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A systematic review of 21 studies covering 24,523 women found higher odds of reported anxiety symptoms during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in the comparison, but the observational findings do not show that menopause causes anxiety or that symptoms rise within individual women 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 women before menopause, while postmenopausal women also had elevated odds. The findings, published in Scientific Reports, put perimenopause at the highest level in the stage comparisons, but do not establish that menopause causes anxiety.
The researchers combined evidence from observational studies examining anxiety across premenopausal, perimenopausal and postmenopausal stages. Of the 21 studies included in the review, 15 contributed data to the meta-analysis. The analysis found that perimenopausal women had 59% higher odds of reporting anxiety symptoms than premenopausal women. Postmenopausal women had 63% higher odds than the premenopausal comparison group.
In a direct comparison between the two later stages, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. That result places perimenopause highest in the review’s comparisons, although the authors reported substantial variation among the studies. These are odds comparisons across groups, not estimates of how many women experience anxiety or proof that an individual woman’s symptoms will change as she moves through menopause.
The review assessed observational research using measures such as standardized questionnaires and interviews. It applied defined criteria for menopausal stages and excluded studies focused on surgical menopause. The researchers used a random-effects approach to pool eligible results; for longitudinal studies, only baseline observations were included in the pooled analyses.
Why Perimenopause Needs Clinical Attention
The findings add pooled evidence to a question that has had less attention than depression in menopause research: whether anxiety reporting differs by menopausal stage. The pattern may help clinicians and researchers pay closer attention to anxiety when discussing symptoms during the menopause transition, rather than assuming it is unrelated to midlife health.
However, the results do not establish a cause or identify which women are most likely to experience anxiety. Anxiety can have multiple contributing factors, and the studies were observational. The review therefore supports awareness and further research, not a conclusion that menopause itself produces anxiety or a change to treatment recommendations on its own.
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How the Review Compared Menopause Stages
Menopause is generally identified retrospectively after 12 consecutive months without menstrual periods, when another cause is not responsible. Perimenopause is the preceding transition, often involving irregular cycles. The review compared these stages with the premenopausal period, using the Stages of Reproductive Aging Workshop +10 criteria or equivalent definitions where available.
Researchers searched MEDLINE, PsycINFO, Embase and Web of Science for eligible studies published through August 16, 2024. The review followed PRISMA reporting guidance and assessed study quality using Critical Appraisal Skills Program checklists. Its authors said earlier evaluations had limitations, including a 2012 narrative review that did not use standardized stage criteria or pool quantitative estimates.
Guidance does not treat anxiety uniformly: the source report says the World Health Organization recognizes it as a possible menopause-related symptom, while UK NICE guidance does not explicitly list anxiety as a menopausal symptom. The new pooled analysis adds evidence to that discussion, but its design cannot settle whether menopause causes anxiety.
“The findings support greater clinical awareness of anxiety symptoms during the menopause transition.”
— The review authors, as summarized in the News-Medical report
Limits of the Anxiety Comparisons
The review reports substantial variation across the included studies, so the pooled pattern may not describe every population or individual experience. Because much of the evidence compared groups at a given point, it cannot show that women’s anxiety symptoms rise as they move from one menopausal stage to another. Nor can it determine whether hormonal changes, sleep disruption, hot flashes, social circumstances or other factors account for the observed association.
The supplied report does not provide the absolute prevalence of anxiety symptoms in each stage, confidence intervals for the pooled estimates, or enough detail to assess how individual study differences affected the results. The 59%, 63% and 21% figures describe relative odds within the stated comparisons; they are not percentage-point increases in the share of women affected. Further longitudinal research would be needed to track individuals and examine possible explanations.
Further Research and Clinical Guidance
The review does not announce a new clinical guideline or treatment. The immediate next step for the research field is to test the pattern in studies that follow women across menopausal stages, use consistent anxiety measures and report absolute rates as well as odds. That could clarify whether the stage differences persist when changes within the same individuals are measured.
Clinicians and health authorities may use the findings as part of continuing discussions about mental health during menopause, but the review alone does not prescribe a change in care. Women experiencing anxiety can discuss their symptoms and circumstances with a qualified health professional; the study does not diagnose individuals or identify a specific treatment.
Key Questions
What did the review find about anxiety in perimenopause?
It found that women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women in the pooled comparison. This is a group-level odds estimate, not a prediction for any one person.
Were anxiety odds also higher after menopause?
Yes. Postmenopausal women had 63% higher odds of reporting anxiety than premenopausal women. In a direct comparison, postmenopausal women had 21% lower odds than perimenopausal women.
Does the study prove menopause causes anxiety?
No. The evidence was observational and shows an association between menopausal stage and reported symptoms. It does not establish cause and effect or show that anxiety increases within an individual as she moves through menopause.
How many women and studies were included?
The review covered 21 studies and 24,523 women; 15 studies contributed to the meta-analysis. The researchers searched for studies published through August 16, 2024.
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