TL;DR
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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 premenopausal women, with the highest odds among the three menopausal stages compared. The findings add evidence about mental health during the menopause transition, but do not establish that menopause causes anxiety.
The review, published in Scientific Reports, examined how anxiety reporting differed among premenopausal, perimenopausal and postmenopausal women. Of the 21 studies included in the review, 15 contributed data to the meta-analysis, which pooled comparisons across the groups. Researchers reported that perimenopausal women had 59% higher odds of reporting anxiety symptoms than premenopausal women.
Postmenopausal women also had higher odds than premenopausal women: 63% higher, according to the pooled analysis. In a direct comparison between the two later stages, postmenopausal women had 21% lower odds of reported anxiety symptoms than perimenopausal women. The results describe odds in the study comparisons; they are not measurements of how many women experienced anxiety or of an individual woman’s risk.
The research team drew on observational studies using standardized anxiety questionnaires, interviews or scales that included anxiety items. The review covered publications found in four research databases from their inception through August 16, 2024. It used a random-effects model to combine eligible results. The authors reported substantial variation among the study findings, a limitation when interpreting the overall pattern.
Why Perimenopause Merits Attention
The findings point to perimenopause as a period associated with elevated anxiety reporting in the studies reviewed. That may help clinicians and researchers pay closer attention to mental health symptoms during the menopause transition, rather than assuming that psychological concerns are limited to other stages. The results may also inform discussions about how menopause-related care addresses anxiety.
The review does not establish a biological cause or show that symptoms necessarily begin or worsen as a woman moves into perimenopause. Its results compare groups drawn from observational research, and the substantial differences between studies mean the pooled estimates should be read as an overall association, not a prediction for every person. For readers, the practical point is that anxiety symptoms are worth discussing with a qualified health professional; the study itself does not offer medical advice or a treatment recommendation.
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How the Menopause Stages Were Compared
Menopause is defined as the permanent end of menstrual periods and is identified retrospectively after 12 consecutive months without menstruation, when no other cause explains the absence. Perimenopause precedes menopause and can involve irregular menstrual cycles. The review compared anxiety reporting across premenopause, perimenopause and postmenopause, using recognized stage definitions, including the STRAW+10 criteria or equivalent definitions.
The authors set out to address uncertainty in earlier research, which had not consistently used standardized definitions or pooled quantitative estimates. The review followed PRISMA reporting guidance, included cross-sectional and longitudinal observational studies, and assessed study quality. Only baseline observations from longitudinal studies were included in the pooled analyses alongside cross-sectional data, so the analysis was not designed to track changes in anxiety within the same women over time.
The authors discussed possible explanations drawn from wider research, including hormonal fluctuations, stress responses, sleep disruption and symptoms such as hot flashes. These are proposed pathways, not mechanisms established by this review. Its central finding concerns the association between menopausal stage and reported anxiety symptoms.
“Perimenopausal and postmenopausal women had significantly higher odds of anxiety symptoms compared with their premenopausal counterparts, with the highest odds observed during perimenopause.”
— The researchers, as summarized in the report
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Limits of the Anxiety Estimates
The review cannot determine whether menopause causes anxiety, whether anxiety increases within individual women over time, or whether other factors explain some of the group differences. Because the included research was observational, the pooled associations do not establish cause and effect. The authors also noted substantial variation between studies, which limits how precisely the overall estimates can represent different populations.
The source report does not provide the pooled confidence intervals, the number of participants in each stage-specific comparison, or a single absolute rate of anxiety symptoms. The odds figures therefore should not be read as percentage-point increases or as the share of women who will experience anxiety. The review also excluded studies involving surgical menopause and certain co-occurring physical or psychiatric conditions, which may limit how well its findings apply to those groups.
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How Care Guidance May Respond
The findings may contribute to further research and discussion of how anxiety is addressed in menopause-related care. The review authors said the results support greater clinical awareness, but the study does not announce a change to any clinical guideline. The source 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.
Further studies that follow women across reproductive stages could help clarify how anxiety symptoms change over time and how much the observed associations vary by population or other circumstances. For now, the review offers a pooled snapshot of published evidence through August 2024; it does not establish an individual prognosis or settle the causes of anxiety during perimenopause.
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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 review found the highest odds among the three stages examined, but the results varied between studies.
Did postmenopausal women also report higher odds of anxiety?
Yes. The analysis found 63% higher odds of reported anxiety symptoms among postmenopausal women than among premenopausal women. In a direct comparison, postmenopausal women had 21% lower odds than perimenopausal women.
Does the study prove that menopause causes anxiety?
No. The review combined observational research, which can identify associations but cannot by itself establish that menopause causes anxiety or that symptoms increase within an individual over time.
How many women and studies were included?
The review included 21 studies and 24,523 women. Fifteen studies contributed to the meta-analysis comparing anxiety reporting across menopausal stages.
What should someone experiencing anxiety do?
The review does not provide treatment guidance. Anyone concerned about anxiety can discuss symptoms and care options with a qualified health professional.
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