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A systematic review of 21 studies involving 24,523 women found that anxiety symptoms were reported more often in perimenopause and after menopause than before menopause. Perimenopause had the highest odds in a direct comparison, but the observational evidence cannot show that menopause causes anxiety or that individual women’s symptoms rise over time.
A review of 21 studies involving 24,523 women found higher odds of reported anxiety symptoms among women in perimenopause and after menopause than among premenopausal women, with the highest odds in the perimenopausal group. The analysis, published in Scientific Reports, describes an association across groups; it does not establish that menopause causes anxiety or that anxiety increases within individual women as they move through menopause.
Researchers combined evidence from observational studies to compare anxiety symptoms across premenopausal, perimenopausal and postmenopausal stages. Of the 21 studies included in the review, 15 contributed data to the meta-analysis. Compared with premenopausal women, perimenopausal women had 59% higher odds of reporting anxiety symptoms, while postmenopausal women had 63% higher odds.
In a direct comparison between the latter two groups, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. This places perimenopause highest in the reported comparisons, but the authors noted substantial variation among the included studies. The percentages describe odds between groups, not the share of women affected or a measure of how severe symptoms were.
The review included cross-sectional and longitudinal observational research. For the pooled analysis, researchers used baseline observations from longitudinal studies alongside cross-sectional data, and applied a random-effects model. Anxiety was assessed with standardized questionnaires, interviews or broader scales that included anxiety items. The search covered four research databases through Aug. 16, 2024.
Why Perimenopause Deserves Attention
The findings point to a stage of midlife when anxiety may be more commonly reported than in the other groups examined. That could matter for clinicians and patients discussing mental health during the menopause transition, particularly because anxiety has not been addressed consistently in public health information and clinical guidance, according to the report.
The results do not show that every woman will experience anxiety, or that menopause is the cause when anxiety occurs. Still, the group-level pattern may support greater awareness and discussion of anxiety symptoms during perimenopause. The study measures reported symptoms, not a diagnosis of an anxiety disorder, and cannot establish what care would help or whether a particular intervention is appropriate.
For readers, the practical takeaway is limited but relevant: anxiety is a symptom worth raising with a qualified health professional, including when it occurs during the menopause transition. The review does not provide personal medical guidance or test a 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 when there is no other cause. Perimenopause precedes it and is marked by changes in menstrual cycles. The review focused on whether reports of anxiety differed across these defined stages, rather than treating all midlife women as one group.
The authors said earlier research reviews had limitations. A 2012 narrative review reported generally low anxiety across stages, but did not use standardized staging criteria or pool quantitative estimates. The current review sought to combine findings using defined menopausal stages and a meta-analysis. Its researchers followed PRISMA review-reporting guidelines, assessed study quality with CASP checklists, and excluded one study rated low quality from the pooled analysis.
The report also notes that guidance is not uniform: the World Health Organization recognizes anxiety as a possible menopause-related symptom, while the United Kingdom’s NICE guidelines do not explicitly list anxiety as a menopausal symptom. These differences make the new pooled estimates relevant to discussions about how mental health is recognized during menopause, but they do not resolve how guidelines should change.
Limits of the Anxiety Evidence
The evidence is observational, so it can identify an association but cannot show that menopausal stage causes anxiety. Because studies compared groups, the findings also do not establish that the same individuals’ anxiety symptoms rose during perimenopause and then fell after menopause. The report explicitly cautions against treating the results as evidence of that personal timeline.
Results varied substantially across studies, and the supplied report does not give a single pooled absolute rate of anxiety symptoms for each stage. The odds comparisons therefore should not be read as the percentage of women who experience anxiety. The findings also depend on the studies’ populations, staging definitions and anxiety measures.
Researchers discussed possible biological explanations, including hormonal fluctuations and changes in stress responses, as well as interactions with symptoms such as hot flashes and disrupted sleep. These are proposed pathways, not mechanisms established by this analysis. The report does not establish which factors account for the differences, or how they may combine with social and personal circumstances.
Questions for Future Research
The review points to a need for further research that follows women over time, uses consistent menopause-stage definitions and measures anxiety in comparable ways. Such studies could help distinguish differences between groups from changes experienced by individuals and examine factors that may contribute to the pattern.
For now, the published analysis offers a comparison rather than a causal answer or a clinical recommendation. The report does not announce a follow-up study or a scheduled change to medical guidance. Any new guidance would require separate evaluation by health authorities; the present findings mainly add evidence for clinicians and researchers considering how anxiety is recognized during perimenopause.
Key Questions
What did the review find about anxiety during perimenopause?
Across the pooled comparisons, women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. This is a comparison of odds between groups, not the percentage of perimenopausal women with anxiety.
Did postmenopausal women also report higher anxiety?
Yes. The review found 63% higher odds of reported anxiety symptoms among postmenopausal women than among premenopausal women. In a direct comparison, postmenopausal women had 21% lower odds than perimenopausal women.
Does the study prove menopause causes anxiety?
No. The studies were observational, so they show an association, not cause and effect. They also do not prove that anxiety rises and falls within the same person as she moves through menopause.
How many women and studies were included?
The systematic review included 21 studies and 24,523 women. Fifteen studies contributed data to the meta-analysis.
What remains uncertain?
The studies varied substantially, and the analysis cannot establish why anxiety reporting differed by stage. Proposed hormonal and stress-related explanations remain hypotheses rather than mechanisms proven by this review.
Source: rss
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