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A systematic review and meta-analysis found that women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. The analysis also found higher odds after menopause, but it cannot show that menopause causes anxiety or that anxiety rises within individual women over time.
A systematic review and meta-analysis 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 examined. The findings, published in Scientific Reports, show an association between menopausal stage and reported anxiety, but do not establish that menopause causes anxiety.
Researchers pooled results from 15 of the 21 studies to compare reported anxiety across premenopause, perimenopause and postmenopause. 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 of the two later stages, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. The authors said results varied substantially across studies, so the pattern should not be read as a precise prediction for any individual woman.
The review included observational research using standardized questionnaires, interviews or scales with anxiety items. It followed PRISMA review guidelines, searched four research databases through August 16, 2024, and used random-effects methods to pool eligible data. One study rated low quality was excluded from the meta-analysis.
Anxiety During the Menopause Transition
The findings point to perimenopause as a stage when anxiety symptoms may warrant attention in health care and research. Recognizing a possible association could help clinicians ask about mental health alongside other concerns during the menopause transition, rather than assuming that anxiety is unrelated to reproductive stage.
The study does not test whether screening or any particular treatment improves outcomes. Nor does it show that hormonal changes are the explanation for the reported differences. The authors discuss possible biological pathways, including changes in estrogen and effects on neurotransmitters and stress responses, as hypotheses informed by wider research—not mechanisms established by this review.
Guidance has not been uniform: the source report says the World Health Organization recognizes anxiety as a possible menopause-related symptom, while UK NICE guidance does not explicitly list anxiety as one. The review may inform discussion of that gap, but its findings alone do not determine clinical policy.
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How Menopausal Stages Were Compared
Menopause is defined as the permanent cessation of menstrual periods, identified retrospectively after 12 consecutive months without menstruation and without another cause. Perimenopause is the preceding period, when cycles can become irregular and hormonal patterns fluctuate. The review compared these stages with premenopause, using recognized staging criteria or equivalent definitions.
An earlier narrative review in 2012 described anxiety as generally low across menopausal stages, but it did not use standardized stage criteria or pool quantitative risk estimates, according to the report. The newer analysis sought to address those limitations by combining evidence across studies; it remains based on observational data rather than an experiment that can establish cause and effect.
“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, as summarized in the News-Medical report
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Limits of the Anxiety Evidence
The pooled results describe odds of reporting symptoms across groups; they do not show that menopause causes anxiety, or that a woman’s anxiety necessarily increases as she moves from one stage to another. Because the included studies were observational, other differences between participants could contribute to the association.
Results also varied substantially across studies. The supplied report does not give pooled absolute rates of anxiety, so the relative odds cannot tell readers how many women experienced symptoms. It also does not provide enough detail to determine how results differed by country, age, assessment tool or other participant characteristics. The proposed roles of hormone fluctuation, sleep disruption, hot flashes and stress responses remain possible explanations, not findings directly proven by this analysis.
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Further Research and Clinical Guidance
The review calls attention to a question that remains open: whether anxiety changes as individuals move through menopausal stages, and what factors might account for any change. Longitudinal research following the same women over time could help answer that question more directly than comparisons made between different groups.
For now, the study offers evidence for clinicians and health-policy groups to weigh alongside other research, but it does not prescribe a screening approach or treatment. The next steps depend on further studies and any subsequent updates to clinical guidance; the supplied report does not identify a specific policy review or follow-up date.
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 finding describes a group-level association, not an individual diagnosis.
Did postmenopausal women also report higher anxiety odds?
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 this prove menopause causes anxiety?
No. The review combined observational studies and found an association. It cannot establish that menopause causes anxiety or show that anxiety increases within the same person over time.
How many women and studies were included?
The review covered 21 studies and 24,523 women. Fifteen studies contributed to the meta-analysis comparing anxiety odds across menopausal stages.
What remains unknown?
The results varied between studies, and the report does not provide absolute anxiety rates or establish why the groups differed. Possible roles for hormonal changes, sleep disruption and other factors require further research.
Source: rss
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