Rethinking Clinical Visibility in Autistic Females: Autistic Camouflaging and Menstrual Cycle Variability

Autism spectrum disorder (hereafter autism) is increasingly recognised as being underdiagnosed in females worldwide, contributing to inequalities in clinical visibility and access to appropriate care. The clinical visibility of autism in females is influenced by diagnostic practices historically developed using predominantly male samples, which may be less sensitive to less overt or more socially camouflaged presentations. Greater levels of autistic camouflaging, including masking, compensations, and assimilation, have been proposed as one factor contributing to differences in the presentation of autism between males and females. However, camouflaging is resource-intensive, associated with significant psychological costs, and varies across contexts. Because camouflaging relies on cognitive-emotional resources, it may also fluctuate under conditions that influence these resources, such as the menstrual cycle. To date, no empirical research has directly investigated this relationship. This opinion article proposes the conceptual hypothesis that menstrual cycle-related fluctuations may influence the cognitive-emotional resources required for autistic camouflaging, with potential implications for clinical visibility, diagnostic recognition, mental health, and equitable access to care. By synthesising indirect evidence from autism, camouflaging, and menstrual health research, this conceptual framework aims to guide future empirical investigation and highlights the urgent need to better understand this overlooked intersection to improve diagnostic equity, clinical recognition, and women's health outcomes globally.