Understanding the impact of prior depressive and anxiety symptoms and autism diagnosis on menopause symptoms

Background There is growing awareness from qualitative research studies that menopause may be particularly challenging for autistic people. Research in the general population suggests that preexisting conditions may be a risk factor for negative experiences during menopause. However, there are limited studies examining variables associated with experiences of menopause symptoms for autistic people. Objectives To explore whether pre-existing depression and anxiety symptoms impact menopause symptoms for autistic and non-autistic people. Design The study design is classified as STROBE. Methods Autistic (n=52) and non-autistic (n=28) people assigned female at birth participated in the longitudinal AgeWellAutism (AWA) study. They reported self-report depression and anxiety symptoms at baseline and menopause symptoms (Greene Climacteric Scale) at follow-up after 4.5 years. Age, autism diagnosis and autism characteristics of mentalising difficulties, sensory reactivity, and social anxiety (subscales from the self-reported Ritvo Autism and Asperger Diagnostic Scale, RAADS) were recorded. Results Regression analyses were conducted with menopause symptoms as the dependent variable and as independent variables: Step 1, age; Step 2, baseline depression and anxiety symptoms, Step 3, autism diagnosis (alternative step 3, RAADS subscales). In the final regression model, younger age, higher baseline depression and autism diagnosis contributed significantly to explaining menopause symptom severity. In the alternative model (including subscales of the RAADS), younger age, higher baseline depression, mentalising difficulties and sensory reactivity contributed significantly to explaining menopause symptom severity. Conclusions Results align with research from the general population suggesting that a history of depression symptoms increases risk of negative experiences during menopause, furthermore, being autistic confers additional risk. Further studies examining the influence of lifetime experiences on menopause symptoms for neurodivergent people are required to better understand and mitigate risk during this critical time.