Women In Perimenopause Report More Anxiety Than Other Menopausal Groups

TL;DR

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A systematic review of 21 studies involving 24,523 women found higher odds of reporting anxiety during perimenopause and after menopause than before menopause. Perimenopause had the highest odds in comparisons between stages, but the observational evidence does 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 point to a need for greater clinical attention to anxiety during the menopause transition, but do not establish that menopause causes anxiety.

In a review published in Scientific Reports, the researchers examined observational evidence on anxiety symptoms across premenopause, perimenopause and postmenopause. Fifteen of the 21 studies contributed data to the pooled analysis. The analysis found that, compared with premenopausal women, those in perimenopause had 59% higher odds of reporting anxiety symptoms. Postmenopausal women had 63% higher odds than premenopausal women.

In a direct comparison between the two later stages, the review found that postmenopausal women had 21% lower odds of reporting anxiety than women in perimenopause. These figures describe relative odds in the included studies, not the proportion of women experiencing anxiety, and they do not establish how symptoms change for an individual over time. The review authors also reported substantial variation in results between studies.

According to the review, researchers searched MEDLINE, PsycINFO, Embase and Web of Science for eligible research available through August 16, 2024. The included cross-sectional and longitudinal observational studies used standardized criteria to classify menopausal stages and questionnaires, interviews or broader scales with anxiety measures. The authors judged one study to be low quality and excluded it from the meta-analysis.

Why Perimenopause Merits Attention

The review authors said the findings could help clinicians and health services pay closer attention to anxiety symptoms during perimenopause, a stage marked by irregular menstrual cycles and changing hormone levels. They suggested that recognizing anxiety reports in this group could inform conversations about mental health during menopause and guide future research and clinical recommendations.

The results do not mean that every woman in perimenopause will experience anxiety, or that menopausal stage alone explains an individual’s symptoms. The review identifies an association across groups; it does not prove a cause. The authors also noted variation between studies, so the pooled estimates summarize mixed research rather than predict outcomes for any one person.

How Researchers Compared Menopausal Stages

Menopause is defined as the permanent end of menstrual periods and is identified retrospectively after 12 consecutive months without menstruation, when no other cause accounts for the absence. Perimenopause comes before menopause and can involve irregular cycles. The review authors used established staging criteria, including STRAW+10 or equivalent definitions, to group participants.

The authors said anxiety across menopausal stages has received less attention than some other mental health outcomes. They described limitations in earlier reviews, including inconsistent definitions of menopausal stage and an inability to combine quantitative estimates. Their pooled analysis aimed to compare anxiety reporting across defined stages, drawing on observational studies rather than experiments.

The review report notes that public health guidance does not address the issue uniformly: the World Health Organization recognizes anxiety as a possible menopause-related symptom, while UK NICE guidance does not explicitly list anxiety as one, though it addresses other psychological symptoms. The authors noted this difference as relevant to discussions of future guidance; the review itself does not set clinical policy.

Limits of the Anxiety Evidence

The review cannot show that menopause causes anxiety. Its included studies were observational, so differences between menopausal groups may reflect factors beyond menopausal stage. The pooled comparisons also cannot show whether anxiety rose or fell within the same women as they moved through menopause; they compare groups’ odds of reporting symptoms.

The source report does not provide absolute rates of anxiety, confidence intervals, or detailed explanations for the substantial variation across studies. It also does not establish which biological or social factors account for the pattern. The review authors discussed possible links involving hormone fluctuations, sleep and other symptoms, but these were proposed explanations, not mechanisms demonstrated by the analysis.

Research and Guidance Ahead

The review authors said the findings may inform further research into how anxiety symptoms relate to menopausal stage and whether clinical guidance should address the issue more directly. The report does not identify a specific forthcoming study, policy review or timetable for guideline changes, so any next steps remain uncertain.

The authors noted that researchers would need evidence following women over time and accounting for relevant differences between participants to clarify how symptoms develop and what may contribute to them. For now, the review supports awareness of anxiety during the menopause transition while leaving its causes and individual course unresolved.

Key Questions

What did the review find about anxiety during perimenopause?

The review’s pooled analysis found that women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. In a direct comparison, the analysis also found higher anxiety odds in perimenopause than postmenopause.

Did postmenopausal women also report more anxiety than premenopausal women?

Yes. The review found 63% higher odds of reporting anxiety among postmenopausal women than among premenopausal women. These are relative odds, not absolute rates.

Does the review prove menopause causes anxiety?

No. The studies included in the review were observational, so the findings show an association between menopausal stage and reported anxiety symptoms, not proof that menopause causes anxiety.

How many women and studies were included?

The review assessed 21 studies involving 24,523 women. According to the review, 15 studies contributed to the meta-analysis comparing anxiety odds across menopausal stages.

What remains unknown?

The review’s pooled findings do not show how anxiety changes within individual women over time or explain what causes the differences between groups. The review authors also reported substantial variation across studies.

Source: rss