Hadjikhani, N.

Lucka, I.

Moseley, Rachel

Ossolińska, A.

Rynkiewicz, A.

Turner-Cobb, Julie

Bournemouth University Research Online

Treatment of menopausal vasomotor symptoms (VMS) and sensory issues: A case-based approach in a 53-year-old Caucasian autistic womanAgnieszka Rynkiewicz1,2, Nouchine Hadjikhani3,4, Rachel Moseley5, Julie Turner-Cobb5, Agata Ossolińska6, Izabela Łucka71Department of Psychiatry, College of Medical Sciences, University of Rzeszow, POLAND 2Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdansk, POLAND, ³Department of Radiology, Harvard Medical School & Neurolimbic Research Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA, ⁴Gillberg Neuropsychiatry Center, University of Gothenburg, SWEDEN, 5Department of Psychology, Bournemouth University, UK, 6Students Research Club, College of Medical Sciences, University of Rzeszow, POLAND, ⁷Department of Developmental Psychiatry, Psychotic and Geriatric Disorders, Medical University of Gdansk, POLANDConclusionsIntensity of the menopausal VMS symptoms were observed in relation to strength ofsensory issues. HRT alleviated majority of VMS experienced by the patient. Sensoryperception and intellectual processing appeared to influence how VMS symptoms wereinterpreted, labeled, and reported. Since gynecologists often lack fundamental knowledgeon ASD, this highlights the need for further research to inform treatment plans, includingHRT and non-pharmacologic approaches that could be offered to autistic women duringmenopause.(…) The financing of the ECHO project reflects itsintention to help those in need, therefore the ECHOmodel programs cannot charge any fees or benefitfrom it. The ECHO Autism model in Poland isfinanced/funded like the programs from the USAand other countries in the world, for example fromgrants, competitions and other forms that mayfinancially support the dissemination of diagnosticstandards and best practices and medical care forpatients with ASD (...). (Domarecki et al. 2022;Rynkiewicz et al. 2022; Sohl et al. 2022).References:1. Rynkiewicz A, Janas-Kozik M, Słopień A. Girls and Women with Autism. Psychiatr. Pol. 2019; 53(4),737–752.2. Groenman, A. P., Torenvliet, C., Radhoe, T. A., Agelink van Rentergem, J. A., & Geurts, H. M. (2022). Menstruation and menopause in autistic adults:  Periods of importance? Autism, 26(6), 1563–1572. 3. Karavidas M, de Visser RO: “It’s not just in my head, and it’s not just irrelevant”: autistic negotiations of menopausal transitions. J Autism Dev Disord 2022; 52: 1143–1155.4. Moseley RL, Druce T, Turner‐Cobb JM: Autism research is ‘all about the blokes and the kids’: autistic women breaking the silence on menopause. Br J Health Psychol 2021; 26: 709–726.5. Domarecki P, Plata-Nazar K, Rynkiewicz A et al.: ECHO Autism model in the context ofgrowing need to incorporate the pediatricians and general practitioners in acomprehensive care for autism spectrum disorder patients in Poland. PrzeglądPediatryczny 2022; 51:4, 47-51.6. Rynkiewicz A, Łucka I, Grylowska G et al.: The future of telehealth for patients withautism spectrum disorder based on the example of Extension for Community HealthOutcomes (ECHO) Autism – a global model introduced in Poland. Psychiatr PsycholKlin 2022; 22:2, 95–99.7. Sohl K, Rynkiewicz A, Nanclares-Nogués V et al.: Project Extension for CommunityHealth Outcomes (ECHO) Autism: a successful model to increase capacity incommunity-based care. Brain Sci 2022; 12: 327.8. Attwood, T., Garnett, M. S., & Rynkiewicz, A. (2011). Girls Questionnaire for Autism Spectrum Conditions (GQ-ASC) [Measurement instrument].9. Brown, C. M., Attwood, T., Garnett, M., & Stokes, M. A. (2020). Am I Autistic? Utility of the Girls Questionnaire for Autism Spectrum Condition as an Autism Assessment in Adult Women. Autism in Adulthood, 2(3), 216-226.Funded by Ministry of Education and Science Republic of Poland (MEiN), grant SKN/SP/535279/2022 and the institutional funds of College of Medical Sciences, University of Rzeszow, Poland. Approved by the Ethics Committee of College of Medical Sciences, University of Rzeszow (KB-2022/093). ACKNOWLEDGEMENTSWe would like to thank our Global ECHO Autism Communities Liaisons and Supporters:Kristin Sohl, MD, FAAP, Alicia Curran, BS, Grad. Cert., Robin Hardesty, Somer Bishop, PhD,Artur Mazur, MD, PhD, Dorota Darmochwał-Kolarz, MD, PhDResults• Magnetic resonance imaging (MRI) of the pituitary gland: smooth-bordered oval focuswith dimensions of approx.4.5x3x4mm in the anterior part of the frontal lobe =microadenoma. A fluid focus of approx.2.5mm between the upper parts of the pituitarylobes = like that in Rathke's pouch cyst.• Initially, hyperprolactinemia was diagnosed with a level of 1425.25 mU/l (normalrange: <557.1), and in the MCP test, there was no increase in prolactin concentration;levels of 1176.4 and 1033.1 mU/l - suggestive of prolactinoma.• The initial cortisol concentration was normal at 360.2 nmol/l with an appropriateACTH concentration of 13.3 pg/ml, and there was complete cortisol suppression at32.7 nmol/l in the 1g DXA test.• Normal IGF concentration of 130.9 ng/ml.• Normal electrolyte balance, blood glucose levels, TSH, FT3, FT4.• Breast ultrasound: Cysts, Ø approx. 4.2 to 11mm visible in both breasts. Transvaginalultrasound and cytological exam: both unremarkable.• Difficulties in functioning and unusual sensory interests: ADOS-2 (Module 4) SA+RRB(11), D1(2)/D2(1)/D4(2)/D5(1); SCQ Lifetime (26), AQ (33), I&B in ADI-R.• MENQOL: hot flashes, night sweats, foggy thinking, vaginal dryness, mood swings andanxiety decreased while aching in muscles and joints, low backache, feeling tired, wornout persisted after HRT implementation.• The patient responded positively to Mindfulness meditation and continued regularsessions beyond the project.• Treatment: Systen Conti (3.2mg Estradiolum + 11.2mg Norethisteroni acetas) - 1 patchtwice a week. Vitamin D3 supplementation; Devikap 4000 IU - 1 tabl./day. Dostinex(Cabergolinum 0.5mg) ½ tabl./week for the hyperprolactinemia, well tolerated by thepatient.CONTACT INFORMATIONAgnieszka Rynkiewicz, MD, MAT, PhD  email: arynkiewicz@ur.edu.plObjectivesTo investigate menopausal vasomotor symptoms (VMS) experienced by an autistic womanand examine whether symptoms were linked to autistic traits and sensory issues.BackgroundAdult autistic women are still under-recognized (Rynkiewicz et al. 2019). Of more than onebillion women aged 50 and over, it is unknown how many are autistic and experiencingmenopause. Still considered a taboo topic in many societies, little research exists on howmenopause affects autistic women’s health and well-being. Existing studies suggest thisoften-difficult transition period is associated with many unmet health needs, a frustratinglack of knowledge and support from healthcare professionals, and an absence of resourcesdedicated to this population (Karavidas & Visser 2022; Rynkiewicz et al. 2022; Moseley et al.2021). Menopausal vasomotor symptoms (VMS), or hot flashes and night sweats, arecardinal symptoms of menopause. While VMS are experienced by most women duringmenopause, in autistic women such symptoms may intensify and worsen sensorysensitivities (Groenman et al. 2022). Recently, more adult women without intellectualdisability have pursued a formal autism diagnosis to define their own autistic identity. Thisoften helps them learn to more effectively recognize warning signs of sensory difficulties andmeltdowns, and can lead to the self-discovery of unexpected strength, resilience, andconfidence in advocating for their needs.Methods53-year-old Caucasian autistic woman, diagnosed with ASD at age 43 by a trainedpsychiatrist, no ID, currently experiencing menopausal symptoms. Anxiety and depressionpreviously recorded and treated pharmacologically, currently no other comorbidities orsomatic illnesses and no medications at the start of recording. Examinations and testscompleted or retrived from the patient’s medical record over the period of 7 months of thestudy: transvaginal, breast ultrasound and cytological exams; hormonal lab testings;magnetic resonance imaging (MRI) of the pituitary gland; ADOS-2 (Module 4); ADI-R (retrivedcodes under Interests & Behaviors: the items 67-79); a modified version of GQ-ASC/Q-ASC(Girls’ Questionnaire for ASC) for adult women (Attwood, Garnett, Rynkiewicz [measurementinstrument 2011] modified by Brown et al. 2020); SCQ Lifetime; AQ; and MENQOL. The patientparticipated in the Mindfulness sessions. Hormone replacement therapy (HRT) wasintroduced to ameliorate symptoms of estradiol and progesterone deficiency.

Treatment of menopausal vasomotor symptoms (VMS) and sensory issues:  A case-based approach in a 53-year-old Caucasian autistic woman

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Treatment of menopausal vasomotor symptoms (VMS) and sensory issues: A case-based approach in a 53-year-old Caucasian autistic woman

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