TL;DR
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A systematic review of 21 studies involving 24,523 women found higher odds of reported anxiety symptoms in perimenopause and after menopause than before menopause. The odds were highest in perimenopause, 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 premenopausal women, with the highest odds among the three stages studied. The findings, published in Scientific Reports, also show elevated odds after menopause, but do not establish that menopause causes anxiety.
Researchers assessed observational evidence on anxiety symptoms before, during and after the menopause transition. Fifteen of the 21 studies contributed data to the meta-analysis, which compared the odds of reporting symptoms across premenopausal, perimenopausal and postmenopausal groups. The review drew on studies from multiple countries and used anxiety measures that included standardized questionnaires and interviews.
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, postmenopausal women had 21% lower odds than women in perimenopause. These are comparisons of odds between groups, not estimates of how many women experience anxiety or of an individual woman’s likelihood of developing it.
The authors reported that findings varied substantially across studies. The researchers pooled observational data using a random-effects model; for studies that followed participants over time, only baseline observations were included in the pooled analyses. One study judged to be low quality was excluded from the meta-analysis after the quality assessment.
Why Perimenopause Merits Attention
The findings suggest that anxiety symptoms deserve attention during the menopause transition, a period when women may be managing irregular menstrual cycles and other changes. The result may help clinicians and researchers focus on how mental health symptoms are assessed across different reproductive stages, rather than treating menopause as one uniform period.
The review does not show that hormonal changes cause anxiety, nor does it establish that anxiety is more severe in perimenopause than at other stages. It compares symptom reporting across groups in observational studies. The authors discuss possible links between hormonal fluctuation, stress responses, sleep disruption and symptoms such as hot flashes, but these are proposed explanations, not mechanisms demonstrated by the meta-analysis.
Guidance is not uniform: the report 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 study may inform discussion of that gap, but it does not itself change clinical recommendations.
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How Researchers Compared Menopause Stages
Menopause is defined as the permanent end of menstrual periods, identified retrospectively after 12 consecutive months without menstruation and without another cause. Perimenopause precedes it and can involve irregular cycles and hormonal fluctuations; postmenopause follows the final menstrual period. The review included studies using recognized staging criteria, including the Stages of Reproductive Aging Workshop +10 framework or equivalent definitions.
The team searched MEDLINE, PsycINFO, Embase and Web of Science for observational research published through August 16, 2024. Studies were eligible if they involved women aged 18 or older and assessed anxiety with standardized tools or measures containing multiple anxiety items. The review excluded research on surgical menopause and studies involving co-occurring physical or psychiatric conditions, so its findings do not necessarily apply to those groups.
The authors framed the analysis as a response to uncertainty about how anxiety reporting differs by menopausal stage. A 2012 narrative review had reported generally low anxiety across stages, but it lacked standardized staging criteria and did not pool quantitative risk estimates. The newer review used defined stages and a meta-analysis, while still being limited by the quality and variation of the underlying studies.
“The findings support greater clinical awareness of anxiety symptoms during the menopause transition.”
— The review authors
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Limits of the Anxiety Findings
The studies found an association between menopausal stage and reported anxiety, but they cannot determine whether the transition itself leads to anxiety. The analysis also cannot show that the same women’s symptoms rise during perimenopause and later fall: the pooled comparisons are between groups, and longitudinal studies contributed baseline observations only.
There was substantial variation between studies, and the source report does not provide a single pooled estimate of how common anxiety symptoms were across all participants. Differences in populations, measures and study methods may affect the comparisons. The review’s exclusions also mean its conclusions may not fit women with surgical menopause or the specified co-occurring conditions.
Proposed biological explanations, including effects of estrogen fluctuations on neurotransmitters or stress responses, remain hypotheses discussed by the authors. The report does not establish which factors account for the pattern or whether the odds differences translate into a meaningful change for any one person.
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Further Research and Clinical Guidance
The review points to a need for more research that follows women across reproductive stages and measures anxiety consistently. Such studies could help clarify whether symptoms change within individuals, how results vary with other menopause-related symptoms, and which factors may explain differences between groups.
No new guideline or clinical policy change is announced in the report. The evidence may contribute to future reviews of mental health guidance around menopause, but any change would depend on further assessment by relevant health authorities. Women concerned about anxiety or other symptoms should discuss them with a qualified health professional, who can consider their circumstances and care options.
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Key Questions
Which group reported the highest odds of anxiety symptoms?
Women in perimenopause had the highest odds in the review’s comparisons. Their odds were 59% higher than those of premenopausal women.
Did postmenopausal women also have higher reported 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 women in perimenopause.
Does the review prove menopause causes anxiety?
No. The evidence is observational and shows an association between menopausal stage and reported symptoms. It does not establish cause and effect or show that anxiety rises within individual women over time.
How many studies and participants were included?
The review included 21 studies and 24,523 women. Fifteen studies contributed to the meta-analysis comparing anxiety odds across menopausal stages.
What should readers do if they are concerned about anxiety?
The study is not personal medical advice. Anyone concerned about anxiety or menopause-related symptoms can discuss them with a qualified health professional.
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