Autistic women report more severe menopausal symptoms than non-autistic women, yet factors explaining this difference remain poorly understood. Executive functioning (EF) may be relevant, because autistic individuals often report EF difficulties and menopause can place substantial cognitive and emotional demands on daily functioning. This cross-sectional study examined whether objective EF performance mediated the association between autism group status and menopausal symptom severity. An exploratory analysis examined psychological distress as a potential mediator. 

Participants were 26 autistic and 33 non-autistic women aged 42–79 years. Menopausal symptoms were assessed using the Menopause Rating Scale, psychological distress using the SCL-90-R, and EF using tasks assessing inhibitory control, cognitive flexibility, and working memory. Autistic women reported significantly more menopausal symptoms and higher psychological distress than non-autistic women. No significant group differences were found for the EF measures. Accordingly, EF did not mediate the relationship between autism group status and menopausal symptom severity. Exploratory analyses provided tentative evidence for an indirect association through psychological distress. 

However, the indirect association appeared to be driven primarily by higher levels of psychological distress among autistic women. These findings do not support objective EF performance as an explanation for elevated menopausal symptom severity in autistic women. Instead, psychological distress may be relevant to the experience of menopausal symptoms in both autistic and non-autistic women. Longitudinal research using larger samples and measures of everyday EF is needed.