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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 direct comparison, 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 premenopausal women, with the highest odds among the menopausal groups compared. The findings, published in Scientific Reports, also show elevated odds after menopause, but do not establish that menopause causes anxiety.
Researchers included evidence from women in multiple countries and pooled results from 15 of the 21 studies in a meta-analysis. Compared with premenopausal women, those in perimenopause had 59% higher odds of reporting anxiety symptoms. Postmenopausal women had 63% higher odds than premenopausal women.
In a direct comparison between the two later stages, postmenopausal women had 21% lower odds of reporting anxiety than women in perimenopause. Taken together, those comparisons place perimenopause as the stage with the highest reported odds in the analysis. The authors also cautioned that results varied substantially between studies.
The review examined observational research, including cross-sectional studies and baseline data from longitudinal cohorts. Anxiety was measured using standardized questionnaires, interviews or broader scales that included anxiety questions. The review searched four research databases through August 16, 2024, and applied defined criteria for classifying menopausal stages.
Why Perimenopause Deserves Attention
The results point to a possible period when anxiety symptoms may be more commonly reported, which could help clinicians and researchers pay closer attention to mental health during the menopause transition. The authors said the findings support greater clinical awareness of anxiety symptoms in this period; they do not establish a cause or prescribe a particular response.
The issue also intersects with differences in how health guidance addresses menopause. 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, although it addresses other psychological symptoms. The review may inform discussion of that gap, but it does not itself change clinical guidance.
The figures describe odds of reporting symptoms across groups, not the proportion of all women who will experience anxiety. They also do not show that an individual’s anxiety will follow the same pattern. That distinction matters for readers interpreting the findings and for decisions about care, which should be discussed with a qualified health professional.
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How Researchers Compared Menopausal 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 hormonal fluctuations. The review compared anxiety reporting across premenopausal, perimenopausal and postmenopausal groups using established staging criteria or equivalent definitions.
The review responds to a gap in research on how anxiety symptoms relate to menopausal stage. Earlier work had not provided pooled quantitative estimates using consistent staging, according to the source report. The researchers followed PRISMA review guidelines, assessed study quality, and excluded one study rated low quality from the meta-analysis. Their pooled analysis used a random-effects model, an approach that accounts for variation among studies.
“The findings support greater clinical awareness of anxiety symptoms during the menopause transition.”
— The review authors, as summarized in News-Medical
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Limits of the Anxiety Evidence
The studies found an association between menopausal stage and anxiety reporting, but observational data cannot establish that the transition caused the symptoms. The pooled comparisons also do not track a single group of women through every stage, so they cannot show that anxiety rises and then falls within individuals.
Results varied substantially across the studies. The source material does not give a single overall prevalence of anxiety, confidence intervals for the reported odds, or enough detail to explain how differences in participants, settings and measurement tools affected the comparisons. The review therefore identifies a pattern in the available evidence, not a definitive estimate for every population.
The authors discussed possible biological pathways, including hormonal fluctuations and effects on stress responses, as well as potential interactions with hot flashes and disrupted sleep. These are proposed explanations, not mechanisms proven by the meta-analysis. The study also does not establish what treatment, if any, is appropriate for an individual experiencing anxiety.
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How Guidance May Respond
The review’s findings may inform future research and discussions about whether clinical guidance should address anxiety more explicitly during the menopause transition. The source report says the work was intended to help inform future mental healthcare policies, but it does not identify a scheduled guideline review or a policy change.
Further studies that follow women across menopausal stages could help clarify how symptoms change over time and how much the pattern differs between individuals. For now, the evidence supports awareness of anxiety symptoms during perimenopause while leaving causation, individual trajectories and the best clinical response unresolved.
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Key Questions
Which menopausal group reported the highest odds of anxiety?
In the review’s comparisons, perimenopausal women had the highest odds of reporting anxiety symptoms. Their odds were 59% higher than those of premenopausal women.
Did postmenopausal women also have higher odds?
Yes. Postmenopausal women had 63% higher odds than premenopausal women in the pooled comparison. In a direct comparison with perimenopausal women, their odds were 21% lower.
Does the review show that menopause causes anxiety?
No. The analysis combined observational studies and found an association between stage and reported symptoms. It cannot establish that menopause causes anxiety.
How many women and studies were included?
The review examined 21 studies involving 24,523 women. Fifteen studies contributed to the meta-analysis.
What remains uncertain about the results?
Results varied substantially between studies, and the pooled comparisons do not show how symptoms change in the same individuals over time. The findings also do not identify a specific treatment or establish the proposed biological explanations.
Source: rss
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