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

To compare the odds of reporting anxiety symptoms across the pre, peri and post-menopausal stages. Medline, PsycInfo, Embase and Web of Science were searched until 16th August 2024. Inclusion criteria were (1) a cross-sectional or longitudinal design (2) a female population aged 18+ (3) assessed anxiety across menopause stages using validated measures. Exclusion criteria were (1) intervention studies (2) systematic reviews (3) studies with samples who had co-morbid physical or psychiatric conditions. Study quality was assessed using the Critical Appraisal Skills Programme tool. 21 studies met the inclusion criteria and 15 studies were included in the meta-analysis. Compared to pre-menopause, women in peri-menopause and post-menopause had higher odds of reporting anxiety symptoms (Pre vs. peri: OR = 1.59, 95% CI: 1.26-2.00; pre vs. post: OR = OR = 1.63, 95% CI: 1.19–2.25). Post-menopausal women had lower odds of anxiety symptoms compared to those in peri-menopause (peri vs. post: OR = 0.79, CI: 0.65–0.96). This review suggests that women in peri-menopause and post-menopause report higher levels of anxiety symptoms compared to pre-menopause, with the highest odds observed during peri-menopause. The menopause transition may represent a period associated with increased reporting of anxiety symptoms, but longitudinal research is needed to clarify directionality, underlying mechanisms, and the role of confounding factors.