Across the long arc of midlife, when the body's reproductive rhythms slowly wind down, many women have been left to wonder whether their unease is part of the passage or simply a companion to it. A review of 21 studies covering more than 24,000 women now suggests that reported anxiety tends to rise through the years around menopause, peaking in the uneven run-up known as perimenopause. Yet the evidence shows a pattern rather than a proven cause, and the researchers are careful to say that the link between hormonal change and worry remains a question still being answered.
Anxiety Reporting Peaks in Perimenopause, Meta-Analysis of 24,000 Women Finds
Highest odds of reporting anxiety came during perimenopause
Mark
Why does a 59% figure matter if it can't say menopause causes anxiety?
Mimi
Because it tells clinicians where to look. The authors' advice is simple: ask about anxiety when a patient raises hot flashes, and refer or offer psychosocial support where it's warranted.
Luke
But be careful with 59%. It's higher odds of reporting symptoms, not a 59% rise in anxiety, and it comes from comparing different groups of women at one point in time.
Mark
So it doesn't follow women as they move through the stages?
Mimi
Right. Only baseline observations from longitudinal cohorts were pooled, so nobody's individual trajectory is shown.
Luke
And the postmenopausal numbers look odd at first: 63% higher than premenopausal, yet 21% lower than perimenopausal. That fits a peak in perimenopause, but the authors say results varied substantially between studies.
Mark
What about the explanations, like estrogen and cortisol?
Mimi
Those come from wider research. The review proposes them but didn't test them.
Luke
Worth adding that no formal certainty-of-evidence assessment was done, and the least-adjusted estimates may still carry confounding from prior anxiety or poor sleep. Hot flashes could also overlap with physical anxiety symptoms on the scales.
Mark
So what would settle it?
Mimi
Large prospective cohorts with consistent anxiety measures and finer reproductive staging.
O Pulso
- Perimenopausal women reported 59% higher odds of anxiety symptoms than premenopausal women, a jolt that sharpens the question of what the body is quietly carrying.
- Postmenopausal women also showed elevated odds of 63%, yet their numbers sat 21% below the perimenopausal group, leaving the timing of distress unexpectedly tangled.
- Results swung widely from one study to the next, and guidance from health bodies remains split on whether anxiety belongs on the list of menopausal symptoms.
- Clinicians are being urged to ask about anxiety alongside hot flashes, while researchers race toward large prospective cohorts that could reveal whether hormones truly drive the worry.
Across the long arc of midlife, when the body's reproductive rhythms slowly wind down, many women have been left to wonder whether their unease is part of the passage or simply a companion to it. A review of 21 studies covering more than 24,000 women now suggests that reported anxiety tends to rise through the years around menopause, peaking in the uneven run-up known as perimenopause. Yet the evidence shows a pattern rather than a proven cause, and the researchers are careful to say that the link between hormonal change and worry remains a question still being answered.
For years, midlife medicine has treated the emotional side of menopause unevenly, and women have often been left to sort out their worries on their own. A new meta-analysis published in Scientific Reports set out to answer a simple question: do women report more anxiety before, during, or after menopause? Researchers pooled 21 peer-reviewed studies covering 24,523 women across several countries, combining 15 of them in the statistical analysis.
The picture that emerged is one of pattern rather than verdict. Women in perimenopause, the irregular run-up marked by shifting hormones, had 59% higher odds of reporting anxiety than those before menopause. Postmenopausal women also reported more anxiety, at 63% higher odds, but when compared directly with the perimenopausal group they reported 21% lower odds. The authors therefore describe perimenopause as the stage of highest reporting, though results differed considerably between studies.
The review also carries its own limits. The anxiety measures varied from study to study, some symptoms of anxiety overlap with menopausal ones, and most of the evidence is cross-sectional, so it cannot show that menopause causes anxiety. Researchers point to plausible biological routes, including estrogen's influence on brain chemistry and stress hormones, but did not test them directly.
For now, the advice is modest. Clinicians are encouraged to ask about anxiety alongside hot flashes and to offer referral and evidence-based support where needed. The authors hope larger, long-term studies will clarify what is happening inside individual women as they move through this transition.
A review published in Scientific Reports has pulled together the evidence on a question that midlife medicine has handled unevenly: do women report more anxiety before, during, or after menopause? The researchers drew on 21 peer-reviewed studies covering 24,523 women in several countries, and 15 of those studies were combined in the statistical analysis.
The headline result is a pattern, not a verdict. 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. When the team compared the two later stages directly, postmenopausal women had 21% lower odds of reporting anxiety than perimenopausal women. That is why the authors describe reporting as highest during perimenopause. They also note that results varied substantially from one study to the next.
Some definitions frame the work. Menopause is identified in hindsight, after 12 consecutive months without a period and with no other pathological or physiological explanation. It usually arrives between ages 45 and 55. Perimenopause is the long run-up, marked by irregular ovulatory cycles and erratic hormone shifts. Psychiatric literature has long linked this transition to a greater risk of depressive symptoms, but how anxiety unfolds across it has received much less study.
A 2012 narrative review had reported generally low anxiety across menopausal stages. It lacked standardized staging criteria and could not pool quantitative risk estimates, which limited its conclusions. Guidance is also inconsistent. The World Health Organization recognizes anxiety as a possible menopause-related symptom, while the guidelines of the UK's National Institute for Health and Care Excellence do not explicitly name it as one, though they address other psychological symptoms. The authors present theirs as the first comprehensive meta-analysis of anxiety across defined menopausal stages.
The team followed PRISMA reporting guidelines and searched MEDLINE, PsycINFO, Embase and Web of Science from each database's start through August 16, 2024. They included cross-sectional and longitudinal observational studies of women 18 or older, with anxiety measured by standardized questionnaires, interviews, or broader scales containing anxiety items, such as the HADS, the STAI and the GAD-7. Studies had to define menopausal stage using the STRAW+10 criteria or an equivalent. Those involving surgical menopause, or co-occurring physical or psychiatric conditions, were excluded. Quality was appraised with CASP checklists, and one study rated low quality was dropped from the meta-analysis. The pooling used a random-effects model with inverse-variance weighting, and from longitudinal cohorts only baseline observations were used.
The authors looked to wider research for possible explanations, which this review did not test directly. Fluctuating estrogen may influence how the brain handles serotonin, dopamine and GABA, and may alter the hypothalamic-pituitary-adrenal axis response to stress, potentially affecting cortisol. Those pathways may interact with hot flashes, fragmented sleep, and cognitive and social stressors.
The limitations are stated plainly. Anxiety measures differed across studies, and physical symptoms of anxiety may overlap with menopausal symptoms. The least-adjusted estimates used for pooling may leave residual confounding from earlier anxiety, sleep problems, vasomotor symptoms and psychosocial stress. Extreme effect estimates were excluded, and no separate formal risk-of-bias or certainty-of-evidence assessment was done. Because the evidence is largely cross-sectional, it cannot show that menopause causes anxiety, or that symptoms rise within an individual woman over time.
The practical recommendation is modest: clinicians should consider asking about anxiety alongside vasomotor complaints, with referral and evidence-based psychosocial interventions where appropriate. For firmer answers, the authors call for large prospective cohorts that track detailed reproductive substages, use consistent anxiety measures, and account for key confounders.
Citações Notáveis
Clinicians should consider asking about anxiety symptoms alongside vasomotor complaints, with referral and evidence-based psychosocial interventions where clinically indicated.— Review authors, Scientific Reports (paraphrased)
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