Anxiety Symptoms by Menopausal Stage: Meta-Analysis Findings

Key Takeaways

• Across studies of adult women at different menopausal stages, peri- and postmenopause were associated with greater reporting of anxiety symptoms than premenopause.
• In the direct comparison of menopausal stages, the authors described lower odds of anxiety symptoms in postmenopause than perimenopause.
• The authors concluded that the directionality, underlying mechanisms, and potential confounding of these associations remain unresolved.

For women moving through menopause, how does reporting of anxiety symptoms differ before, during, and after the transition? Reported symptoms are distinct from diagnosed anxiety disorders, and comparisons across stages cannot trace any one woman's symptoms over time. Investigators compared symptom reporting among women at different stages using validated anxiety measures.

Investigators conducted Mehta and colleagues' Scientific Reports systematic review and meta-analysis of anxiety symptom reporting across menopausal stages. They searched Medline, PsycInfo, Embase, and Web of Science through August 16, 2024. Eligible studies used cross-sectional or longitudinal designs, included adult female participants, and assessed anxiety across stages with validated measures. Intervention studies and systematic reviews were excluded; the investigators compared menopausal stages rather than evaluating a treatment. Of the 21 studies meeting inclusion criteria, 15 contributed to the meta-analysis.

Perimenopause was associated with greater odds of reporting anxiety symptoms than premenopause: the odds ratio (OR) was 1.59, with a 95% confidence interval (CI) of 1.26–2.00. The estimate concerns reported symptoms, not the frequency of diagnosed anxiety disorders.

Postmenopause was also associated with greater odds of reporting anxiety symptoms than premenopause, with an OR of 1.63 and a 95% CI of 1.19–2.25. In a separate, direct comparison, the authors described lower odds in postmenopause than perimenopause and reported an OR of 0.79 (CI, 0.65–0.96). The abbreviated label accompanying that estimate does not clearly identify its reference category, so its direction should not be independently inferred from the ratio.

These observational associations do not establish that menopause causes anxiety symptoms or describe how symptoms change within the same woman over time. According to the report, the pooled estimates used the least-adjusted figures, leaving possible residual confounding from prior anxiety, sleep problems, vasomotor symptoms, and psychosocial stressors. The authors called for longitudinal research to clarify the direction of the relationship, underlying mechanisms, and the role of confounding factors.

The authors characterized perimenopause as the stage with the highest odds of reporting anxiety symptoms. That characterization draws on their stated interpretation of the direct comparison with postmenopause, not an independent ranking of the separate estimates against premenopause.

Clinician Questions

Were women with comorbid psychiatric or physical conditions included in the menopausal anxiety comparisons?

Mehta and colleagues excluded studies whose samples had comorbid physical or psychiatric conditions. This eligibility restriction does not show whether the associations differ in women with those conditions.

How was study quality assessed in the review of anxiety symptoms across menopausal stages?

Investigators assessed eligible studies using the Critical Appraisal Skills Programme tool.