TL;DR
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A systematic review of 21 studies covering 24,523 women found higher odds of reporting anxiety symptoms during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in a direct comparison, but the observational findings do not show that menopause causes anxiety or that individuals’ symptoms rise over time.
A review of 21 studies involving 24,523 women found that women in perimenopause had higher odds of reporting anxiety symptoms than women before menopause, while postmenopausal women also had elevated odds. The meta-analysis, published in Scientific Reports, found the highest odds in perimenopause, but its observational evidence does not establish that menopause causes anxiety.
The researchers synthesized evidence from studies conducted in multiple countries to examine how reported anxiety differed across premenopause, perimenopause and postmenopause. Fifteen studies contributed data to the meta-analysis comparing the odds of anxiety symptoms between stages. Anxiety was assessed using standardized questionnaires, interviews or broader measures that included anxiety items.
Compared with premenopausal women, women in perimenopause had 59% higher odds of reporting anxiety symptoms. The corresponding odds for postmenopausal women were 63% higher than for premenopausal women. In a direct comparison between the latter two groups, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. These are comparisons of odds across groups, not estimates of an individual woman’s likelihood of developing anxiety.
The authors said results differed substantially across studies. The pooled pattern points to higher anxiety reporting during the menopause transition, particularly perimenopause, but the review does not show that symptoms necessarily rise and then fall for each person. It also does not identify a single explanation for the differences.
Anxiety Across Menopause Stages
The findings give clinicians and researchers a pooled estimate for a question the review describes as understudied in midlife mental health: whether anxiety reporting differs before, during and after menopause. The perimenopause result may support asking about anxiety symptoms during care for women experiencing the menopause transition, rather than focusing only on physical symptoms.
That relevance should not be mistaken for proof of causation or a change to clinical guidance. The study compared groups using observational research; it did not test whether menopause triggered anxiety, evaluate a treatment, or establish that screening at a particular stage improves outcomes. Anxiety can have many contributing factors, and a reported symptom is not by itself a diagnosis.
The review also highlights a gap in public health messaging. According to the source report, the World Health Organization recognizes anxiety as a possible menopause-related symptom, while UK National Institute for Health and Care Excellence guidance does not explicitly list anxiety as a menopausal symptom, although it addresses other psychological symptoms. The findings may inform discussion of guidance, but do not themselves set clinical recommendations.
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How the Review Compared Stages
Menopause is defined clinically after 12 consecutive months without menstrual periods, when no other cause accounts for the absence of menstruation. Perimenopause is the period leading up to menopause, often marked by irregular cycles and changing hormone levels. The review used the Stages of Reproductive Aging Workshop +10 criteria or equivalent definitions to classify participants.
Researchers searched MEDLINE, PsycINFO, Embase and Web of Science for studies available through August 16, 2024. They included cross-sectional and longitudinal observational studies of women aged 18 or older that measured anxiety with recognized tools, including the Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory and Generalized Anxiety Disorder 7-item scale. For longitudinal cohorts, only baseline observations were pooled alongside cross-sectional data.
The authors proposed possible biological pathways for future investigation, including effects of changing estrogen levels on neurotransmitters and stress responses. They also noted that factors such as hot flashes and disrupted sleep may interact with psychological and social circumstances. These are possible explanations discussed in the report, not mechanisms demonstrated by the meta-analysis.
“Perimenopausal and postmenopausal women had significantly higher odds of anxiety symptoms compared with their premenopausal counterparts, with the highest odds observed during perimenopause.”
— The review authors, as summarized by News-Medical
Limits of the Anxiety Evidence
The review establishes an association between menopausal stage and reported anxiety symptoms, not a cause-and-effect relationship. Because the pooled results compare groups and include baseline observations from longitudinal studies, they cannot show whether anxiety increased within the same women as they moved through menopause. The findings also do not determine whether menopausal changes explain anxiety in any particular person.
Study results varied substantially, and the source report does not provide a single estimate that explains how much that variation reflects differences in participants, anxiety measures or study methods. The research also excluded studies involving surgical menopause or co-occurring physical or psychiatric conditions, which limits how broadly its results can be applied. Further work is needed to clarify the pattern and the factors behind it.
Questions for Future Research
The review authors said the findings could inform future mental health policy and clinical awareness, but the report does not announce a change to existing guidelines. The next research step is to clarify whether anxiety changes within individuals over time and how menopausal symptoms, health and social factors may contribute. Studies that follow women across defined stages could help address questions the pooled group comparisons cannot answer.
For now, the results add evidence that anxiety symptoms are reported more often in the perimenopausal and postmenopausal groups than in the premenopausal group. They should be read as population-level associations, not as a diagnosis or a prediction for an individual. The review does not provide an intervention or treatment recommendation.
Key Questions
What did the review find about anxiety during perimenopause?
Women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women in the pooled comparison. The review also found higher odds among postmenopausal women, with the highest odds in the direct comparison observed during perimenopause.
Does the study show that menopause causes anxiety?
No. The research synthesized observational studies and found an association between menopausal stage and reported anxiety. It does not establish that menopause causes anxiety.
Does this mean anxiety rises for every woman during perimenopause?
No. The analysis compared groups and does not show how symptoms change within each individual over time. Results also varied substantially between studies.
How many women and studies were included?
The review included 21 studies involving 24,523 women. Fifteen studies contributed data to the meta-analysis comparing odds of reported anxiety across menopausal stages.
What remains uncertain?
The evidence does not identify why anxiety reporting differs across stages or establish how the pattern unfolds for individuals. The review authors discussed possible biological and symptom-related factors, but those explanations were not proven by the meta-analysis.
Source: news-medical.net
