Mental HealthPregnancy and Newborn Health

Autism: Reproductive Health in Autistic Adults

Until the 1990s, it was considered that Autism was prevalent only in young boys and men. Recently, studies have shown that for every 3 to 4 men affected with autism, there is 1 woman diagnosed with autism. The major issue is that women are diagnosed at a much later stage sometimes in their 30s and 40s as women have the ability to mimic non-autistic individuals by camouflaging their symptoms.

MedPiper Technologies and JournoMed with Daffodil Health conducted a webinar on April 22, 2022, titled “Celebrating Autism – An Awareness Webinar in Association with Daffodil Health” where the speaker Dr. Poongothai Balaji covered the reproductive health, obstetrics and gynaecology healthcare in autistic adults.

She is a consultant in the Obstetrics and Gynaecology Department and the founder of the Nalam Foundation. She was able to reach more than one lakh women in urban and rural areas focusing on preventing breast and cervical cancer. Her organization is largely working around schools and colleges emphasizing the hazards of alcohol, tobacco and STDs.

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What are the causes behind Autism?

It is a multifactorial condition- genetic, environmental and increasingly more and more persons are being diagnosed with autism.

When do health care professionals come in contact with Autistic patients?

  • As a referral from a clinical psychologist or psychiatrist usually a prepubescent individual.
  • In case of an unwanted pregnancy.
  • An individual requesting contraception.

Pre-Pubertal Stage

  • There is a false perception that individuals with autism are asexual. Often, caregivers approach gynaecologists when seeking to suppress menstruation for autistic girls. We need to ensure that the young female gets sufficient estrogen for development and not suppress menstruation. Young girls can easily be taught how to manage their menses with hygienic practices. If later on they are not able to manage menstruation, only then we must look into suppressing menses and providing contraception.
  • The most commonly used methods are giving Depo-Provera, continuous combined oral contraceptive pills for 8 weeks and then they have breakthrough bleeding, progesterone-only pills, GnRH analogues, Levonorgestrel intrauterine device. These have a drawback that they decrease bone marrow density and cause weight gain. COCP increases the risk of thromboembolism, cervical and breast cancer.
  • Secondly, there is another false belief that young girls with autism have early menarche. What they do suffer from is irregular and heavy bleeding.
  • We must focus on the sexuality of the girl which refers to the overall healthy development towards sex including the way the young girl feels towards her changing body, understands the emotional component including intimacy, attraction and feelings towards others so as to build a long standing relationship. A holistic approach by providing adequate sex education is necessary. Sex education is also necessary so they do not develop hypersexuality, paraphilia and sexual offences. This will also help in the prevention of sexually transmitted diseases.
  • Studies suggest that 15-35% of individuals suffering from autism have a homosexual or bisexual orientation.
  • Women in intense relationships have good camouflaging skills. They are not able to sustain their relationships and they find sexual relationships very unpleasant, more so than boys affected with autism. They may also be victims of sexual assault.
  • There is a false belief that women with autism suffer more from premenstrual syndrome but it is, in reality, equivalent to their non-autistic counterparts.
  • Consent for these children is tricky when inserting an intrauterine device. In the UK, a high court order is needed before inserting the device.

Reproductive Age Group: Can individuals with autism become parents? The Dos and Don’ts.

  • Depending on the spectrum, individuals may or may not be able to get pregnant.
  • Individuals with mild autism often have queries regarding their children experiencing autism as well. There is no prenatal diagnostic test for autism and there are about 100 to 200 genetic variations involved in autism so we can’t pinpoint the specific cause.
  • But many studies have proved that the chances of the child having autism are more when both the parents are affected and when both the parents are aged higher. Non-autistic parents also have the risk of having children with autism in the future because the mutation keeps changing.
  • Complications for the women who do get pregnant include difficulty in adapting to the physiological changes in pregnancy, especially in the first and last trimester. For this, they need to be counselled appropriately.
  • The risk of the child having autism increases when the mother is suffering from gestational diabetes. Since preterm labour is very common, they might have to terminate their pregnancy. The risk also increases if the mother suffers from anaemia.
  • If the autistic individual is obese at the start of their pregnancy, there is a risk of pre-eclampsia.
  • These issues must be explained to both the primary caregivers and the individual.
  • Antiepileptics must not be stopped as the incidence of epilepsy increases in pregnancy and the child might be at risk due to hypoxia.

Menopausal Age 

  • Although the age of onset of menopause is the same, the intensity of the symptoms is much higher in autistic individuals. We must ensure that they receive calcium supplements. If required, hormone replacement therapy should be given in the long term.
  • Studies suggest that ASD individuals have an average life span of around 35 years. For individuals with autism without learning disabilities, their life span is around 56 years as they are at a higher tendency of suicide.

Since it’s not a visible disability and there is a lack of awareness, parents have a tough time coming to terms with the child’s autism especially if it’s on the milder side. The need of the hour is the increase awareness and sustained educational programs, especially for healthcare workers and the caregivers. We also need more research on autism and how to provide care socially and economically.

Some of the updates in the diagnosis and early intervention of autism are coming up. One such tool is used by ophthalmologists to track the eye movement of children during nursery rhymes and predict if the child is at risk of developing autism. We should show more empathy toward autistic patients and a more case-based approach needs to be taken over a protocol-driven approach. A multidisciplinary approach along with consulting various stakeholders and prolonged counselling time for patients is the most viable option.

Author

Rupali Sachdev

Rupali Sachdev is an intern doctor at Grant Medical College and Sir JJ Group of Hospitals in Mumbai. With experience in writing, design, medical technology, public speaking, and social service, she believes that doctors need to broaden their horizons and look at patient care more holistically.

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