PMS, PMDD, and Autism

PMS vs PMDD: What is the difference?

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are recurring physical, emotional, and behavioral symptoms experienced by many women before menstruation. While PMS commonly includes symptoms like irritability, mood swings, and fatigue, PMDD is a more severe form that brings intense mood disturbances, often significantly impacting daily life.

Though research on PMS and PMDD has often centered around neurotypical individuals, emerging studies reveal that these menstrual challenges have a unique impact on neurodivergent women, especially those with autism or ADHD. Since autism and ADHD involve sensory sensitivities and challenges with emotional regulation, PMS and PMDD symptoms can be much more intense for neurodivergent women. This article explores the connections between neurodivergence, autism, and PMDD, highlighting the need for autism-informed menstrual care.

How Common is PMDD in Neurodivergent Women?

A study conducted in 2008 by researchers Obaydi and Puri found a significant connection between autism and PMDD. According to their findings, 92% of autistic women met the criteria for PMDD, compared to just 11% of their non-autistic peers. This stark difference suggests that PMDD is more prevalent among autistic women, underscoring the need to understand its impact on neurodivergent individuals.

In general, women with autism report heightened sensitivity to physical, emotional, and sensory stimuli during PMS. These symptoms are often much more intense than those experienced by neurotypical women, compounding challenges with sensory sensitivity and emotional dysregulation. For autistic women, this can lead to a more challenging mental health experience each month.

How PMS and PMDD Affect Sensory and Emotional Regulation in Neurodivergent Women

Sensory Sensitivities

For many women with autism or ADHD, PMS brings intensified sensitivity to environmental stimuli, including noise, light, and touch. These sensory overloads can become overwhelming during PMS, creating added layers of discomfort and stress.

Behavioral and Emotional Dysregulation

Autistic and ADHD women may also experience worsened mood swings, irritability, and emotional instability during PMS. These challenges can increase the likelihood of meltdowns or periods of emotional overwhelm, making it even harder to manage daily tasks and responsibilities.

Executive Functioning and Nervous System Imbalances

Executive dysfunction and difficulties in planning and organizing are common for neurodivergent individuals. During PMS, these challenges often worsen due to hormonal changes that affect the autonomic nervous system (ANS), making self-regulation and daily routines even more challenging.

Hormones, the Nervous System, and How They Contribute to PMS and PMDD in Autism

Hormone-Induced Nervous System Changes

Hormonal fluctuations during the menstrual cycle can disrupt the autonomic nervous system, which helps regulate physiological responses and emotional balance. For women with PMDD, studies show decreased heart rate variability (HRV), which may indicate ANS dysfunction. This imbalance can make neurodivergent individuals more sensitive to PMS and PMDD symptoms, amplifying sensory discomfort and emotional dysregulation.

Heightened Sensory Sensitivity

Autistic and ADHD individuals already experience heightened baseline sensory sensitivity. When hormonal shifts occur during PMS, these sensitivities can intensify, increasing susceptibility to sensory overload, mood swings, and difficulties in emotional regulation. Many women find that the days leading up to their period bring added stress, anxiety, and sensory discomfort.

Challenges with Social Situations and Daily Life

For many neurodivergent women, PMS-related sensory sensitivities and emotional changes can make social situations, work, and daily tasks overwhelming. As Kirsty Kendall, a researcher and writer on this topic, has noted, autistic women often find it particularly challenging to manage obligations and routines during PMS due to sensory overload and heightened stress.

Current Research on PMDD and Autism

Observational and Qualitative Studies

Studies like Obaydi and Puri’s research (2008) use observer-based assessments to evaluate fluctuations in PMS symptoms over several menstrual cycles. These methods allow researchers to identify patterns in the ways PMS affects autistic women compared to neurotypical women. Qualitative surveys and thematic analysis also provide insights by capturing the voices of autistic women, revealing personal experiences of sensory overload and emotional struggles during PMS.

Challenges in Researching PMS and Autism

Communication barriers in autism and ADHD can make it difficult to collect accurate data through traditional self-reporting methods. Researchers now recognize the need for new approaches that accommodate neurodivergent communication styles to improve our understanding of PMS and PMDD in autism and ADHD populations.

What Studies Say About PMDD and Autism

Increased Rates of PMDD

The 2008 Obaydi and Puri study found that 92% of autistic women met PMDD criteria, highlighting a significant increase in severe premenstrual symptoms compared to non-autistic women. Other studies have documented commonly reported symptoms like irritability, sleep disturbances, mood swings, and sensory overload, which tend to be more intense for neurodivergent women.

Sensory Overload triggered by PMS

Many autistic and ADHD women describe PMS as a period of increased sensory discomfort, which can make managing daily responsibilities particularly challenging. Themes from survey studies highlight the need for better menstrual education, coping strategies, and support for neurodivergent individuals in managing PMS symptoms.

Why Neurodivergent Women Experience PMS Differently

Stronger Impacts on Daily Life

Research shows that PMS symptoms are often more severe for autistic and ADHD women than for their neurotypical peers, leading to increased sensory and emotional challenges each month. Hormonal sensitivity and nervous system imbalances may increase the intensity of PMS symptoms, affecting neurodivergent women more acutely.

How Healthcare Providers Can Help

For healthcare providers, understanding the unique needs of autistic and ADHD women during PMS is crucial. Sensory-friendly healthcare approaches, adaptive support strategies, and regular screenings for PMDD can help providers offer more effective care. Menstrual education should also be adapted to be accessible for neurodivergent women and their caregivers, with clear information on what to expect and ways to manage symptoms.

Conclusion: The Need for Research and Support

The high prevalence and intensity of PMDD in autistic women, combined with sensory sensitivities, executive dysfunction, and emotional regulation difficulties, create significant monthly challenges. ADHD women also face similar difficulties, underscoring the need for further research on PMS and PMDD across neurodivergent groups.

Advocacy and Research Gaps

More interdisciplinary studies on the biological and psychological aspects of PMS and PMDD in neurodivergent individuals are necessary to improve our understanding. Developing autism-informed support systems will help autistic and ADHD women manage PMS and PMDD symptoms, leading to a better quality of life and mental health outcomes.
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PMS vs PMDD: What is the difference?

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) represent recurring sets of physical, emotional, and behavioral symptoms that many women experience before menstruation. PMS often includes irritability, mood swings, and fatigue, while PMDD encompasses more intense mood disturbances that significantly impact daily functioning.

Though research on PMS and PMDD has often centered around neurotypical individuals, emerging studies reveal that these menstrual challenges have a unique impact on neurodivergent women, especially those with autism or ADHD. Since autism and ADHD involve sensory sensitivities and challenges with emotional regulation, PMS and PMDD symptoms can be much more intense for neurodivergent women. This article explores the connections between neurodivergence, autism, and PMDD, highlighting the need for autism-informed menstrual care.

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How Common is PMDD in Neurodivergent Women?

A 2008 study by Obaydi and Puri revealed striking findings: 92% of autistic women with were reported to meet PMDD criteria, compared to just 11% of their non-autistic counterparts. This significant difference highlights a need to consider PMS and PMDD’s heightened impact on neurodivergent women.

Autistic and ADHD women often report increased sensitivity to physical, emotional, and sensory stimuli during PMS. These symptoms compound the daily challenges of autism and ADHD, intensifying issues with sensory sensitivity, emotional dysregulation, and overall mental health.

PMDD Symptoms and Challenges Unique to Autistic Women

• Sensory Sensitivities: Women with autism report heightened sensitivity to stimuli like noise, light, and touch during PMS. The sensory overload can become overwhelming.
• Behavioral and Emotional Dysregulation: PMS exacerbates mood swings, irritability, meltdowns, and emotional control difficulties in neurodivergent women. For those with autism, these symptoms can lead to pronounced emotional upheavals.
• Executive Function and Autonomic Dysfunction: PMS and PMDD may worsen executive dysfunction, and altered autonomic nervous system (ANS) activity can further complicate planning, organization, and self-regulation.

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The Link Between ADHD, Autism, PMDD, and PMS

Hormonal Influence and Autonomic Nervous System (ANS) Dysfunction

• Altered ANS Activity in PMDD: Studies indicate that PMDD is associated with reduced heart rate variability (HRV), suggesting ANS dysfunction potentially caused by hormonal fluctuations. Hormone-induced ANS changes can intensify both physiological and emotional dysregulation, which may lead to more intense premenstrual symptoms for autistic and ADHD individuals, who are often highly sensitive to fluctuations.
• Nervous System Hypersensitivity in Autism and ADHD: Neurodivergent individuals often display heightened baseline sensory sensitivity. During PMS, hormone fluctuations amplify these sensitivities, making autistic and ADHD women more vulnerable to sensory overload and mood disturbances.

Impact on Daily Functioning and Social Life

• Real-World Implications: For many neurodivergent women, PMS-related sensory sensitivities and mood swings lead to avoidance of social interactions and difficulty managing tasks at work or home. In Kirsty Kendall’s work, autistic women reported finding it especially hard to manage daily tasks and social obligations during PMS due to extreme sensory discomfort and overstimulation.
• Functional Limitations: Fatigue, anxiety, and overstimulation restrict the ability of autistic and ADHD women to maintain routines and participate in social activities, thereby impacting their quality of life.

Methodologies in Current Research on PMDD and Autism

Study Design in Existing Literature

• Quantitative and Observer-Based Approaches: Studies like Obaydi and Puri’s 2008 research employed observer-rated assessments conducted daily over menstrual cycles to capture fluctuations in PMS symptoms more accurately.
• Qualitative Surveys: Surveys and thematic analysis provide valuable insights into the subjective experiences of autistic women, revealing unique menstrual challenges that traditional research may overlook. For instance, survey findings often highlight autistic women’s struggles with emotional regulation and sensory overload during PMS, underscoring the need for more personalized support and understanding.

Challenges in Assessing Autism, ADHD, and PMS

• Limitations in Self-Reporting for Neurodivergent Individuals: Communication challenges in autism and ADHD can hinder accurate self-reporting of PMS symptoms.
• Potential Biases and Future Directions: Tailored research methodologies that account for neurodivergent communication differences are essential for a fuller understanding of PMS and PMDD in autism and ADHD populations.

Implications for Clinical Practice

• Tailored Gynecological Care: Specialized healthcare approaches that consider sensory needs and adaptive support are crucial for helping autistic and ADHD women manage cyclic symptoms effectively. Healthcare providers should also consider regularly screening autistic women for PMDD, given the high prevalence observed in research like Obaydi & Puri’s study.
• Improved Menstrual Education and Support: Accessible and neurodivergent-sensitive educational materials on menstrual health are essential for both autistic and ADHD women and their caregivers. These materials should include sensory-friendly resources and provide clear explanations of menstrual health changes, addressing the unique ways autistic and ADHD women experience PMS and PMDD.

Conclusion

This review highlights the elevated prevalence and severity of PMDD in autistic women, compounded by sensory sensitivities, executive dysfunction, and emotional dysregulation. Similar challenges exist in ADHD populations, underscoring the need for research on PMS and PMDD across neurodivergent groups. Further interdisciplinary studies are needed to explore the biological and psychological aspects of PMS and PMDD in neurodivergent individuals. Developing tailored clinical and social support systems can improve the quality of life for autistic and ADHD women managing PMS and PMDD, leading to better mental health and daily functioning.

References

Steward, Robyn, et al. “‘Life Is Much More Difficult to Manage During Periods’: Autistic Experiences of Menstruation.” Journal of Autism and Developmental Disorders, vol. 48, no. 12, 2018, pp. 4287–4292. https://doi.org/10.1007/s10803-018-3664-0.

Obaydi, Hazim, and B. K. Puri. "Prevalence of Premenstrual Syndrome in Autism: A Prospective Observer-Rated Study." The Journal of International Medical Research, vol. 36, no. 2, 2008, pp. 268–272. https://doi.org/10.1177/147323000803600208.

Kendall, Kirsty. "This Is Why PMS Is a Struggle for Autistic Women." Kirsty Kendall Blog, 10 Feb. 2023. https://kirstykendall.com/pms-autistic-women/.

Groenman, Annabeth P., et al. “Menstruation and Menopause in Autistic Adults: Periods of Importance?” Autism, vol. 26, no. 6, 2022, pp. 1563–1572. https://doi.org/10.1177/13623613211059721.

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FAQ

Is PMDD and autism linked?
Yes, research suggests a link between PMDD (Premenstrual Dysphoric Disorder) and autism. PMDD affects people of various neurotypes but appears to be more common in individuals with autism and ADHD. Those with autism may experience increased sensory sensitivities, emotional dysregulation, and executive dysfunction, which can intensify during PMDD. This heightened impact underscores the importance of understanding how PMDD uniquely affects neurodivergent individuals.

What is the rate of PMDD in autism?
Studies indicate that PMDD disproportionately affects individuals with autism. Research, such as the Obaydi & Puri study, found that up to 92% of autistic women met the criteria for PMDD. Although estimates vary, this suggests that autistic women may experience PMDD at significantly higher rates than neurotypical populations, emphasizing the need for targeted support and healthcare approaches.

Can PMS make autism symptoms worse?
Yes, PMS can exacerbate autism symptoms. During PMS, individuals with autism often report heightened sensory sensitivities, increased anxiety, irritability, and more frequent meltdowns. Emotional regulation and executive functioning challenges may also worsen, making daily tasks and social interactions more difficult during this time. This link highlights the importance of providing autism-informed care for managing PMS symptoms.

Is PMDD a recognized disability?
In some regions, PMDD is considered a recognized disability, particularly when symptoms are severe enough to impair daily functioning. For autistic individuals who experience intensified PMDD symptoms, recognizing PMDD as a disability can help access tailored healthcare support, accommodations, and resources that address both menstrual health and neurodivergent needs.

Can PMDD cause sensory issues?
Yes, PMDD can intensify sensory issues, especially for individuals with autism or ADHD, who already experience heightened sensory sensitivity. Hormonal changes during the menstrual cycle may worsen reactions to stimuli such as light, sound, or touch, making everyday environments feel overwhelming. This can lead to increased discomfort, anxiety, and challenges in social and work settings.

Is PMDD a form of autism?
No, PMDD is not a form of autism. PMDD is a severe form of premenstrual syndrome characterized by intense mood and behavioral symptoms that occur in the luteal phase of the menstrual cycle. However, PMDD and autism can co-occur, and research suggests that neurodivergent individuals, including those with autism, may be more susceptible to PMDD and its symptoms.

References

Steward, Robyn, et al. “‘Life Is Much More Difficult to Manage During Periods’: Autistic Experiences of Menstruation.” Journal of Autism and Developmental Disorders, vol. 48, no. 12, 2018, pp. 4287–4292. https://doi.org/10.1007/s10803-018-3664-0.

Obaydi, Hazim, and B. K. Puri. "Prevalence of Premenstrual Syndrome in Autism: A Prospective Observer-Rated Study." The Journal of International Medical Research, vol. 36, no. 2, 2008, pp. 268–272. https://doi.org/10.1177/147323000803600208.

Kendall, Kirsty. "This Is Why PMS Is a Struggle for Autistic Women." Kirsty Kendall Blog, 10 Feb. 2023. https://kirstykendall.com/pms-autistic-women/.

Groenman, Annabeth P., et al. “Menstruation and Menopause in Autistic Adults: Periods of Importance?” Autism, vol. 26, no. 6, 2022, pp. 1563–1572. https://doi.org/10.1177/13623613211059721.

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