Menopause Representations as Predictors of Health and Well-being During Menopause: A Comparison Study of Autistic and Non-Autistic People

Background: Menopause can be a challenging time for health and well-being. Research suggests that autistic people may experience menopause differently than non-autistic people, although explanatory mechanisms for this are under-investigated. Using a short-term repeated measures approach over 5 consecutive weeks, we examined whether menopause representations (thoughts, beliefs, and feelings about menopause) are associated with perceived menopause symptom severity, mental health (depressive and anxiety symptoms), and quality of life in autistic and non-autistic people. Methods: Over 5 weeks, we measured menopause representations, menopause symptom severity, quality of life, depression, and anxiety using self-report standardized scales in 476 autistic and 425 non-autistic participants aged 40–60 years. Using mediation analyses, we examined associations between menopause representations, and health and well-being outcomes (perceived menopause symptom severity, depression, anxiety, and quality of life) across all timepoints. Results: Autistic participants reported more severe menopause symptoms, greater depression and anxiety, and poorer quality of life, across all timepoints. Sense of control and sense of coherence, 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. Conclusion: While requiring replication under more controlled conditions, our findings suggest that menopause representations may partially explain poorer health outcomes in autistic people who are peri- or postmenopausal. This partial mediation reflects that other mechanisms exist through which aspects of being autistic are associated with these poorer outcomes. Further investigation is needed to elucidate health inequalities during and after menopause, yet our findings suggest that feelings of control and coherence may be important for well-being during menopause, highlighting the importance of appropriate information and support to help autistic individuals confidently navigate this life stage.