Anxiety symptoms rise during perimenopause, meta-analysis finds

Women in perimenopause and after menopause report more anxiety symptoms than women before menopause, according to a systematic review and meta-analysis published in Scientific Reports. The analysis included 21 studies that assessed anxiety across menopausal stages using validated measures, with 15 studies contributing to the statistical synthesis. Compared with premenopausal women, those in perimenopause had 59 percent higher odds of reporting anxiety symptoms, while postmenopausal women had 63 percent higher odds.

The research team, led by Alisha Mehta and colleagues, searched Medline, PsycInfo, Embase and Web of Science for studies published up to 16 August 2024. To be included, studies had to use a cross-sectional or longitudinal design, involve women aged 18 or older, and measure anxiety across menopause stages with validated instruments. Intervention studies, previous systematic reviews and samples with co-existing physical or psychiatric conditions were excluded. Study quality was evaluated with the Critical Appraisal Skills Programme tool.

A notable pattern emerged when the menopausal stages were compared directly with one another. Postmenopausal women showed lower odds of anxiety symptoms than women in perimenopause, with an odds ratio of 0.79 and a 95 percent confidence interval of 0.65 to 0.96. This indicates that the highest odds of reporting anxiety symptoms were observed during perimenopause. The confidence intervals for the comparisons against premenopause did not cross 1, indicating statistically significant differences in both cases.

The authors caution that the menopause transition may represent a period associated with increased reporting of anxiety symptoms, but that the evidence does not establish cause and effect. Because the included studies were cross-sectional or longitudinal in design, the review cannot determine whether the menopausal transition drives anxiety symptoms or whether other factors explain the association. The authors state that longitudinal research is needed to clarify directionality, the underlying mechanisms and the role of confounding factors.

The review suggests that women in perimenopause and postmenopause report higher levels of anxiety symptoms compared with premenopause, with perimenopause standing out as the stage with the greatest odds. Confirming the pattern and explaining it will require the longitudinal work the authors call for, which they say should address directionality, mechanisms and confounding. Until then, the pooled odds ratios provide a quantitative summary of how reported anxiety symptoms differ across the menopausal stages in the studies analysed.

Subject of Research: Anxiety symptoms across premenopausal, perimenopausal and postmenopausal stages

Article Title: Anxiety symptoms across menopausal stages: a systematic review and meta-analysis

Article References: Mehta, A., Spector, A., Bahhar, N., & Desai, R. (2026). Anxiety symptoms across menopausal stages: a systematic review and meta-analysis. Scientific Reports. https://doi.org/10.1038/s41598-026-75578-x

Image Credits: AI Generated

DOI: 10.1038/s41598-026-75578-x

Keywords: menopause, perimenopause, anxiety, meta-analysis, systematic review, women's health, mental health, symptoms, across, menopausal, stages, systematic