Sensory Inclusive Schools

In our most recent Sensory Inclusive Schools drop-in session, we discussed how, for some girls, women, and people who menstruate, hormonal fluctuations across the menstrual cycle may affect sensory capacity. This means that the same sound, smell, light, touch, movement or internal body sensation may feel very different at different points in the month. Noise may feel sharper. Clothing may feel more irritating. Smells may feel stronger. Pain may feel harder to ignore. Temperature may feel more uncomfortable. Movement may feel more effortful. Busy environments may feel much harder to manage.

This does not mean the person is being inconsistent. It does not mean they are being avoidant. It does not mean a strategy has stopped working. It may mean their sensory system is working with a different level of capacity because of what is happening inside their body.

Hormones are part of that internal sensory picture. Oestrogen and progesterone do not only have a role in reproductive health. They also interact with the nervous system and may influence some of the processes involved in sensory processing, including arousal, pain modulation, sensory gating, sensory thresholds and the integration of sensory information.

Sensory gating is one way the nervous system filters information. It helps us reduce our response to repeated or less relevant input so that we can attend to what matters. When hormone levels fluctuate across the menstrual cycle, pregnancy, the postnatal period, perimenopause or menopause, some people may notice that sensory input feels different in the ways described above.

But it is not only the hormone change itself that matters. Other internal body experiences that differ during different stages of the menstrual cycle can also affect sensory regulation. Pain, discomfort, bloating, nausea, headaches, changes in bowel habits, constipation, diarrhoea, poor sleep and fatigue can all reduce capacity. If the body is already working hard to manage internal sensations, there may be less capacity available for noise, touch, movement, social interaction, learning or personal care.

Why tracking may help

Some young people and their families find it helpful to keep a private record of sensory experiences across the month. This is entirely a personal choice and is not something schools should ask for or expect to see. The purpose is simply to help the individual, and those close to them at home, notice whether certain times of the month are more difficult, so they can plan ahead and seek appropriate adjustments if needed.

Where a young person or family does identify a pattern, they may choose to share that information with school in general terms — for example, flagging that certain days are likely to be harder. What this means in practice is that sensory strategies, environments and task demands may need to flex across the month. A student who usually benefits from movement may need more rest on some days. A young person who usually manages noise with headphones may also need access to a quieter space. A student who usually copes with uniform may need a more comfortable alternative at certain times.

Using the PEO Model

The Person, Environment, Occupation model gives us a helpful way to think about hormone fluctuations and sensory capacity.

The person is not just their sensory profile. They are a whole body. We need to think about pain, fatigue, sleep, temperature, interoception, emotional capacity, body awareness, hormone changes and body discomfort. Changes in bowel habits, bloating, constipation, diarrhoea, nausea or period pain may all affect how much capacity someone has to regulate, engage and participate.

The environment is not neutral. Bright lights, noisy corridors, busy classrooms, shared toilets, strong smells, crowded dining halls, unpredictable routines, and lack of privacy can all add sensory load. But the important point is that the environment that works well at one point in the cycle may not work as well at another. A student who can usually manage the dining hall may need a quieter space during times of increased pain, fatigue or smell sensitivity. An adult who can usually manage a shared bathroom may need more privacy, warmth or predictability when their body feels more uncomfortable.

The occupation also matters. Dressing, washing, changing period products, sitting still, concentrating, eating, joining PE, travelling, socialising and attending lessons all require sensory, motor, emotional and cognitive capacity. These occupations may need to be adjusted depending on the person’s cycle. The task may need to happen at a different time, in a different place, with different clothing, with more support, with less language, with more privacy, or with more time for rest and recovery afterwards.

When hormone fluctuations and body discomfort reduce capacity, the task may need to change. The environment may need to change. The expectation may need to change. Not forever. Maybe just for today. Maybe just for a few days each month. But those few days matter.

The aim is not to remove all demands. The aim is to match the environment and occupation to the person’s current capacity, so participation becomes more possible.

Hormone changes happen across the lifespan

This is not only about the menstrual cycle. Hormone changes during puberty, pregnancy, the postnatal period, perimenopause and menopause may also affect sensory capacity.

During puberty, a student may be managing body changes, social demands, emotional changes, pain, fatigue and new personal care routines, all while still being expected to manage the sensory demands of school.

During pregnancy, smell, touch, temperature, pain, movement, sleep and body awareness may all change. After birth, sensory capacity may be affected by sleep deprivation, feeding demands, body recovery, noise, touch and the constant sensory input involved in caring for a baby.

During perimenopause and menopause, changes in sleep, temperature regulation, pain, fatigue, emotional capacity and sensory tolerance may also affect daily participation.

This is why hormone fluctuations should be part of our sensory thinking across the lifespan.

The key message

When support appears to stop working, we often ask what has changed in the environment, what has changed in the task, or what has changed in the behaviour. These are important questions, but we also need to ask what has changed in the body.

For some people, hormone fluctuations can change sensory thresholds, body awareness, emotional capacity, pain, fatigue and tolerance of everyday sensory input. The internal body experiences that may come alongside these changes — such as pain, discomfort, nausea, bloating or changes in bowel habits — can further affect their ability to regulate, engage and participate.

Best wishes

Beth