TL;DR
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A systematic review covering 24,523 women found that anxiety symptoms were reported at higher odds during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in a direct comparison with postmenopause, but the observational results do not show that menopause causes anxiety or that anxiety rises within each individual woman.
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 review’s comparisons showing the highest odds during perimenopause. The findings describe an association across groups, not proof that the menopause transition causes anxiety or that any individual woman’s symptoms increase over time.
Researchers reviewed observational studies comparing anxiety across premenopausal, perimenopausal and postmenopausal stages. Of the 21 studies included in the review, 15 contributed data to the meta-analysis. The authors searched four research databases through August 16, 2024, and included studies that used standardized measures such as the GAD-7, the Hospital Anxiety and Depression Scale, or the State-Trait Anxiety Inventory.
Compared with premenopausal women, perimenopausal women 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 relative odds from pooled observational evidence, not estimates of how many women experience anxiety or how severe their symptoms are.
The report says results varied substantially between studies. The analysis used a random-effects model to pool eligible data, and only baseline observations from longitudinal studies were included alongside cross-sectional findings. The study was published in Scientific Reports under the title “Anxiety symptoms across menopausal stages: a systematic review and meta-analysis.”
Why Perimenopause May Need More Attention
The findings may help clinicians and patients recognize that anxiety symptoms can be reported during the menopause transition, a period that has received less attention in research than depressive symptoms. The authors say the pattern supports greater clinical awareness of anxiety during menopause; it does not establish a cause or prescribe a particular treatment.
The topic also matters because guidance does not frame anxiety in the same way across health systems. The source report notes that the World Health Organization identifies 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 may inform future research and discussions about guidance, but it does not itself change clinical recommendations.
For readers, the results are a reason to take distress seriously rather than assume it is an inevitable or uniform part of menopause. The study does not assess a person’s symptoms or provide medical advice. Anyone concerned about anxiety should discuss it with a qualified health professional, who can consider individual circumstances and possible causes.
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How Menopause Stages Were Compared
Menopause is defined clinically as the permanent end of menstrual periods, confirmed retrospectively after 12 consecutive months without menstruation when no other cause explains it. Perimenopause precedes menopause and can involve irregular cycles and hormonal changes. The review compared groups classified by accepted reproductive-aging criteria or equivalent definitions.
Earlier reviews had limitations, according to the source report. A 2012 narrative review described anxiety as generally low across menopausal stages, but did not use consistent staging criteria or pool quantitative estimates. The newer review sought to address that gap by bringing together studies using defined stages and established anxiety measures. It included observational research, rather than trials designed to test whether menopause causes anxiety.
“The findings support greater clinical awareness of anxiety symptoms during the menopause transition.”
— The review authors, as summarized by News-Medical
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What the Study Cannot Establish
The review found differences in reported anxiety across menopausal-stage groups, but observational comparisons cannot show that menopause caused those differences. Nor can the findings establish that anxiety symptoms rise within the same women as they move from premenopause to perimenopause and then postmenopause. The pooled estimates compare groups and should not be read as an individual prognosis.
There was substantial variation among the included studies, and the source material does not provide a single explanation for that variation. The researchers discussed possible biological pathways, including changes in estrogen and stress responses, as well as interactions with hot flashes, disrupted sleep, and social or psychological factors. These are proposed explanations drawing on wider research, not mechanisms demonstrated by this meta-analysis.
The report does not give enough information to determine how the pattern differs by age, country, symptom severity, or other characteristics, or how representative the study samples are of all women. It also does not establish whether treating menopause-related symptoms changes anxiety outcomes. Those questions remain open.
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Further Research and Clinical Guidance
The review’s findings give researchers a basis for more consistent studies of anxiety across reproductive stages. Longitudinal research that follows the same participants over time could help distinguish changes within individuals from differences between groups. Studies could also examine how sleep disruption, vasomotor symptoms, mental health history, and social factors relate to anxiety reporting, while testing whether the pattern holds across different populations.
The authors frame the results as support for increased clinical awareness, not as a change to diagnostic criteria or treatment guidance. Whether professional guidelines will be revised is not stated in the source material. For now, the next steps are further research and continued evaluation of how anxiety is recognized and discussed in care during the menopause transition.
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Key Questions
What did the review find about anxiety during perimenopause?
Perimenopausal women had 59% higher odds of reporting anxiety symptoms than premenopausal women in the pooled analysis. This is a relative comparison between groups, not a measure of an individual woman’s likelihood or symptom severity.
Did postmenopausal women also report more anxiety?
Yes. The review found 63% higher odds of anxiety symptoms among postmenopausal women than among premenopausal women. In a direct comparison with perimenopause, postmenopausal women had 21% lower odds.
Does the study prove menopause causes anxiety?
No. The evidence came from observational studies and shows an association between menopausal stage and reported symptoms. It does not establish that menopause causes anxiety or that symptoms rise within each woman over time.
How many women and studies were included?
The review included 21 studies and 24,523 women; 15 studies contributed to the meta-analysis. The studies assessed anxiety using standardized questionnaires, interviews, or scales containing anxiety items.
What should someone do if they are worried about anxiety?
The review is not personal medical guidance. Someone concerned about anxiety can discuss their symptoms with a qualified health professional, who can assess their situation and discuss appropriate support.
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