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. 2025 Jan 28;38(1):e70017. doi: 10.1111/jar.70017

The Impact of Menopause on the Mental Health of Women With an Intellectual Disability: A Scoping Review

Stephanie Corrigan 1,✉, Mary McCarron 1, Philip McCallion 2, Éilish Burke 1
PMCID: PMC11774133  PMID: 39871807

ABSTRACT

Background

Negative mental health implications of menopause found in the general population, combined with high rates of mental health conditions found in women with intellectual disabilities, provide rationale to examine the existing literature to determine the impact of menopause on women with intellectual disabilities.

Methods

The review was conducted using scoping review methodology by Arksey and O'Malley. A systematic search was conducted across multiple databases. Relevant articles were screened according to inclusion/exclusion criteria. Braun and Clarke's thematic analysis was utilised to identify themes.

Results

After screening, eight articles satisfied the inclusion/exclusion criteria, and after thematic analysis, themes found were: changes in mood, lack of reporting of psychological symptoms and difficulty attributing psychological symptoms to menopause.

Conclusions

Findings indicate the paucity of literature and the lack of attention paid to examining the impact of menopause on the experiences and mental health of women with intellectual disabilities.

Keywords: intellectual disability, menopause, mental health, women's health

1. Introduction

Major health inequalities exist between individuals with intellectual disabilities and the general population (O'Leary, Cooper, and Hughes‐Mccormack 2018; Taggart, McMillan, and Lawson 2010). In general, people with intellectual disabilities suffer poorer health outcomes (van Schrojenstein Lantman‐de Valk and Walsh 2008) and die younger than the general population (Doyle et al. 2020; McCarron et al. 2015). Women from this population are excluded from mainstream research dedicated to sexual and reproductive health—including studies on menopause (Earle et al. 2024; McCarthy and Millard 2003). This omission from research implies a paucity of knowledge of menopause in this population (Powell et al. 2020) which can impact delivery and quality of health care (Greenwood and Wilkinson 2013; Servais 2006). Such omission from research and limited access to healthcare can affect overall physical and mental health (Wiseman and Ferrie 2020) and has been identified as a factor for premature mortality in this population (Robertson et al. 2021).

Menopause can be defined as the complete cessation of menstruation for 12 months, in the absence of any pathologic cause for amenorrohea (World Health Organisation [WHO] 2022). Individuals with intellectual disabilities typically have problems with general abilities that affect both intellectual and adaptive functioning, which manifest before age 18 years (WHO 2019). As such, without appropriate education and support, their ability to comprehend more complex ideas surrounding their sexual and reproductive health may be limited. In addition, predictors of menopausal symptoms found in the general population such as socioeconomic status and negative perceptions of menopause (Langer‐Shapland, Minton, and Richards 2023) may not be mirrored in this population, thus necessitating more specialised, generalisable research into menopausal symptoms in women with intellectual disabilities.

In the general population, the impact of menopause on mental health is also considered an underresearched topic (Short 2019), yet compared to research available for women with intellectual disabilities, it seems well established. Recent findings suggest that negative psychological symptoms such as anxiety, depression and mood swings can manifest due to decreasing levels of oestrogen (Kulkarni 2023). In fact, a recent meta‐analysis conducted in India found that as many as 42.5% of menopausal women experienced depression (Yadav et al. 2021). Additionally, during the transitional phase of perimenopause, it was found that depressive symptoms were particularly high (de Kruif, Spijker, and Molendijk 2016), suggesting that mental health effects are present in the general population during all stages of the menopausal transition. Similar research has not occurred for people with intellectual disabilities.

In general, people with intellectual disabilities do experience mental health difficulties at a higher rate than the neurotypical population (Adams and Matson 2015), despite the antiquated belief that their cognitive impairment is protective against mental illness (Mollison et al. 2014). Similar to the general population, women with intellectual disabilities are more likely to suffer from anxiety or depression than men (Kohen 2004; Taggart, McMillan, and Lawson 2008), with both conditions found to be linked to menopause in the general population.

Considering both the mental health risks associated with menopause found in the general population and the heightened levels of mental illness in women with intellectual disabilities, it is imperative to systematically assess the current research available on the effect of menopause on the mental health of women with intellectual disabilities to determine the exact symptoms faced by this population.

2. Methodology

The study follows a scoping review design originally put forward by Arksey and O'Malley (2005), which was later updated by Levac, Colquhoun, and O'Brien (2010) and Peters et al. (2015). The review was conducted to determine from existing literature the effect of menopause on the mental health of women with intellectual disabilities and to highlight any gaps in existing knowledge (Arksey and O'Malley 2005). In addition, the scoping review design was suitable as the literature available on menopause and intellectual disability is limited; thus, a broad research question was necessary which could be explored in an iterative process. A five‐step framework (see, Arksey and O'Malley 2005; Levac, Colquhoun, and O'Brien 2010; Peters et al. 2015) was used to conduct the scoping review as follows:

  1. Identification of the research question.

  2. Identification of the relevant studies.

  3. Study selection.

  4. Charting the data.

  5. Collating, summarising and reporting the results.

The methods and results section have been outlined in accordance with the PRISMA‐ScR checklist to ensure methodological rigour (Tricco et al. 2018).

2.1. Step 1: Identifying the Research Question

PICO was used to define the research question. PICO was originally developed by Richardson et al. (1995) to ensure accuracy when searching databases. The acronym was used in the current review as follows:

  • Population being addressed: menopausal women with intellectual disabilities.

  • Intervention or exposure: menopause.

  • Comparison intervention or exposure: menopausal status (as in, mental health of women will be compared on the basis that they have or have not gone through menopause).

  • Outcome: impact on mental health.

Therefore, the research question to be addressed is: what research exists concerning the effect of menopause on the mental health of women with intellectual disabilities?

2.2. Step 2: Identifying Relevant Studies

Multiple databases and grey literature sources were searched to ensure comprehensiveness. Databases searched included Medline, PubMed, Embase, PsycINFO, CINAHL and ScienceDirect. The grey literature sources utilised were: CADTH Grey Matters, OpenGrey, The CORDIS library, and ProQuest (Dissertations and Theses).

Relevant concepts were identified to build the search strategy using the PICO framework (Richardson et al. 1995). The three main concepts identified were ‘menopause’, ‘women with intellectual disabilities’ and ‘mental health’. Individual search strings specific to each database were constructed using synonyms, truncations and controlled vocabulary (see Table 1, for an example of the search strategy used for PubMed). The search took place in July 2023. There were no date restrictions, and each search was conducted in all fields, for example, not limited to abstract and title. Additionally, a subject librarian was consulted to examine and enhance the search strategy.

TABLE 1.

Example search strategy for PubMed database.

Concept Controlled vocabulary Keywords
Menopause ‘Menopause’[Mesh] OR ‘Menopause, Premature’[Mesh] OR ‘Postmenopause’[Mesh] OR ‘Premenopause’[Mesh] Menopaus* OR climacteric OR perimenopause* OR postmenopaus* OR premenopaus* OR ‘change of life’ OR ‘premature menopause’
Intellectual disability ‘Intellectual Disability’[Mesh] OR ‘Persons with Mental Disabilities’[Mesh] ‘Intellectual disability’ OR ‘intellectually disabled’ OR ‘intellectual disabilities’ OR ‘mental retardation’ OR ‘mentally handicapped’ OR ‘Down syndrome’ OR ‘developmental delay’ OR ‘developmental disability’ OR ‘IDD’ OR ‘mentally disabled’ OR ‘mentally retarded’ OR ‘learning disability’ OR ‘learning disabilities’
Mental health ‘Mental Health’[Mesh] ‘Mental health’ OR ‘emotional health’ OR ‘emotional wellbeing’ OR psych* OR ‘psychological impact’ OR ‘psychological effects’ OR ‘emotions OR “mental wellbeing”))’ ‘psychological impact’ OR ‘psychological effects’ OR emotions OR ‘mental wellbeing’
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2.3. Step 3: Study Selection

Suitable articles were selected based on the following inclusion and exclusion criteria.

Inclusion criteria:

  • Population: perimenopausal, menopausal and postmenopausal women with intellectual disabilities and/or their carers.

  • Language: English.

  • Study type: all types of primary studies.

  • Study design: all study designs.

  • Content: must refer to mental health of perimenopausal, menopausal and postmenopausal women with intellectual disabilities.

  • Timeframe: no restriction on timeframe.

Exclusion criteria:

  • Population: men with or without intellectual disabilities. Women who do not have an intellectual disability, or women who have an intellectual disability who are not perimenopausal, menopausal or postmenopausal, that is, they are premenopausal or present with amenorrhea.

  • Language: articles that are not available in English.

  • Study design: any form of review paper (i.e., scoping, systematic and meta‐analysis) or case study.

Results from the various databases were exported to the citation software Endnote where duplicates were removed, and titles and abstracts were screened for relevant information in keeping with the inclusion criteria, meaning several titles were then excluded. After screening, the full‐texts were read to determine the relevant articles to be included.

2.4. Stage 4: Charting the Data

Articles satisfying the inclusion criteria were charted (see, Table 2) under the following headings as recommended by the original framework (see, Arksey and O'Malley 2005). The headings were adapted to suit the topic at hand in line with a recent scoping review in a similar area (see, Powell et al. 2020) and can be defined as follows:

  • Citation: details of the publication.

  • Setting: where the study took place.

  • Study population: clarifying the nature of the sample and the sample size.

  • Methodology: the nature of the study (i.e., qualitative).

  • Aims of study: the objectives of the study.

  • Key findings: the relevant findings in line with the research question.

TABLE 2.

Charting the data.

Citation Setting Study population Methodology Aims of study Key findings
Langer‐Shapland, Minton, and Richards 2023 England N = 5; menopausal women with intellectual disabilities Qualitative; semistructured interviews and IPA To explore the psychological, social and physical experiences of menopausal women with an intellectual disability, with the hope that their experiences can inform the services they receive. All participants experienced changes in mood. The changes in mood varied from misery to anger to happiness. Interestingly, participants experienced an increase in social connectedness as they felt freer no longer having to deal with menstruation.
McCarthy 2002a England N = 154; GPs, paid staff and family carers of women with intellectual disabilities; n = 73 (GPs); n = 66 (day service and residential staff); n = 15 (relatives and family carers—all mothers) Qualitative; survey To explore the experiences and attitudes of carers and practitioners when it comes to women with intellectual disabilities going through menopause. Women were less likely to report psychological symptoms than physical symptoms. According to the authors, this lack of reporting is linked to the lack of understanding concerning reproductive health.
McCarthy 2002b England N = 15; women with mild/moderate intellectual disability aged 43–65 years; n = 11 were peri/postmenopausal and n = 4 were premenopausal. Qualitative; semistructured interviews To explore the perceptions and experiences of women with an intellectual disability as they go through menopause. Participants noted changes in mood that could be due to menopause. It was noted that it can be incredibly difficult to attribute mental health issues directly to menopause due to co‐occurring factors.
McCarthy and Millard 2003 England N = 30; menopausal women with learning disabilities aged 40+. Qualitative; semistructured interviews and multi‐stage narrative analysis To gain some insights into the way in which women with learning disabilities perceive menopause Psychological symptoms were less likely to be reported than physical symptoms. Due to differing social roles, women with intellectual disability may not experience the same psychological symptoms as women from the general population.
Willis 2008 Scotland N = 15; women with mild/moderate intellectual disability who were either peri‐ or postmenopausal Qualitative, semistructured interviews To extend previous research into the experiences and knowledge of women with intellectual disabilities and aims to investigate educational resources available. Some participants mentioned changes in mood; however, it was difficult to confirm whether this was directly related to menopause.
Willis, Wishart, and Muir 2010 Scotland N = 69; carers of pre‐, peri‐ and postmenopausal women with an intellectual disability Qualitative To investigate carer knowledge of how menopause affects women with intellectual disability and what they can do to help. Carers found it difficult to distinguish between existing behaviours and possible mental health symptoms related to menopause.
Willis, Wishart, and Muir 2010 Scotland N = 45; women with mild to severe intellectual disability aged 35–65 years; 10 pre‐, 15 peri‐ and 20 postmenopausal. Qualitative; semistructured interviews To explore menopausal experiences in women with intellectual disability with a view to assessing levels of knowledge of menopause and its associated effects. One‐fifth of the sample reported mood swings; however, it was unsure whether they were directly related to menopause.
Taggart, McMillan, and Lawson 2010 The United Kingdom N = 32; paid staff caring for people with women with intellectual disabilities who have mental health problems Qualitative; interview and focus groups, and thematic content analysis To examine the knowledge of paid care staff regarding caring for women with intellectual disability who have mental health difficulties—with a focus on protective and risk factors. Very few carers considered the impact hormones may have on the mental health of women with intellectual disability.
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2.5. Stage 5: Collating, Summarising and Reporting the Results

After the data were charted, characteristics of the data were noted and the data were thematically analysed using Braun and Clarke's (2006) six‐step framework as follows: (a) Familiarisation, (b) Coding, (c) Generating themes, (d) Reviewing themes, (e) Defining and naming themes, and (f) Writing up (see, Table 3). To do this, one author read through the eight articles multiple times building familiarity and systematically searching the papers highlighting relevant sections containing information about menopause and mental health in this population. Relevant extracts from each article were copied into an Excel spreadsheet. Each individual extract in the spreadsheet was analysed and coded inductively, whereby codes were selected diversely to summarise the data in each relevant extract (Braun and Clarke 2006). Visual strategies such as colour‐coding and mind‐mapping were used to form groups of related codes to help to determine overarching themes. These overarching themes were refined, and final themes were selected that accurately reflected the relevant content of the reviewed articles. Please note that throughout the duration of this process, a reflexive diary was kept encouraging the author to reflect on any internal biases ensuring minimal impact on the interpretation of the data.

TABLE 3.

Themes with associated codes.

Themes Codes
Changes in mood Mood swings
Challenging behaviours
Increase in social connectivity
Relief of not having a period
Anger
GP reported mood swings
Bad temper
Anxiety
Independence
Lack of psychological symptoms reported Participants were deemed ‘unlikely’ to report psychological symptoms
The lack of psychological impact was ‘unsurprising’
Psychological symptoms labelled as challenging behaviour
Difficulty distinguishing between physical and psychological symptoms
Psychological effects could be similar to the general population
Managing symptoms by shouting or blowing off steam
Symptoms likely to be mainly physical
Difficulty attributing psychological symptoms to menopause Difficulty distinguishing between behaviour and menopausal symptoms
Failure to link between hormones and mental health
Any psychological symptoms reported could not be attributed to menopause due to other confounding factors
Other life changes or life events
Pre‐existing problems
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3. Results

3.1. Extent of the Literature

The initial search yielded 1586 published works, across six databases and various grey literature sources (see Figure 1). After duplicates were removed, 1375 remained. Screening articles using titles and abstracts reduced the total to 54 articles. After review of full‐texts, eight articles were selected which satisfied the necessary inclusion and exclusion criteria and answered the research question.

FIGURE 1.

FIGURE 1

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Prisma flowchart illustrating the process of study selection.

Each of the selected studies was conducted in the United Kingdom (e.g., England and Scotlands). Seven articles were published between 2002 and 2010, with one recent publication in 2023. All articles followed a qualitative methodology, with most studies using semistructured interviews to collect data, and no standardised mental health assessments or doctor's diagnoses were used. Purposive sampling was predominantly used, and none of the articles employed random sampling. In general, the sample populations consisted of menopausal women with intellectual disabilities and/or their carers. Some samples involved premenopausal women and/or their carers, alongside menopausal women (McCarthy 2002a, 2002b; Taggart, McMillan, and Lawson 2010; Willis, Wishart, and Muir 2010, 2011). One study focused on carers and paid staff of women who struggled with their mental health; in this case, some of the women cared for were menopausal (Taggart, McMillan, and Lawson 2010). All studies contained information about the three main concepts identified in the research question: menopause, mental health and women with intellectual disabilities.

3.2. Thematic Findings

After following the methodology for thematic analysis (Braun and Clarke 2006), three themes were found to summarise the data: (1) Changes in mood, (2) Lack of psychological symptoms reported and (3) Difficulty attributing psychological symptoms to menopause (see, Table 3). All themes are discussed independently; however, they are all strongly interconnected.

3.3. Changes in Mood

All reviewed literature reported that women with intellectual disabilities experience changes in mood or behaviour in relation to menopause. Most studies (75%, n = 6) reported that women with intellectual disabilities or their carers had experienced or observed mood swings around the time of menopause, which commonly manifested in grumpiness or anger (Langer‐Shapland, Minton, and Richards 2023; McCarthy 2002a, 2002b; Willis 2008; Willis, Wishart, and Muir 2010, 2011). For example, in the study by Willis, Wishart, and Muir (2011) a participant described her experience of a menopause‐related mood swing ‘One minute I am up in the air, the next down in the dumps’. Other menopause‐related mood changes were: anxiety (McCarthy and Millard 2003), depression (Willis, Wishart, and Muir 2010) and challenging behaviour (Taggart, McMillan, and Lawson 2010). Contrastingly, the most recent study by Langer‐Shapland, Minton, and Richards (2023), mentioned that menopausal women with intellectual disabilities can experience an increase in social connectivity due to menopause. Reportedly, this was predominantly due to the relief of not having a period, the associated constraints it placed on the women's lives (McCarthy and Millard 2003; Willis 2008) and a new‐found sense of community shared with other menopausal women (Langer‐Shapland, Minton, and Richards 2023). In addition, two articles reported that women felt proud of their ability to self‐manage their symptoms, for example, going for a walk when in a bad mood (Langer‐Shapland, Minton, and Richards 2023; Willis, Wishart, and Muir 2011). Menopause‐related mood changes were a recurrent theme across the reviewed literature, both positive and negative.

3.4. Lack of Psychological Symptoms Reported

Despite the observation of menopause‐related mood changes across all reviewed studies, it was widely acknowledged that menopause‐related psychological symptoms were less likely to be reported than physical symptoms by women with intellectual disabilities, and were often dismissed by carers and healthcare providers (McCarthy 2002a, 2002b, 2010; McCarthy and Millard 2003; Taggart, McMillan, and Lawson 2010; Willis 2008). Explanations were offered throughout the literature to explain this. For example, it was proposed that women with intellectual disabilities will not experience the same level of mental distress in response to certain menopausal changes, such as a decline in fertility, in comparison to the general population as they so rarely marry and have children (McCarthy 2002a, 2002b; McCarthy and Millard 2003). It was also suggested that psychological symptoms were unlikely to be reported due to a lack of understanding of menopause and its link to fertility and ageing, with one participant admitting she was unaware of her ability to conceive until she reached menopause and no longer could (McCarthy and Millard 2003). It could also be due to a lack of education surrounding menopause, with women and carers not looking out for psychological symptoms due to lack of awareness (Taggart, McMillan, and Lawson 2010), suggesting that many psychological symptoms may be overlooked and dismissed. However, despite the lack of psychological symptoms reported in her study, Willis (2008) acknowledged that menopausal women with intellectual disabilities had the propensity to experience similar psychological symptoms as women from the general population.

3.5. Difficulty Attributing Psychological Symptoms to Menopause

The final theme was widespread throughout the reviewed literature. It was extremely difficult for women with intellectual disabilities and their carers to attribute psychological symptoms directly to menopause (Langer‐Shapland, Minton, and Richards 2023; McCarthy 2002a, 2002b; McCarthy and Millard 2003; Taggart, McMillan, and Lawson 2010; Willis 2008; Willis, Wishart, and Muir 2010, 2011). Therefore, if a menopause‐related psychological symptom was reported, it was unlikely to be attributed to the correct cause. This could be due to a general lack of awareness caused by poor education on menopause (Langer‐Shapland, Minton, and Richards 2023; McCarthy 2002a, 2002b; McCarthy and Millard 2003; Taggart, McMillan, and Lawson 2010; Willis 2008; Willis, Wishart, and Muir 2010, 2011). For example, in the study by Willis (2008), three perimenopausal women reported feeling ‘angry’; however, when probed further, they did not know why they were feeling angry. Difficulty attributing symptoms to menopause could also be due to confounding factors such as other life events happening concurrently, for example, the death of a parent or a house move (Langer‐Shapland, Minton, and Richards 2023; McCarthy 2002a, 2002b; Willis, Wishart, and Muir 2010, 2011).

In addition, menopause‐related psychological symptoms experienced by women with intellectual disabilities may be mistaken for challenging behaviours by carers and healthcare providers (McCarthy 2002b; Taggart, McMillan, and Lawson 2010; Willis, Wishart, and Muir 2010). For example, some women found it difficult to articulate their emotions—expressing themselves instead through noises or attempting to self‐regulate by shouting (Langer‐Shapland, Minton, and Richards 2023). Similarly, in Taggart, McMillan, and Lawson (2010), carers admitted that they often failed to consider the link between hormones and mental health in women with intellectual disabilities, stating that symptoms were difficult to distinguish due to diagnostic overshadowing and challenging behaviours, despite extensive empirical evidence supporting psychological implications of menopause in the neurotypical population.

Recommendations were offered by Langer‐Shapland, Minton, and Richards (2023) which could help to raise awareness around menopausal symptoms in a bid to combat diagnostic overshadowing. For example, providing accessible information about menopause to facilitate conversations about menopause between women with intellectual disabilities, their carers and healthcare providers, to provide a deeper understanding of menopausal symptoms and experiences. It was also recommended across the literature to ensure specialised training is received by carers and healthcare providers to support the understanding of the various impacts of menopause on women with intellectual disabilities and how these may manifest differently to the general population (Langer‐Shapland, Minton, and Richards 2023; McCarthy 2002a; McCarthy and Millard 2003).

4. Discussion

This scoping review summarises the existing literature on the impact of menopause on the mental health of women with intellectual disabilities. Only eight articles satisfied the criteria for inclusion in the review. And while the thematic findings highlight key issues which could guide future research, the limited number of articles identified through the systematic search indicates the scarcity of research on this key topic which lends to large gaps in the evidence base. The articles selected were general in nature—focusing primarily on women's experiences of menopause. The articles explored the broad topic of menopause in a qualitative manner, and various psychological symptoms emerged during the interviews but were not the main focus of any study. The lack of methodological diversity and rigour found in the articles reviewed emphasises the weakness of the existing evidence. The lack of focused, systematic research highlights that we truly don't know the psychological implications of menopause on this population. This drives the need for novel and focused research on this topic, particularly as none of the selected studies were designed specifically to investigate the topic at hand.

All articles selected for review were published before 2011, with the exception of one recent publication in 2023. Therefore, women with intellectual disabilities are being excluded from current, cutting‐edge menopause research (Earle et al. 2024; McCarthy and Millard 2003) demonstrated by numerous publications on menopause in the general population in leading journals such as the Lancet (Brown et al. 2024) and Nature (Martin‐Key et al. 2024). Their exclusion from recent research effectively silences the voices of this often‐marginalised group excluding them from mainstream conversations on menopause. For example, the recent World Menopause Congress held in Melbourne in October 2024 led by the International Menopause Society did not include any conference proceedings relating to women with any type of disability (International Menopause Society 2024). In their recent review, Earle et al. (2024) highlighted that outdated research is much less pertinent to the current generation of women with intellectual disabilities, particularly in the context of the United Kingdom and Ireland with recent policy changes resulting in changes in living circumstances from institutional to community living for the majority of people with intellectual disabilities. Without up‐to‐date research in line with the general population, the health outcomes of women with intellectual disabilities could suffer.

The spread of literature was extremely limited with all reviewed studies conducted in the United Kingdom. Any menopause‐related studies conducted outside the United Kingdom did not contain any information regarding mental health and menopause, and therefore did not meet the inclusion criteria of the scoping review. For example, there has been a large body of work carried out in the United States by Schupf and colleagues (see, Schupf et al. 2018; Schupf et al. 2003; Schupf et al. 2006; Schupf et al. 1997) with the main focus of their research on the link between menopause and dementia in women with Down syndrome. Furthermore, research carried out in Taiwan (see, Chou, Lu, and Pu 2013; Lin et al. 2011b; Lin et al. 2011a) focuses primarily on attitudes towards menopause and, however, fails to capture information on any potential mental health implications. Clearly, there is a need for a global effort to discern the effect of menopause on the mental health of women from this population in a generalisable and representative manner.

Despite the lack of research available in this area, the review managed to highlight some archaic and problematic perceptions surrounding mental health and menopause in women with intellectual disabilities. Over 25 years ago, Cooper (1997) outlined the dismissive nature of carers surrounding the psychiatric morbidity of elderly people with intellectual disabilities, and from the findings in this review, it appears that this attitude has not significantly improved. Despite the mood and behaviour changes observed across the reviewed articles, the possibility of psychological implications caused by menopause among this population was explicitly denied by caregivers in many of the articles (see, McCarthy 2002a, 2002b; McCarthy and Millard 2003) due to lack of understanding of menopause and the idea that women with intellectual disabilities may not want to or even know that they can have children (McCarthy and Millard 2003). This viewpoint is extremely dismissive and reductionist, denying both the observed changes in mood and behaviour, and the opportunity for these women to express concerns regarding their own mental health. This is especially concerning as mental health problems are particularly salient among women with intellectual disabilities (Taggart, McMillan, and Lawson 2008). Fortunately, psychological symptoms have been highlighted as a research priority in the more recent research (Langer‐Shapland, Minton, and Richards 2023) corroborating the findings of the current review and driving the need for more research in this area. However, as it stands, due to the predominantly outdated research available on menopause, the dismissive attitude alluded to by Cooper (1997) still rings true in this review as menopause‐related psychological problems faced by women with intellectual disabilities are neglected.

Another striking finding highlighted by the themes uncovered was the lack of awareness of both the women with intellectual disabilities and their carers on the relationship between menopause and mental health. Failure to consider the link between hormones and their effect on mental health was alluded to in Taggart, McMillan, and Lawson (2010) and was echoed in the remaining articles through the inability to attribute mental health symptoms directly to menopause. Attributing symptoms to the wrong causes could lead to diagnostic overshadowing, a common problem in this population with healthcare workers often unable to look beyond a person's intellectual disability for other possible causes of mental health and behavioural issues (Patel, Esbensen, and Sannar 2020). This implies a lack of awareness from caregivers and healthcare providers of the potential for menopause‐related mental health implications in this population, despite the findings from this review indicating that menopausal women with intellectual disabilities can face changes in mood/behaviour. However, the poor knowledge of this topic is not surprising and reflects the lack of research on menopause (Moore, Reidy, and Foran 2023) and the complexity of mental health (Taggart, McMillan, and Lawson 2008) in this population.

Although mental health symptoms are mentioned in relation to menopause in the current review, the research available is nonspecific and no studies have been dedicated to determining the exact mental health symptoms faced by women with intellectual disabilities during menopause. This is particularly concerning considering the strong association between menopause and mental health conditions such as anxiety or depression in the general population (Hogervorst, Craig, and O'Donnell 2022; Martin‐Key et al. 2024). However, contrary to expectation, findings from the current review indicate that women with intellectual disabilities may experience positive mental health implications as they enter menopause (Langer‐Shapland, Minton, and Richards 2023) due to the cessation of menstruation and associated discomforts (Willis 2008). Therefore, it is essential that focused research is carried out to determine the exact psychological symptoms faced by women with intellectual disabilities (if any) as they go through menopause. Additionally, it is also important to distinguish between menopause‐specific and nonmenopause‐specific mental health symptoms to avoid diagnostic overshadowing and to ensure correct treatment options are provided to target problems at the source. For example, due to established links between physical and mental health symptoms of menopause found in the general population (Chedraui et al. 2009), it is vital to consider menopause‐specific treatments such as hormone replacement therapy for women with intellectual disabilities in an attempt to target root causes of menopause‐related mental health symptoms, in order to enhance care received (Langer‐Shapland, Minton, and Richards 2023).

4.1. Strengths and Limitations

A major strength of this scoping review is the methodological and reporting quality. It follows the most up‐to‐date scoping review methodologies as originally put forth by Arksey and O'Malley (2005), and later updated by Levac, Colquhoun, and O'Brien (2010) and Peters et al. (2015). In addition, the Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping reviews checklist was closely adhered to (PRISMA‐ScR; Tricco et al. 2018). The scoping review was the correct choice for the current review due to the lack of research available on the topic (Arksey and O'Malley 2005), and it successfully identified both the lack of available research on the topic and the gaps and weaknesses in the research.

A recent scoping review was published by Moore, Reidy, and Foran (2023) which provides a general overview on menopause in women with intellectual disabilities. Moore et al. review six of the eight articles in the current review and similarly highlight important aspects of menopause for women with intellectual disabilities such as lack of knowledge of menopause, difficulties attributing menopausal symptoms to menopause and importance of carers in providing education regarding menopause. The strength of the current review is that it conducts an in‐depth exploration into existing research examining the psychological implications of menopause. Due to the general nature of the review by Moore, Reidy, and Foran (2023), there is little emphasis on menopause‐related mental health implications picked up from the articles reviewed, although possible changes in mood and behaviour as reported by McCarthy (2002b) were acknowledged. As a result, the findings do not overlap significantly, enhancing the relevance and importance of the current review. The current review provides a comprehensive overview of the current state of science on this underresearched topic, highlighting the gap in the evidence base and providing direction for future research.

Despite the extensive search strategy employed across numerous databases, it is possible that some relevant studies were missed due to the inclusion/exclusion criteria and availability of articles on the selected databases. Furthermore, all the research articles selected followed a qualitative methodology. While this is a valuable methodology, and can provide directions for future research, it is not possible to make generalisable deductions from research conducted in this manner due to limited sample sizes and a lack of comparable standardised mental health assessments. In addition, none of the samples were random, with most adopting a purposive approach as is common across the qualitative literature (Palinkas et al. 2015). The distribution of the literature was limited, with all studies conducted in the United Kingdom. Therefore, there was a lack of generalisability to the findings due to small, nonrepresentative sample sizes and similar methodological approaches. Additionally, the articles were not quality assessed as per scoping review methodology (Arksey and O'Malley 2005); therefore, the findings must be interpreted cautiously.

4.2. Implications for Practice and/or Policy

Historically, people with intellectual disabilities have been marginalised, particularly regarding their sexual and reproductive health (Greenwood and Wilkinson 2013). Article 25 of the UN Convention on the Rights of Persons with Disabilities (United Nations 2007) states that women with disabilities are entitled to accessible and unbiased education on their sexual and reproductive health. Therefore, it is key that the findings from this scoping review are used to drive further research on the effect of menopause on the mental health of this cohort and to inform accurate educational materials to be provided in an accessible manner. Education in conjunction with the recent Assisted Decision Making (Capacity) Act 2015 (ADM), which was promulgated in 2023 in Ireland and encourages people with intellectual disabilities to make their own decisions where possible, could encourage and empower women with intellectual disabilities to make important decisions surrounding their sexual and reproductive health, so that they can self‐manage or seek help regarding menopausal symptoms. For some women with intellectual disabilities this could provide a sense of fulfilment and independence, as uncovered in the current review (Langer‐Shapland, Minton, and Richards 2023; Willis, Wishart, and Muir 2011).

Additionally, in Ireland's recent Women's Health Action Plan 2022–2023 targeted at improving women's health in Ireland, women with intellectual disabilities were not mentioned, despite the acknowledgement of other minority groups such as the travelling community (Department of Health 2022). This is mirrored in the Women's Health Strategy in the United Kingdom (Department of Health and Social Care 2022) which contains no dedicated mention of specialised care initiatives or interventions aimed at improving the sexual and reproductive health of women with intellectual disabilities (McAteer 2022). Such lack of representation is unacceptable and violates the rights people with intellectual disabilities as per Article 25 of the UNCRPD (United Nations 2007). As detailed by the World Health Organization (WHO), marginalised groups such as women with intellectual disabilities need specialised, targeted policy recommendations tailored to their needs to better address the evident disparities faced in accessing sexual and reproductive health services (WHO 2016). Representation in future women's health policies worldwide will help to improve service provision and increase access to sexual and reproductive health services for women with intellectual disabilities globally.

Future work must include more quantitative research that seeks to include large, representative samples of women and uses standardised measures and clinical diagnoses so that results can be generalised to the wider population and drive change in this essential area politically, academically and in practice. In tandem with additional quantitative work, it is important to include the voice of the woman with an intellectual disability to ensure data‐driven findings are contextualised in terms of their lived experience. Focused qualitative work will be critical to ensure that the unique menopausal experiences of this population are captured in detail. Future research will be critical to inform the education of women with intellectual disability and their carers and healthcare providers about possible psychological symptoms they may face.

The role of the carer in providing menopause education to women with intellectual disabilities cannot be overstated (Powell et al. 2020). As advised by Langer‐Shapland, Minton, and Richards (2023), it is critical for carers and healthcare providers to initiate conversations and provide educational materials to the women they support. This education must not be limited to menopausal women but must also target younger women to prepare them in advance of menopause. Educational materials have been developed on menopause (e.g., Millard and McCarthy 2017), but barriers to such resources exist, with the main one being financial (Earle et al. 2024). There were no specific mentions in the current review of resources available that specifically target mental health implications of menopause—which could be indicative of the lack of research in this area specifically. It is essential to conduct research to inform the development of a suite of publicly available, accessible, educational materials targeted at carers, healthcare providers and women with intellectual disabilities on the psychological implications of menopause in this population. This will provide carers with the critical training to help with symptom detection and management, and to support the education of women with intellectual disabilities.

5. Conclusions

The current scoping review investigated the effect of menopause on the mental health of women with intellectual disabilities. The limited literature available suggests that menopause could have an effect on the mental health of this population that is not being recognised. The review highlights the need for more up‐to‐date, focused, representative research necessary to determine the mental health implications of menopause as experienced by women with intellectual disabilities. Better knowledge of symptoms and experiences will aid in the development of care practices and of educational materials to raise awareness around the possible mental health implications of menopause with the aim of improving health outcomes for women with intellectual disabilities as they age.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

Open access funding provided by IReL.

Funding: Open access funding provided by IReL.

Data Availability Statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

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