Menopause representations as predictors of health and wellbeing during menopause: A comparison study of autistic and non-autistic people

BackgroundMenopause can be a challenging time for health and wellbeing. Research suggests that autistic people may experience menopause differently to non-autistic people, although no explanatory mechanisms for this have been examined. Using a longitudinal approach, we examined whether menopause representations (i.e. thoughts, beliefs and feelings about menopause) are associated with the severity of menopause symptoms, poorer mental health (depressive and anxiety symptoms) and quality of life over time in autistic and non-autistic people.MethodsWe measured menopause representations, menopause symptom severity, quality of life, depressive and anxiety symptoms using self-report standardised scales in 476 autistic and 425 non-autistic participants aged 40-60 years. We collected data over five consecutive weeks. Using mediation analyses, we examined associations between menopause representations and health and wellbeing outcomes (perceived menopause symptom severity, anxiety, depression and quality of life) across all timepoints. ResultsAutistic participants reported more severe menopause symptoms, greater anxiety and depression, and poorer quality of life, across all timepoints. Sense of control and sense of coherence in relation to menopause, two aspects of menopause representations, were significant predictors of health outcomes over time. Feeling less in control and having a less coherent understanding of menopause mediated relationships between being autistic and increased menopause symptoms, depressive and anxiety symptoms, and reduced quality of life, across all timepoints.ConclusionFindings suggest that menopause representations partially explain poorer health outcomes in autistic people who are peri- or postmenopausal, and acknowledge that other mechanisms exist through which aspects of being autistic are associated with these poorer outcomes. While further investigation is needed to identify the mechanisms of health inequalities during and after menopause, our findings suggest that feelings of control and coherence are important for wellbeing during menopause, highlighting the importance of appropriate information and support to help autistic individuals navigate this life stage confidently.