TL;DR
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A systematic review of 21 studies involving 24,523 women found that perimenopausal women had higher odds of reporting anxiety symptoms than premenopausal women, with postmenopausal women also showing elevated odds. The observational findings describe associations, not proof that menopause causes anxiety or that anxiety rises within individual women over time.
A systematic review of 21 studies and 24,523 women found that women in perimenopause had higher odds of reporting anxiety symptoms than premenopausal women, with the highest odds among the three menopausal groups examined. The findings, published in Scientific Reports, also showed elevated odds after menopause, but do not establish that the menopause transition causes anxiety.
In the pooled analysis, women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. Postmenopausal women had 63% higher odds than the premenopausal group. In a direct comparison between the two later stages, postmenopausal women had 21% lower odds of reported anxiety than perimenopausal women. These are comparisons of odds across groups, not estimates of how many women experience anxiety or how an individual’s symptoms change over time.
The review included 21 peer-reviewed observational studies from multiple countries; 15 contributed data to the meta-analysis. Researchers searched four databases for studies available through August 16, 2024, and included research that assessed anxiety with standardized questionnaires, interviews or scales containing anxiety measures. They used defined criteria for menopausal stages and excluded studies involving surgical menopause or co-occurring physical or psychiatric conditions.
The authors reported that results varied substantially between studies. The review pooled baseline data from longitudinal studies alongside cross-sectional findings, so it does not show that participants’ anxiety increased as they moved from one stage to another. The authors said the pattern supports greater clinical awareness of anxiety during the menopause transition, while stressing that the analysis identifies an association rather than cause and effect.
Why Perimenopause Merits Attention
The findings point to perimenopause as a stage when reported anxiety may be more common than before menopause, giving clinicians and patients a reason to include mental health symptoms in conversations about midlife health. The authors argue that better recognition could inform future clinical guidance and mental healthcare policies.
Guidance does not address the issue uniformly. The review notes that 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 study does not test a particular screening or treatment approach, so it cannot show what clinical response would be most effective.
The results should not be read as a prediction for every woman. Odds comparisons describe patterns across groups in the included studies; they do not establish that menopause is the cause of anxiety, that all women in perimenopause will experience it, or that symptoms will resolve after the transition.
How the Review Compared Stages
Menopause is defined as the permanent cessation of menstrual periods, identified retrospectively after 12 consecutive months without menstruation when no other cause explains it. Perimenopause precedes menopause and can involve irregular cycles and changing hormone levels. The review compared anxiety reports across premenopausal, perimenopausal and postmenopausal groups using accepted stage definitions or equivalent criteria.
Earlier work had left uncertainty about how anxiety reporting differs by stage. The source report describes a 2012 narrative review that found generally low anxiety across stages but did not use standardized staging criteria or pool quantitative estimates. The newer review applied systematic search and screening methods and used a random-effects meta-analysis for eligible data, although differences among the underlying studies remain important when interpreting its results.
Researchers proposed possible biological pathways involving estrogen fluctuations and stress responses, as well as possible interactions with hot flashes and disrupted sleep. These are explanations discussed by the authors, not mechanisms established by this meta-analysis. The study assessed reported anxiety symptoms and did not establish why group differences appeared.
“Perimenopausal and postmenopausal women had significantly higher odds of anxiety symptoms compared with premenopausal women, with the highest odds observed during perimenopause.”
— The review authors
Limits of the Anxiety Evidence
The analysis cannot determine whether menopausal changes cause anxiety, whether anxiety symptoms rise within the same person as she enters perimenopause, or whether other factors account for some of the differences between groups. Because the included studies used different populations and methods, the authors reported substantial variation in results.
The findings also do not establish the best way to identify or manage anxiety during the menopause transition. The review assessed symptom reporting, rather than testing screening programs or treatments. Its database search covered studies available through August 16, 2024, so later research was not part of the analysis. The source report does not provide a single overall prevalence estimate for anxiety across the groups.
What Future Research Can Clarify
The review authors said the findings may help inform future clinical guidance and mental healthcare policy. The analysis itself does not announce a policy change or prescribe a new standard of care. Further research would be needed to clarify how anxiety changes within individuals across menopausal stages and how biological, sleep-related and social factors may contribute.
For now, the main development is evidence of a group-level association: reported anxiety odds were highest in perimenopause among the stages compared, while postmenopausal odds also exceeded premenopausal odds. Whether guidance changes, and what assessment or support approaches may follow, remain open questions.
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 result compares groups and does not predict an individual woman’s experience.
Did postmenopausal women also report higher anxiety odds?
Yes. The review found 63% higher odds among postmenopausal women than premenopausal women. In a direct comparison, postmenopausal women had 21% lower odds than those in perimenopause.
Does the study prove menopause causes anxiety?
No. The researchers synthesized observational studies, which show associations but cannot establish that menopause caused anxiety or that symptoms increased within individual women over time.
How much research was included?
The systematic review included 21 studies involving 24,523 women. Fifteen studies contributed to the meta-analysis, which compared anxiety reporting across menopausal stages.
What remains uncertain?
Results varied substantially among studies, and the review cannot determine the causes of the group differences or which clinical approach works best. Its evidence search included studies available through August 16, 2024.
Source: rss
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