This review examines the mechanisms of anxiety and depression in menopausal syndrome from an integrated physiological to psychological perspective. Fluctuations in estrogen and progesterone levels during menopause affect neurotransmitter systems (including serotonin, norepinephrine, and dopamine), hypothalamic-pituitary-adrenal axis function, inflammatory processes, and neurotrophic factor expression, collectively diminishing the resilience of emotional regulation neural circuits. Simultaneously, vasomotor symptoms (such as hot flashes and night sweats), sleep disruption, genetic susceptibility, and epigenetic modifications interact with mood disorders, while psychosocial factors (such as midlife stressors and role transitions) and cognitive factors (including negative schemas about aging, attentional bias toward threats, and difficulties in emotional regulation) further shape women’s experiences of menopausal changes. Clinical practice should adopt a biopsychosocial model, employing personalized multimodal approaches through hormone therapy, antidepressants, psychotherapy, and lifestyle adjustments, while future research should focus on developing biomarkers, utilizing advanced technologies, and developing targeted interventions to support women’s psychological wellbeing during menopause.
Lang et al. (2025) studied this question.