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A systematic review of 21 studies involving 24,523 women found that anxiety symptoms were reported more often by women in perimenopause and after menopause than by premenopausal women. The pooled results showed the highest odds during perimenopause, but substantial variation between studies and the observational design mean they do not show that menopause causes anxiety or that individuals’ 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 three menopausal groups examined. The analysis, published in Scientific Reports, also found elevated odds among postmenopausal women, but it does not establish that menopause causes anxiety or that anxiety increases within individual women as they move through menopause.
The researchers’ systematic review and meta-analysis assessed observational evidence on anxiety reporting before, during and after menopause. Of the 21 studies included in the review, 15 contributed to the pooled analysis, which compared anxiety symptoms across premenopausal, perimenopausal and postmenopausal groups. Studies used standardized questionnaires, interviews or broader measures that included anxiety items.
Compared with premenopausal women, participants 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 than perimenopausal women. These are comparisons of odds between groups, not estimates of how many women experience anxiety or of an individual woman’s likelihood over time.
The authors reported that results varied substantially between studies. The review used observational research, including cross-sectional studies and baseline data from longitudinal cohorts. It therefore identifies an association between menopausal stage and reported symptoms, rather than showing that stage caused the differences. One study judged to be low quality was left out of the meta-analysis.
Anxiety During the Menopause Transition
The review pooled evidence on whether anxiety reporting differs across stages of menopause. Its findings indicate that reported anxiety symptoms were more common in the perimenopausal and postmenopausal groups than in the premenopausal group, although the study differences were substantial.
The source article 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. The review reports an association; its findings alone do not establish whether clinical guidance or treatment should change.
The results are population-level findings, not a diagnosis or prediction for any one person. Anxiety can have multiple contributing factors, and this analysis does not determine the cause of symptoms. Anyone concerned about anxiety or other symptoms should discuss them with a qualified health professional.
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How the Review Compared 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 precedes menopause and can involve irregular cycles. The review compared these stages with the premenopausal group using definitions based on the Stages of Reproductive Aging Workshop +10 criteria or equivalent systems.
Researchers searched MEDLINE, PsycINFO, Embase and Web of Science from their inception through August 16, 2024. They included cross-sectional and longitudinal observational studies of women aged 18 or older that assessed anxiety using standardized tools, including measures such as the GAD-7, STAI and HADS. Studies involving surgical menopause or specified co-occurring physical or psychiatric conditions were excluded.
The review addressed limits in earlier work. A 2012 narrative review had reported generally low anxiety across menopausal stages, but it did not use the same standardized staging approach or pool quantitative estimates. The new analysis combined results from eligible studies, although differences between those studies remained substantial.
Limits of the Anxiety Evidence
The analysis cannot determine whether menopause itself leads to anxiety. Because the evidence is observational, differences between groups could reflect other factors, and the pooled comparisons do not track changes in the same women through each stage. The authors also found substantial variation across studies, limiting how uniformly the results can be applied.
The source report describes possible biological explanations, including changes in estrogen and interactions with sleep disruption, hot flashes and stress responses. These are proposed pathways, not mechanisms demonstrated by this meta-analysis. The available material does not provide enough detail to assess how the pooled estimates differed by country, age or individual study, or whether symptom severity followed the same pattern as symptom reporting.
Questions for Future Research
The review itself does not announce a follow-up trial or a change to clinical guidance. Future research could follow women across menopausal stages, use consistent definitions and anxiety measures, and account for other factors that could affect symptoms. Such work could clarify whether the group-level pattern reflects changes over time within individuals.
The reported estimates provide evidence for clinicians and researchers to consider when discussing mental health during the menopause transition. Whether guidance should change, and which approaches to assessment or care are appropriate, remain unresolved questions for further research and professional review.
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 result compares groups and does not show an individual woman’s risk over time.
Did postmenopausal women also report higher anxiety?
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.
Does the study prove menopause causes anxiety?
No. The review combined observational studies and found an association. It does not establish that menopause causes anxiety or that symptoms increase within the same person during the transition.
How many studies and participants were included?
The review included 21 studies and 24,523 women; 15 studies contributed data to the meta-analysis.
What should someone do if they are experiencing anxiety?
The findings are not a diagnosis or treatment recommendation. Someone concerned about anxiety should discuss symptoms and possible causes with a qualified health professional.
Source: rss
