Infertility, involuntary childlessness linked to midlife depressive, anxiety symptoms
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ANAHEIM, Calif. — Midlife women with a history of infertility or involuntary childlessness had more depressive symptoms, particularly before menopause, and anxiety after menopause, compared with women without infertility.
“While there has been some work to suggest an association of infertility and menopausal symptoms, there is still a need for more clarification of this relationship,” Victoria W. Fitz, MD, MSCR, a third-year fellow in reproductive endocrinology and infertility at Massachusetts General Hospital in Boston, said in a presentation. “Our goal was to explore this question of whether women with a history of infertility experience menopausal symptoms differently from non-infertile women, and if that’s influenced by parity or menopausal stage.”
Fitz and colleagues analyzed 16 years of follow-up data from the Study of Women’s Health Across the Nation (SWAN) to determine associations between a history of infertility and involuntary childlessness — defined as infertility and nulliparity — and measures of midlife health. Specifically, the researchers examined vasomotor symptoms, sleep, and depressive and anxiety symptoms as reported in follow-up visits.
In total, 3,061 participants were included in the study, 600 (19.6%) of whom had a history of infertility and were parous and 172 (4.1%) of whom were involuntarily childless.
Fertility and parity history were not associated with sleep problems or vasomotor symptoms at any stage of menopause.
Compared with no history of infertility, the risk for depressive symptoms was higher in the premenopause stage for women with a history of infertility (RR = 1.25; 95% CI, 1.06-1.49) and involuntary childlessness (RR = 1.44; 95% CI, 1.05-1.97) compared with women with no history of infertility. Additionally, the risk for anxiety symptoms after the menopause transition was greater among women with involuntary childlessness compared with those who had no history of infertility (RR = 1.38; 95% CI, 1.06-1.79).
“While research on the impact of infertility during the menopause experience is pretty limited, the research suggests a connection between infertility and/or involuntary childlessness and mental health issues in women during the menopausal transition and beyond,” ASRM President Marcelle Cedars, MD, said in a press release.
References:
- Fitz VW, et al. Infertility and involuntary childlessness are associated with depressive and anxiety symptoms in menopause: SWAN analyses. Presented at: ASRM Scientific Congress & Expo; Oct. 22-26, 2022; Anaheim, California.
- Infertility and involuntary childlessness are associated with depressive and anxiety symptoms in menopause. Published Oct. 25, 2022. Accessed Oct. 25, 2022.
Perspective
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This presentation is an interesting outgrowth of the SWAN study. The SWAN study is an ongoing survey of very diverse cohorts of women as they have traversed the premenopausal state through the life cycle. Although intended to follow women through the menopausal transition, they have rich databases to study ancillary issues, such as infertility and its sequelae. Many of the SWAN investigators — including Jan L. Shifren, MD, Genevieve Neal-Perry, MD, PhD, and Nanette Santoro, MD — are well-known senior investigators in the field of infertility as well as menopause.
These data confirm that many women experiencing infertility develop depressive symptoms and that women with involuntary childlessness have a higher risk for anxiety post-menopausally. Rates of depression as women go through menopause are known to be higher among women with a previous history of depression, and anxiety issues may well resurface at that time as well.
One issue that could also be studied is whether only the hormonal issues of menopause produce the depressive and anxiety symptoms, or whether women reaching the end of their reproductive lives contributes to these feelings. Many women view menopause as a time to reassess where they are in their lives, and it would be interesting to assess the contribution of the finality of reproduction on their feelings at this time.
As the SWAN study will be continuing for many years, it will be interesting to follow this cohort even further.
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Fitz VW, et al. Infertility and involuntary childlessness are associated with depressive and anxiety symptoms in menopause: SWAN analyses. Presented at: ASRM Scientific Congress & Expo; Oct. 22-26, 2022; Anaheim, California.
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