TL;DR
A systematic review and meta-analysis of 21 studies involving 24,523 women found higher odds of reporting anxiety symptoms during perimenopause and after menopause than before menopause. The odds were highest during perimenopause in the comparisons, but results varied across studies and do not show that menopause causes anxiety or that an individual’s symptoms rise over time.
A 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 stages compared. The analysis, published in Scientific Reports, also found elevated odds after menopause, but it does not establish that menopause causes anxiety or that symptoms increase within individual women over time.
Researchers compared anxiety reporting across premenopause, perimenopause and postmenopause. Of the 21 studies in the review, 15 contributed data to the meta-analysis. 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 between the two later stages, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. These are comparisons of odds between groups, not estimates of how many women experience anxiety or proof that the same person’s symptoms rise and then fall during the transition.
The review drew on observational studies from multiple countries. Anxiety was assessed through standardized questionnaires, interviews or broader scales that included anxiety items. The researchers pooled eligible results using a random-effects meta-analysis; one study assessed as low quality was excluded from the pooled analysis.
Anxiety During the Menopause Transition
The findings add quantitative evidence to a question that has received less attention than some other mental health concerns during the menopause transition: whether anxiety reporting differs by reproductive stage. The pattern may support greater clinical awareness of anxiety symptoms among people in perimenopause, particularly when they seek care for concerns such as disrupted sleep or other symptoms.
The results do not show that every woman will experience anxiety, nor do they identify its cause. The authors discuss possible biological pathways, including hormonal fluctuations and changes in stress responses, as well as possible interactions with hot flashes, sleep disruption and social or psychological factors. These are proposed explanations, not mechanisms established by the review. The evidence may inform discussion of clinical guidance, but it does not by itself determine what care should be provided.
How the Review Compared Menopausal Stages
Menopause is defined as the permanent end of menstrual periods and is identified retrospectively after 12 consecutive months without menstruation, when no other cause explains the absence. Perimenopause is the period leading up to menopause, often marked by irregular cycles and hormonal changes. The review included studies that classified stages using the STRAW+10 criteria or equivalent definitions.
The research team searched MEDLINE, PsycINFO, Embase and Web of Science through August 16, 2024, screening observational studies of women aged 18 or older. Earlier work had examined mental health around menopause, but a 2012 narrative review cited in the report did not use consistently defined stages or pool quantitative risk estimates. The new analysis sought to compare anxiety reporting across defined stages using pooled data.
Public guidance has not framed anxiety uniformly: the source report says the World Health Organization recognizes it as a possible menopause-related symptom, while UK NICE guidelines do not explicitly list anxiety as a menopausal symptom. That difference makes evidence on stage-specific reporting relevant to ongoing clinical discussions, though this review alone cannot settle guidance.
“The results do not establish that menopause causes anxiety or that symptoms increase within individual women over time.”
— The review authors
Limits of the Anxiety Evidence
The studies showed substantial variation in results, and the pooled findings are observational. They establish an association between menopausal stage and reported anxiety, not a cause-and-effect relationship. Because the analysis compared groups, it also cannot show whether a particular woman’s anxiety changed as she moved through menopause.
The source material does not provide the review’s full confidence intervals, detailed study-by-study results or a single estimate of how common anxiety was across the groups. It is also unclear from the reported findings how much differences in measurement, participant characteristics or other influences contributed to variation between studies. The review excluded some populations, including people with surgical menopause or certain co-occurring conditions, so its findings may not apply to every clinical situation.
Further Research and Clinical Guidance
The review does not announce a new clinical guideline or treatment recommendation. Its findings may inform future research and discussion about how anxiety is assessed during the menopause transition, but the next steps are not specified in the available report.
Further studies that follow the same participants over time could help clarify whether anxiety changes within individuals across reproductive stages and how symptoms relate to sleep, hot flashes, hormonal changes and other factors. Until that evidence is available, the reported odds should be read as group-level associations rather than predictions about an individual.
Key Questions
Did the review find the highest anxiety odds during perimenopause?
Yes. Perimenopausal women had 59% higher odds of reporting anxiety than premenopausal women. Postmenopausal women also had higher odds than the premenopausal group, while their odds were 21% lower than those of the perimenopausal group.
Does this study prove menopause causes anxiety?
No. The review combined observational evidence and found an association between menopausal stage and anxiety reporting. It cannot establish that menopause causes anxiety.
Does the result mean an individual’s anxiety will decline after perimenopause?
No. The comparison is between groups at different stages, not a record of the same women’s symptoms over time. The findings do not predict an individual’s experience.
How many women and studies were included?
The review included 21 studies and 24,523 women. Fifteen studies contributed data to the meta-analysis comparing anxiety reporting between menopausal stages.
Source: rss
