Does risk for anxiety increase during the menopausal transition? Study of Women's Health Across the Nation

Objective: Little is known about the risk of anxiety in women during midlife and the menopausal transition. We examined anxiety as a cluster of four symptoms and determined the association between menopausal stage and high anxiety during 10 years of follow-up of 2,956 women of multiple race/ethnicities. Methods: This study was a longitudinal analysis of data from the multisite Study of Women's Health Across the Nation, a study of menopause and aging. Women were aged 42 to 52 at study entry. The outcome was high anxiety, with a score of 4 or greater on the sum of four anxiety symptoms rated according to frequency in the previous 2 weeks from 0 (none) to 4 (daily; upper 20%). Covariates included sociodemographics, health factors, stressors, and vasomotor symptoms. Results: Women with low anxiety at baseline were more likely to report high-anxiety symptoms at early or late perimenopause or postmenopause than at premenopause (odds ratio, 1.56-1.61), independent of multiple risk factors, including upsetting life events, financial strain, fair/poor perceived health, and vasomotor symptoms. Women with high anxiety at baseline continued to have high rates of high anxiety throughout follow-up, but odds ratios did not differ by menopausal stage. Conclusions: Women with high anxiety at premenopause may be more often anxious and are not at increased risk for high anxiety at specific stages of the menopausal transition. In contrast, women with low anxiety at premenopause may be more susceptible to high anxiety during and after the menopausal transition than before the menopausal transition.