The Pubertal and Menstrual Experiences of Autistic Females: What are the Implications for Education and Support?

Many autistic girls experience misdiagnoses and often feel overlooked, misunderstood, unsupported, and exhausted from trying to fit into an unaccommodating neurotypical world. Early adolescence brings additional challenges, including the onset of puberty. This systematic literature review summarised research on autistic girls' and women's experiences of puberty and menstruation, alongside the perspectives of their caregivers. The review also explored what effective support looks like and considered whether autistic voices are included in intervention design and evaluation. Including autistic voice in research is essential to ensure literature reflects issues most important to autistic individuals and leads to meaningful support. Using narrative synthesis, findings from 17 studies described autistic females' preparation for and experiences of puberty and the support they desire. Challenges included limited education before puberty, negative impacts on wellbeing, difficulties with menstrual self-care, and the interaction between autism and pubertal changes. While some alignment existed between desired support and intervention focus, particularly regarding self-care, most intervention studies lacked autistic input and focused on within-child change. Recommendations include early education emphasising the normality of puberty and menstruation, promoting self-care, dignity, advocacy, individualised support, and greater inclusion of autistic voices in research and practice.Lay AbstractMany autistic girls are diagnosed late, wrongly diagnosed, or not diagnosed at all. They can feel misunderstood, unsupported, and very tired from trying to fit into a world that is not designed for them. The early teenage years and puberty can be a particularly difficult time. It is important that research includes the voices of autistic people so that studies focus on what matters most to them and lead to better support. This review included 17 studies about autistic girls' and women's experiences of puberty and periods, as well as the views of parents and caregivers. The aim was to understand what challenges autistic girls face during puberty and what kinds of support help the most. The findings showed that many autistic girls did not receive enough education about puberty before it started. Puberty could also affect their wellbeing and make some things harder, such as managing period care. Some support programmes teach practical self-care skills, which matches what many girls say they need. However, most programmes were designed without input from autistic people. The review suggests earlier education about puberty, support for self-care and independence, and greater involvement of autistic people in research and support design are needed.