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A systematic review of 21 studies involving 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 comparisons, but the observational findings do not 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 women before menopause, while postmenopausal women also had higher odds than the premenopausal group. The results, published in Scientific Reports, put the highest odds in perimenopause but do not establish that menopause causes anxiety.
For the pooled analysis, researchers used data from 15 of the 21 studies, comparing anxiety reporting across premenopausal, perimenopausal and postmenopausal groups. Compared with premenopausal women, those in perimenopause had 59% higher odds of reporting anxiety symptoms. The postmenopausal group had 63% higher odds than the premenopausal group.
In a direct comparison between the two later stages, postmenopausal women had 21% lower odds of reported anxiety than perimenopausal women. These are odds comparisons between groups, not estimates of how many women experience anxiety or of how an individual woman’s symptoms change over time. Results also varied substantially across studies, the review reported.
The researchers combined observational evidence, including cross-sectional studies and baseline data from longitudinal cohorts. Anxiety was assessed with standardized questionnaires, interviews or scales that included anxiety items. The review searched four research databases through August 16, 2024 and applied defined criteria for classifying menopausal stages.
Anxiety During the Menopause Transition
The findings may help clinicians and researchers pay closer attention to anxiety symptoms during perimenopause, a stage the review identifies as having the highest odds in its comparisons. Recognizing symptoms can matter for women seeking support and for practitioners deciding what to ask about during midlife care.
The results also point to a gap in how menopause-related mental health is described. The review notes that the World Health Organization recognizes anxiety as a possible symptom associated with menopause, while UK National Institute for Health and Care Excellence guidance does not explicitly list anxiety as a menopausal symptom. The study does not settle what guidance should say, but it adds pooled evidence to a topic the authors describe as understudied.
Importantly, the study cannot establish cause and effect. Higher odds in one stage do not mean menopause itself causes anxiety, nor do they show that every woman experiences worsening symptoms. The evidence supports awareness of a possible association, not a prediction about any individual.
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How the Review Compared Stages
Menopause is defined clinically as the permanent end of menstrual periods, identified retrospectively after 12 consecutive months without menstruation when no other cause explains it. Perimenopause precedes menopause and can involve irregular cycles and hormonal fluctuations; postmenopause follows the final menstrual period.
Earlier work had not provided a pooled quantitative comparison across consistently defined stages. The review used criteria such as STRAW+10 or equivalent definitions and assessed study quality. One study rated as low quality was excluded from the meta-analysis. The authors used a random-effects method to combine eligible results, which accounts for variation among studies rather than assuming they all estimate an identical effect.
The paper discusses possible biological explanations, including changing estrogen levels and potential effects on neurotransmitters and stress responses. It also notes possible interactions with hot flashes, disrupted sleep and social stress. These are proposed pathways discussed by the authors, not mechanisms demonstrated by this meta-analysis.
“Perimenopausal and postmenopausal women had significantly higher odds of anxiety symptoms compared with their premenopausal counterparts, with the highest odds observed during perimenopause.”
— The review authors, as summarized in the report
Limits of the Anxiety Evidence
The evidence is observational, so it cannot show whether menopausal stage causes anxiety symptoms. Because the pooled comparison included cross-sectional data and only baseline observations from longitudinal studies, it also does not establish that anxiety rises or falls within the same women as they move through menopause.
There was substantial variation between study results, and the review’s estimates depend on the populations, symptom measures and staging approaches used in the underlying research. The report does not provide a single absolute prevalence figure that would show what proportion of women experience anxiety in each stage. It is also unclear from these pooled results how factors such as sleep disruption, physical symptoms, existing mental health conditions or social circumstances may contribute to the differences.
The literature search ended on August 16, 2024, so studies published after that date were not included. The proposed hormonal and stress-response explanations remain hypotheses discussed by the authors rather than conclusions tested by the pooled analysis.
Further Research and Clinical Guidance
The findings add evidence for future research on when anxiety symptoms occur across the menopause transition and how they relate to other health and life factors. Longitudinal studies that follow the same participants through different stages could help distinguish changes within individuals from differences between groups.
Researchers and guideline bodies may also weigh the results alongside other evidence when considering how anxiety should be addressed in menopause care. The review itself does not announce a change to clinical guidance or recommend a particular treatment. For now, the reported association supports clinical awareness while leaving questions about cause, individual risk and the best response open.
Key Questions
What did the review find about anxiety during perimenopause?
Across the pooled studies, women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. This is a comparison of odds between groups, not the percentage of all perimenopausal women who have anxiety.
Did postmenopausal women also report higher odds?
Yes. The review found 63% higher odds of reported anxiety symptoms among postmenopausal women than among premenopausal women. In the direct comparison, postmenopausal women had 21% lower odds than women in perimenopause.
Does the study prove menopause causes anxiety?
No. The review combined observational studies, which can identify associations but cannot establish that menopause causes anxiety. It also does not show that symptoms increase within individual women over time.
How many women and studies were included?
The review covered 21 studies and 24,523 women. Fifteen studies contributed data to the meta-analysis comparing the odds of anxiety symptoms across menopausal stages.
What should readers take from the findings?
The study suggests that anxiety symptoms deserve attention during the menopause transition, particularly in perimenopause, but it does not predict an individual woman’s experience. The findings do not prescribe treatment; people with concerns about symptoms can discuss them with a qualified health professional.
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