDD can make autism symptoms worse for some people. The intense emotional upheaval associated with PMDD can:

• Increase sensory sensitivities and repetitive behaviors
• Worsen physical menstrual pain
• Heighten the risk of self-harm 
• Make it more difficult to recognize and regulate emotions (often leading to meltdowns)
• Create increased challenges with executive functioning skills (like having trouble remembering to change a tampon)
• Increase worry and anxiety

PMDD may make it more difficult to mask or manage symptoms of autism. However, the reverse can also be true. Having autism might make it harder to manage menstruation. So if your period is negatively affecting your life in serious ways, don’t hesitate to reach out for help. It could be a sign of PMDD, underlying autism, or both, and receiving an accurate diagnosis is one of the most important things you can do to maintain your health.

Guidance for living with PMDD and autism

Treating PMDD typically involves a combination of talk therapy and medication to help balance your mood and hormone levels. One type of therapy in particular — cognitive behavioral therapy (CBT) — has been proven to help people with PMDD. And it can be successfully modified to meet the needs of people with autism. If you’re curious whether medication might be right for you, you can discuss the options with your provider.

In addition to professional help, there are also some individual strategies you can use to manage symptoms of autism and PMDD. This could include:

• Tracking your cycle: Since the luteal phase (the one to two weeks before your period) is when PMDD symptoms tend to arise, knowing when it will occur can help you prepare. You can keep track of your cycle on your calendar or using an app designed for that purpose.
• Avoiding isolation: The physical and emotional symptoms of PMDD may make you want to avoid other people, and it’s OK to take some time for yourself. But it can also help to talk to someone you trust about what you’re experiencing.
• Caring for your body: Prioritizing your physical well-being throughout your cycle can help you weather PMDD symptoms with greater ease. So try to get enough sleep, eat a balanced diet, and engage in regular exercise you enjoy.
• Making a comfort kit: It can be hard to know what will bring you comfort when you’re experiencing symptoms of PMDD. So take some time to brainstorm ideas when you’re not in your luteal phase. For example, you could create a comfort kit with books, movies, toys, blankets, fuzzy socks, photos, a favorite snack, or other soothing objects.

Find care with Rula

PMDD and autism are two conditions that can make menstruation more difficult, and they frequently occur together. Research estimates that over 90% of menstruating people with autism experience PMDD. So if you’re autistic and your periods are seriously affecting your well-being and quality of life, it could be a sign of underlying PMDD, and you may benefit from professional help. 

No matter the issues you’re facing, you can take an important step toward strengthening your mental health today by contacting Rula. With our therapist-matching program, you can quickly sort through your options and find a provider who takes your insurance in just a few clicks. From there, you can schedule your first live video session with a therapist of your choice as soon as tomorrow.

Find a therapist with Rula