Anxiety during the menopausal transition: a systematic review

There have been relatively few studies of the relationship between anxiety and menopause. Despite the paucity of clear evidence, some authors have suggested that the menopausal transition is a time of heightened risk for onset or exacerbation of anxiety symptoms. There is also controversy as to whether anxiety predates or is a consequence of hot flashes. The aim of this paper is to examine the evidence as to the relationship between menopause and anxiety, and between anxiety and hot flushes, one of the core symptoms of menopause.

A systematic review was undertaken based on literature published between 1960 and 2011, using the Medline, Web of Science and PsychINFO databases. The key terms 'anxiety', 'anxiety symptoms', 'anxiety disorder', 'menopause', 'menopausal transition', 'midlife', 'hot flushes or flashes' and 'vasomotor symptoms' were entered into the search. Studies were included if they reported original research using a clearly described measure of anxiety or investigated the relationship between anxiety and vasomotor symptoms.

Nine studies reporting the relationship between menopause and anxiety, two studies reporting the prevalence of panic disorder, and eight studies investigating the relationship between anxiety and vasomotor symptoms were identified. Overall, anxiety symptom levels were low throughout the menopausal transition, but the studies were characterised by poor measurement of both menopausal status and anxiety symptoms and relied heavily on the use of brief, largely nonvalidated measures of anxiety symptoms, which are of unknown clinical significance. In the studies that also measured factors such as attitude to menopause, and dispositional optimism or changes in family life these emerged as important predictors of vasomotor symptom severity.

None of the available studies provides solid data on the prevalence of anxiety disorders that meet diagnostic criteria, and the present state of knowledge does not be no justify the inclusion of "menopausal anxiety" as a reproductive-related disorder. With respect to the relationship between hot flashes and anxiety, studies need to ensure that somatic and psychological symptoms are not confounded by the use of unsuitable anxiety measures, and that psychological variables are given serious consideration.