TL;DR
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A systematic review of 21 studies involving 24,523 women found higher odds of reporting anxiety symptoms during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in comparisons between stages, but the observational findings do not show that menopause causes anxiety or that individual women’s symptoms rise over time.
A systematic review of 21 studies involving 24,523 women found that women in perimenopause had higher odds of reporting anxiety symptoms than women before menopause, with the strongest association among the stages compared. The analysis, published in Scientific Reports, also found higher odds among postmenopausal women, but it cannot establish that menopause causes anxiety or that symptoms increase within individual women over time.
Researchers synthesized observational evidence on anxiety symptoms across premenopause, perimenopause and postmenopause. Fifteen of the 21 studies contributed data to the meta-analysis, which compared the odds of reporting anxiety between groups. The review included studies using standardized anxiety questionnaires, interviews or broader mental-health scales with anxiety items.
Compared with premenopausal women, those in perimenopause had 59% higher odds of reporting anxiety symptoms. Postmenopausal women had 63% higher odds than the premenopausal group. In a direct comparison, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. These are comparisons between groups, not measures of how much an individual’s anxiety changes over time.
The authors reported that findings varied substantially across studies. The researchers used a random-effects approach to pool results, reflecting differences among the included studies. The review covered observational research rather than experiments, so its results establish an association, not a cause-and-effect relationship.
Why Anxiety Screening May Matter
The findings add quantitative evidence to a question that has not been consistently addressed in menopause care: how anxiety reports differ by menopausal stage. The apparent concentration of higher odds in perimenopause could help clinicians and patients discuss mental-health symptoms during the menopause transition, alongside other changes that may affect daily life.
The results do not mean that anxiety is inevitable, or that menopause is the cause of anxiety for a particular person. Anxiety can have multiple contributing factors, and the review did not establish a biological mechanism. Still, an association across studies may support greater clinical awareness when women seek care during midlife, especially if anxiety symptoms are affecting their wellbeing.
The public-health implications include how menopause guidance describes psychological symptoms. The source report notes that the World Health Organization recognizes anxiety as a possible menopause-related symptom, while UK NICE guidance does not explicitly list anxiety as a menopausal symptom, although it addresses other psychological symptoms. The review may inform future discussion, but it does not itself set clinical guidance or recommend a specific treatment.
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How the Review Compared Menopause Stages
Menopause is defined as the permanent end of menstrual periods, confirmed retrospectively after 12 consecutive months without menstruation and without another cause. Perimenopause is the preceding period, which can involve irregular cycles and hormonal fluctuations. The review assessed anxiety reports across these defined stages rather than treating menopause as a single point in time.
Researchers searched MEDLINE, PsycINFO, Embase and Web of Science for relevant studies published through August 16, 2024. Eligible research included cross-sectional and longitudinal observational studies and used established staging definitions, including STRAW+10 or equivalent criteria. Studies involving surgical menopause or certain co-occurring physical or psychiatric conditions were excluded. For longitudinal studies, only baseline observations were included in the pooled comparisons.
The authors framed the work as addressing limitations in earlier evidence. A 2012 narrative review had reported generally low anxiety across menopausal stages, but it did not use standardized staging criteria or pool quantitative estimates. The newer review’s larger evidence base permits numerical comparisons, though the substantial variation between studies remains relevant to interpreting them.
“Perimenopausal and postmenopausal women had significantly higher odds of anxiety symptoms compared to 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 does not show whether menopausal changes cause anxiety. Because most of the evidence is observational and the pooled comparisons include baseline observations from longitudinal studies, it cannot establish that a woman’s anxiety rises as she moves from one stage to another. The researchers also reported substantial variation between studies, which may reflect differences in populations, methods and symptom measures.
The results concern reported symptoms as measured in the included studies; they do not establish rates of diagnosed anxiety disorders. The source material does not provide a single overall prevalence figure, nor does it identify which women are most likely to experience symptoms. The proposed role of estrogen fluctuations, neurotransmitters, stress responses, hot flashes and sleep disruption is a possible explanation discussed in the report, not a mechanism proven by this meta-analysis.
What Future Research Could Clarify
The review may help shape further research and discussion about how menopause guidance addresses anxiety. The source material does not announce a new clinical guideline or a specific follow-up study. Further research that follows women across menopausal stages could help clarify whether anxiety symptoms change within individuals and how those changes relate to other factors.
For now, the reported findings support awareness rather than a causal conclusion: anxiety was more commonly reported in the menopausal groups than before menopause in the pooled comparisons, while the reasons and individual trajectories remain unresolved.
Key Questions
What did the review find about anxiety in perimenopause?
Women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women in the pooled analysis. The comparison is about odds between groups, not a measure of individual change over time.
Did postmenopausal women also report higher anxiety?
Yes. Postmenopausal women had 63% higher odds of reporting anxiety symptoms than premenopausal women. In a direct comparison with perimenopause, postmenopausal women had 21% lower odds.
Does the study prove menopause causes anxiety?
No. The review analyzed observational studies and found an association. It does not establish that menopause causes anxiety or that an individual woman’s symptoms increase as she moves through the stages.
How many women and studies were included?
The review covered 21 studies and 24,523 women. Fifteen studies contributed to the meta-analysis that pooled comparisons across menopausal stages.
What remains unknown about the findings?
Results varied substantially between studies, and the review did not establish why anxiety reports differed by stage. It also did not determine individual symptom trajectories or prove the biological explanations discussed in the report.
Source: rss
