Women in Perimenopause Report More Anxiety Than Other Menopausal Groups, New Study Finds

For many women, the years leading up to menopause can bring unexpected changes that affect far more than their menstrual cycles. Sleep may become harder to manage, emotions may feel less predictable, and everyday responsibilities can suddenly seem more overwhelming. A new research review is drawing attention to one aspect of this transition that deserves greater recognition: anxiety.

A systematic review and meta-analysis published in Scientific Reports on October 22, 2026, found that women in perimenopause and postmenopause had higher odds of reporting anxiety symptoms than women who had not yet entered menopause. Among the groups studied, women in perimenopause had the highest odds of reporting anxiety symptoms compared with their postmenopausal counterparts.

The researchers reviewed 21 studies involving 24,523 women, with 15 studies contributing data to the statistical meta-analysis. Their findings add to growing research into women’s mental health during midlife and highlight the importance of recognizing emotional changes alongside familiar menopause symptoms such as hot flashes, night sweats, and irregular periods.

However, the findings do not prove that hormonal changes directly cause anxiety, nor do they mean every woman will experience mental health difficulties during perimenopause. Instead, the research points to a period when women may benefit from better information, more open conversations with healthcare professionals, and appropriate support when symptoms begin affecting daily life.

What Did the New Study Find About Perimenopause and Anxiety?

The study, titled “Anxiety symptoms across menopausal stages: a systematic review and meta-analysis,” examined the relationship between reproductive stages and the likelihood of reporting anxiety symptoms. The researchers compared premenopausal, perimenopausal, and postmenopausal women using evidence from studies conducted in multiple countries.

According to the published findings, women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. Postmenopausal women also had higher odds, at 63% above the premenopausal comparison group.

At first glance, the postmenopausal figure may appear higher. However, the researchers also directly compared women in perimenopause with those who were postmenopausal. That comparison found that postmenopausal women had approximately 21% lower odds of reporting anxiety symptoms than women in perimenopause.

These results suggest that anxiety symptoms may be particularly prominent during the transition leading up to menopause, although symptoms can continue after menstrual periods have stopped.

It is important to understand what these numbers mean. An increase in odds does not mean that 59% or 63% of women will develop anxiety. It also does not mean every woman will experience an increase in symptoms as she moves through menopause. The figures describe differences between groups in the studies included in the review.

The research is valuable because it brings together findings from multiple studies rather than relying on the experiences of a single group of women. Nevertheless, differences in study design, anxiety measurements, and participant characteristics mean the results should be interpreted carefully.

The authors concluded that the menopause transition deserves greater attention in discussions about women’s mental health and that further research is needed to understand how anxiety symptoms change over time.

What Is Perimenopause, and When Does It Begin?

Perimenopause is the transitional stage during which the body moves toward menopause. During this period, ovarian hormone levels fluctuate, menstrual cycles may become irregular, and women can experience a range of physical and emotional symptoms.

The timing varies considerably. Some women begin noticing changes in their 40s, while others experience the transition earlier or later. Perimenopause can last several years, and its symptoms are not identical for everyone.

Common physical changes include irregular periods, hot flashes, night sweats, changes in sleep, vaginal dryness, and shifts in sexual comfort or desire. Some women also describe difficulty concentrating, irritability, mood changes, or feelings of anxiety that seem unfamiliar.

Menopause itself is defined retrospectively after 12 consecutive months without a menstrual period, provided there is no other medical explanation. The period after that point is known as postmenopause.

Understanding these distinctions matters because women may experience symptoms at different stages and for different lengths of time. A woman who is still menstruating irregularly may be in perimenopause even if she has not yet missed her periods completely.

For women experiencing new or worsening anxiety in midlife, recognizing the possibility of a connection with the menopause transition can provide a useful starting point for a healthcare conversation. It should not, however, replace an assessment for other possible causes.

Why Might Perimenopause Be Associated With Anxiety?

Researchers believe several overlapping factors may help explain why anxiety symptoms are more frequently reported during the menopause transition. Hormonal fluctuations are one possible contributor, but sleep disturbances, physical symptoms, previous mental health experiences, and everyday stress may also play important roles.

Estrogen is involved in several processes that influence brain function, including systems associated with mood and the body’s response to stress. As estrogen levels fluctuate during perimenopause, some women may experience changes in emotional regulation or become more sensitive to stress.

Researchers have proposed that hormonal changes may interact with neurotransmitters such as serotonin, dopamine, and gamma-aminobutyric acid, which are involved in mood, motivation, and nervous system activity. Changes in the body’s stress-response systems may also be relevant.

These mechanisms are plausible explanations, not findings directly established by the new meta-analysis. The review examined associations between menopausal stages and reported anxiety symptoms; it did not test the biological pathways responsible for those associations.

Sleep may be another important factor. Night sweats and hot flashes can interrupt rest, leaving women tired and less able to cope with everyday pressures. Poor sleep and anxiety can reinforce one another: worry can make it harder to fall asleep, while repeated sleep disruption can affect mood and concentration.

Physical changes can also create uncertainty. A racing heartbeat, sweating, dizziness, or a sudden sense of unease may feel alarming, especially when a woman does not know whether the experience is related to hormonal changes, anxiety, or another health issue.

Life circumstances may add another layer. Many women experience perimenopause while managing careers, caregiving, financial pressures, relationships, and changing family responsibilities. These pressures do not affect everyone equally, but they may contribute to how symptoms are experienced.

The most useful interpretation is therefore not that hormones explain everything. Perimenopausal anxiety may reflect a combination of biological, physical, psychological, and social influences.

What Does Anxiety During Perimenopause Feel Like?

Anxiety does not look the same for every woman. Some may notice persistent worrying or a sense that something is wrong, even when they cannot identify a clear reason. Others may experience restlessness, irritability, difficulty concentrating, muscle tension, or trouble relaxing.

Physical symptoms can include sweating, a racing heart, nausea, or feeling unusually alert. These symptoms may overlap with other menopause-related experiences, making it difficult to determine what is causing them without further assessment.

Some women may find themselves worrying more about their health, relationships, work performance, or everyday decisions. Others may feel overwhelmed by situations that previously seemed manageable. Anxiety can also interfere with sleep, creating a cycle of fatigue and increased emotional strain.

Experiencing occasional worry is part of life and does not automatically indicate an anxiety disorder. The concern becomes more significant when symptoms are persistent, distressing, difficult to control, or disruptive to work, relationships, sleep, or other daily activities.

Women should not assume that all emotional changes are simply part of getting older or something they must tolerate. If anxiety is new, intensifying, or interfering with daily life, it is reasonable to seek medical advice.

A healthcare professional can help assess whether symptoms may be associated with perimenopause, an anxiety disorder, a sleep problem, medication effects, thyroid conditions, or another health issue.

Why Women’s Mental Health During Midlife Deserves More Attention

Menopause discussions have traditionally focused heavily on physical symptoms, including hot flashes, night sweats, and changes in menstrual cycles. While these symptoms are important, the emotional experience of the transition also deserves attention.

Women may not immediately connect anxiety with perimenopause, particularly if they have never experienced significant anxiety before. They may blame themselves for becoming less patient, assume they are failing to manage stress, or worry that they are losing their ability to cope.

A clearer understanding of the possible connection between perimenopause and anxiety may help women describe their experiences and seek support earlier. It may also encourage healthcare professionals to ask about emotional well-being when discussing menopause-related symptoms.

The American College of Obstetricians and Gynecologists notes that some women experience anxiety during perimenopause and encourages them to discuss mood changes with their obstetrician-gynecologist. Assessment can help distinguish menopause-related symptoms from other mental health conditions and identify appropriate treatment options.

Greater awareness is especially important because anxiety can be difficult to recognize when it develops gradually. A woman may first notice poor sleep or increasing irritability before realizing that persistent worry is affecting her quality of life.

At the same time, awareness should not turn perimenopause into an expectation of distress. Many women navigate the transition without significant anxiety, while others may experience symptoms that require professional support. Individual experiences vary, and women should be taken seriously whether their symptoms are mild, moderate, or severe.

What Can Women Do to Manage Perimenopausal Anxiety?

Women experiencing anxiety during perimenopause have several options for seeking support. The right approach depends on symptom severity, medical history, personal preferences, and whether other menopause symptoms are present.

The first step is to discuss the changes with a qualified healthcare professional. Describing when symptoms began, how often they occur, and whether they coincide with irregular periods, hot flashes, or sleep disturbances can help guide an assessment.

Keeping a brief symptom diary may also be useful. Women can record sleep quality, menstrual changes, anxiety episodes, caffeine intake, stressful events, and other symptoms. This information may help identify patterns without assuming that every symptom has the same cause.

Regular physical activity can support general health and may help improve mood and sleep. Activities such as walking, swimming, cycling, yoga, or strength training can be adapted to individual ability and preferences. The goal is consistency rather than pushing through exhaustion or treating exercise as a substitute for care.

Sleep habits also matter. Maintaining a regular bedtime, creating a comfortable sleeping environment, limiting late-day caffeine, and establishing a relaxing evening routine may help some women. If night sweats or hot flashes repeatedly disrupt sleep, a healthcare professional can discuss ways to manage those symptoms.

Psychological support may be helpful when worry becomes difficult to manage. Cognitive behavioral therapy, for example, can help people identify unhelpful thought patterns and develop practical strategies for responding to anxiety. Other forms of counseling or mental health treatment may be appropriate depending on individual needs.

Medication may also be considered in some circumstances. A clinician can discuss options for treating anxiety and whether menopause-related treatment is appropriate for a woman’s symptoms and medical history. Hormone therapy is not suitable for everyone and should not be started solely on the assumption that anxiety is caused by fluctuating estrogen.

Women should be cautious about supplements marketed as menopause or anxiety solutions. Products described as natural are not necessarily effective or risk-free, and some may interact with medications. A healthcare professional or pharmacist can help assess their safety.

Most importantly, women do not need to wait until anxiety becomes overwhelming before asking for help. Early conversations can clarify what is happening and help women find support that fits their circumstances.

What Are the Limitations of the New Research?

Although the review included more than 24,000 women, its findings have limitations. The researchers combined evidence from observational studies, which can identify associations but cannot by themselves establish cause and effect.

This means the analysis cannot prove that perimenopause directly causes anxiety or that hormonal fluctuations are the only explanation for the differences between groups. Previous anxiety, sleep disturbances, hot flashes, stressful life events, and other health factors may influence the results.

The studies also used different tools and approaches to measure anxiety. Some relied on standardized questionnaires, while others used interviews or broader scales that included anxiety-related questions. Differences in how symptoms were measured can make comparisons less straightforward.

The researchers noted substantial variation between studies and limitations in how potential confounding factors were handled. The evidence also does not establish a precise timeline for an individual woman. Group-level differences cannot predict how a particular person will feel as she moves through menopause.

More long-term studies following the same women across different reproductive stages could help clarify whether symptoms begin, worsen, or improve at particular points in the transition. Consistent anxiety measurements and more detailed information about sleep, previous mental health conditions, and other relevant factors would strengthen future research.

For now, the study supports increased clinical awareness, not a universal prediction that women will become anxious during perimenopause.

Frequently Asked Questions About Perimenopause and Anxiety

Do women experience more anxiety during perimenopause?

The 2026 systematic review found that women in perimenopause had 59% higher odds of reporting anxiety symptoms than premenopausal women. The findings describe group-level differences and do not mean every woman will experience anxiety.

Is anxiety a symptom of perimenopause?

Some women report anxiety during perimenopause. Hormonal fluctuations, sleep disruption, physical symptoms, and life stress may contribute, but anxiety can have multiple causes. A healthcare professional can help determine what may be contributing to an individual’s symptoms.

Does anxiety improve after menopause?

The review found lower odds of reporting anxiety in postmenopausal women than in perimenopausal women. However, this does not guarantee that anxiety will improve for every individual. Some women continue to experience symptoms after menopause.

How can women manage anxiety during perimenopause?

Possible approaches include professional assessment, regular physical activity, improved sleep habits, psychological therapies such as cognitive behavioral therapy, and appropriate medical treatment when needed. The best approach depends on the individual’s symptoms and health history.

When should a woman seek help for perimenopausal anxiety?

A woman should consider speaking with a healthcare professional if anxiety is persistent, worsening, difficult to control, or affecting sleep, work, relationships, or everyday activities. Severe symptoms or thoughts of self-harm require urgent support.

Conclusion: Making Perimenopausal Mental Health Part of the Conversation

The new review of 21 studies involving 24,523 women highlights a meaningful pattern: anxiety symptoms are reported more frequently among women in perimenopause and postmenopause than among premenopausal women, with the highest odds observed during perimenopause in the direct comparison between the later stages.

The findings reinforce the importance of treating women’s mental health as part of the wider conversation about menopause. Hormonal changes may contribute to anxiety for some women, but sleep, physical symptoms, personal history, and life circumstances can also matter. More research is needed to understand these influences and how symptoms evolve over time.

Women should not feel that anxiety is something they must silently endure or that every emotional change should automatically be attributed to hormones. Understanding possible connections, discussing symptoms with a healthcare professional, and accessing appropriate support can make the transition easier to navigate.

As research continues, better awareness may help women recognize their experiences, receive timely care, and approach midlife with more information and less stigma.

Medical disclaimer: This article is for educational purposes only and does not replace professional medical advice, diagnosis, or treatment.

Sources

1. Mehta, A., Spector, A., Bahhar, N., and Desai, R. (2026). “Anxiety symptoms across menopausal stages: a systematic review and meta-analysis.” Scientific Reports. Read the original research.
2. News-Medical. “Women in perimenopause report more anxiety than other menopausal groups.” October 25, 2026. Read the news report.
3. American College of Obstetricians and Gynecologists. “Mood Changes During Perimenopause Are Real. Here’s What to Know.” Read the women’s health guidance.
4. Bromberger, J. T., et al. (2013). “Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation.” Read the research abstract on PubMed.