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A systematic review and meta-analysis of studies involving 24,523 women found higher odds of reported anxiety symptoms during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in the comparisons, but the observational findings do not show that menopause causes anxiety or that anxiety rises in each individual over time.
A systematic review and meta-analysis of 21 studies involving 24,523 women found that women in perimenopause had higher odds of reporting anxiety symptoms than premenopausal women, with postmenopausal women also showing elevated odds. The findings, published in Scientific Reports, point to perimenopause as a stage when clinicians may need to pay attention to anxiety, but they do not establish that menopause causes anxiety.
Researchers assessed observational evidence on anxiety across premenopausal, perimenopausal and postmenopausal stages. Of the 21 studies included in the review, 15 contributed data to the meta-analysis, which compared the odds of reporting anxiety between groups. The review included research from multiple countries and used studies that applied defined criteria for menopausal stage and standardized anxiety measures or interviews.
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 relative odds from pooled observational studies, not estimates of how many women experience anxiety or proof of a change within individuals over time.
The authors reported substantial variation among the study results. The review followed PRISMA reporting guidance and searched four research databases through August 16, 2024. One study judged to be low quality was excluded from the pooled analysis. The studies assessed anxiety using tools that included the Hospital Anxiety and Depression Scale, the State-Trait Anxiety Inventory and the GAD-7, though measures and study designs differed.
Why Perimenopause Merits Attention
The results could help clinicians and health services recognize that anxiety symptoms may be reported more often during the menopause transition than before it. That matters because anxiety can affect daily functioning and may occur alongside other concerns during midlife. The study does not show that every woman will experience anxiety, or that a menopausal stage alone explains an individual’s symptoms.
The findings also speak to differences in how menopause-related mental health is represented in public guidance. The source report says 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. A clearer evidence base may inform future research and guidance, but this review by itself does not prescribe a change in care.
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How the Review Compared Stages
Menopause is defined retrospectively after 12 consecutive months without menstrual periods, when no other cause accounts for the absence. Perimenopause precedes it and is associated with irregular cycles. The review focused on whether reported anxiety differed across these stages, a question the source says has received less attention than some other mental health issues during the menopause transition.
Earlier evidence had limitations: a 2012 narrative review described generally low anxiety across menopausal stages, but did not use consistent staging criteria or pool quantitative estimates. The newer review sought to compare findings across studies with specified menopausal definitions. It included cross-sectional research and baseline data from longitudinal cohorts, so its pooled comparisons capture associations between groups rather than a tracked trajectory for every participant.
The review authors also discussed possible biological explanations, including changes in estrogen and potential effects on neurotransmitters and stress responses. They noted that sleep disruption and vasomotor symptoms such as hot flashes could also be relevant. These are proposed pathways and possible interacting factors, 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 analysis cannot establish whether menopausal changes cause anxiety. It compares groups across observational studies and does not show that an individual woman’s anxiety increased as she moved from one stage to another. The source report also says results varied substantially between studies, which limits how uniformly the pooled pattern can be applied.
The review’s estimates concern odds of reporting symptoms, not a diagnosis of an anxiety disorder, the severity of symptoms, or an absolute probability that a woman will experience anxiety. Differences in measurement, populations and study design may affect the comparisons. The available source material does not provide confidence intervals or enough detail to assess the precision of each estimate here. Proposed hormonal, sleep-related and social explanations remain unconfirmed by these pooled results.
Further Research and Clinical Guidance
The review identifies a need for further research that follows women over time and uses consistent definitions of menopausal stage and anxiety. Such studies could help clarify whether anxiety changes within individuals during the transition and how symptoms relate to sleep, hot flashes, hormone changes and other factors.
For now, the findings support awareness of anxiety during perimenopause but do not establish a specific treatment or change to clinical guidance. The review searched literature only through August 16, 2024; how newer studies might affect the evidence is not covered by this analysis. Future research and any updates to health guidance will determine whether the observed pattern leads to more specific recommendations.
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 analysis. The review also found elevated odds among postmenopausal women compared with premenopausal women.
Did the study prove menopause causes anxiety?
No. The review combined observational studies and found an association between menopausal stage and reported anxiety. It cannot show that menopause causes anxiety or that symptoms rise within each woman over time.
Were anxiety odds higher after menopause too?
Yes. Postmenopausal women had 63% higher odds of reporting anxiety symptoms than premenopausal women. In a direct comparison, their odds were 21% lower than those of perimenopausal women.
How many studies and women were included?
The review included 21 studies and 24,523 women; 15 studies contributed to the meta-analysis. The researchers searched databases for eligible studies through August 16, 2024.
Does the finding mean every woman will have anxiety in perimenopause?
No. The results describe group-level odds of reporting symptoms, not an individual prediction or a diagnosis. The studies also varied, and the review does not establish the cause of any person’s anxiety.
Source: rss
