Aging is hard for everyone — but it can be especially difficult for those who struggle with change.

For many women, there’s no greater change than menopause, which signals the end of their reproductive years.

The phase often brings hormonal shifts, hot flashes, night sweats and brain fog, disrupting daily routines.

And for many people with autism, a strict routine helps to manage chaos and lessen anxiety.

That’s why researchers from Bournemouth University in England are sounding the alarm that women with autism may suffer more severe menopausal symptoms than women without autism.

“We know that menopause can be challenging for non-autistic people — the symptoms force 1 in 10 women to leave the workforce,” said study author Eunhee Kim, a PhD student.

“Autistic people can already struggle with memory, planning, managing emotions and sensory sensitivities, and many try hard to fit in and mask their differences while struggling with these things, so menopause could worsen things that are already difficult for them.”

What researchers found

Autism affects an estimated 1 in 45 US adults and is nearly as common in women as in men.

The neurodevelopmental condition influences social communication, interaction and behavior.

Researchers compared the menopause experiences of 476 participants with autism and 425 participants without autism to see how they differed in symptom severity, quality of life, depression and anxiety. Women ranged in age from 40 to 60.

Across the board, participants with autism reported their menopause symptoms were about six points worse than the non-autistic participants.

These symptoms included hot flashes, irregular periods, weight gain, vaginal dryness, headaches, problems with concentration and bladder problems.

Depression and anxiety were nearly four points higher on average among autistic participants.

Quality of life had the most stark difference: autistic participants scored theirs on average 12.14 points lower.

The findings were published Tuesday in the journal Autism in Adulthood.

Authors note that depression, anxiety and quality of life were all linked to the severity of menopause symptoms.

Autistic participants were also much more likely to have serious health conditions. They were twice as likely to have one or more cardiovascular issues, such as heart disease, compared to the control group.

They were also over four times more likely to have a musculoskeletal condition like hypermobility (unstable joints causing frequent injury) and chronic pain.

Many autistic participants also had several serious and chronic health conditions.

Why does autism make menopause harder?

One factor at play is these heart conditions. Kim muses that having pre-existing mental and physical health conditions could make for “an especially difficult time during menopause.”

Her team also found that “feeling out of control and struggling to understand menopausal changes to the body and mind” appeared to predict how severe menopause symptoms would be.

“Autistic people have often told us, ‘I thought I was going mad,’ or ‘I thought I had a disease,’ because their menopausal experiences don’t resemble what they’ve read or heard about in other people,” said study author Julie Gamble-Turner.

“Helping people feel less frightened, confused and out of control — for instance, by giving them information tailored for autistic people about what to expect during menopause — means we are better able to help them.”

Author Rachel Moseley suggests that doctors and other healthcare professionals take note to better help patients with autism.

“Sometimes, doctors do not believe how much they are struggling, perhaps because autistic people do not necessarily show their distress in the way non-autistic people expect,” she said.

“Autistic people can be in crisis yet sound quite calm and logical. It’s so important to believe any person who tells you they are struggling.”