Does Anxiety Risk Increase During the Menopausal Transition?
Does Anxiety Risk Increase During the Menopausal Transition?
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.
The prevalence of anxiety symptoms in midlife women is substantial, with up to 51% of women aged 40 to 55 years reporting any tension/nervousness or irritability in the past 2 weeks or at the moment and with 25% reporting frequent irritability or nervousness. Compared with premenopausal women, perimenopausal women have a greater risk for each symptom of anxiety. However, studies have reported conflicting results concerning the extent to which the prevalence of anxiety symptoms varies during different stages of the menopausal transition, with some studies indicating no statistically significant differences by menopausal stage and with others finding that early or late perimenopausal women have significantly higher rates of anxiety symptoms than premenopausal women. Thus, whether the menopausal transition is a period of increased risk for anxiety is unclear.
The absence of consistent findings regarding associations between anxiety and menopause status is probably caused by the assessment of different symptoms, study designs, and populations studied. Anxiety is a general term that refers to varying symptoms characterizing different anxiety disorders such as panic disorder (eg, suddenly feeling fearful for no reason), social phobia (eg, fear of social or performance situations), or generalized anxiety (eg, excessive and uncontrollable worry, irritability). Such heterogeneity in anxiety symptoms and disorders is reflected in the literature, most of which include diverse measures of individual anxiety symptoms such as "irritability" or "feelings of panic," making it difficult to compare studies and to draw conclusions.
Compared with depression, anxiety symptoms and disorders have generated far less attention in studies of midlife women despite the prevalence of anxiety and their association with distress, impaired quality of life, and vasomotor symptoms (VMS). Indeed, studies that focus on anxiety symptoms or syndromes usually focus on their association with VMS rather than on their association with menopause status. Nevertheless, a greater understanding of the unique influence of the menopausal transition on the occurrence of anxiety symptoms and syndromes is important because anxiety is not only prevalent in community populations but is also a problem frequently reported to healthcare providers by midlife women.
Analysis of cross-sectional baseline data from the Study of Women’s Health Across the Nation (SWAN) found that the odds of frequent (≥6 d in the past 2 wk) irritability (odds ratio [OR], 1.33) and nervousness (OR, 1.54), adjusted for multiple covariates, were significantly higher among early perimenopausal women than among premenopausal women. However, conclusions about the increased risk of anxiety associated with the menopausal transition based on these data are limited by the cross-sectional design, lack of late perimenopausal and postmenopausal women in the sample, and assessment of individual symptoms.
Importantly, anxiety has been consistently and significantly associated with VMS (hot flashes/night sweats) in studies of the menopausal transition. Because VMS are highly prevalent during the transition, it is difficult to determine if VMS underlie an observed association between anxiety and menopausal stage. Thus, it is unclear whether the transition from premenopause to postmenopause is a time of increased risk for high anxiety, independent of VMS. If so, what are the characteristics of women at greatest risk?
An individual symptom, although potentially distressing or bothersome, is not informative of its underlying condition or disorder and may be one of the reasons that studies do not report consistent findings. Therefore, in the current report, we aimed to extend the research on anxiety in three ways: (1) by assessing anxiety as a cluster of four symptoms; (2) by determining the association between menopausal stage and high anxiety during 10 years of follow-up of 2,956 women enrolled in SWAN; and (3) by evaluating whether the risk for high anxiety is different between women with high anxiety at study entry and women without high anxiety at study entry. We used the new measure to test the hypothesis that a cluster of anxiety symptoms—specifically irritability, tension/ nervousness, feeling fearful for no reason, and heart racing or pounding—would be more likely to occur during or after the menopausal transition than before the menopausal transition, independent of demographic factors, psychosocial factors, health factors, and VMS.
Abstract and Introduction
Abstract
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.
Introduction
The prevalence of anxiety symptoms in midlife women is substantial, with up to 51% of women aged 40 to 55 years reporting any tension/nervousness or irritability in the past 2 weeks or at the moment and with 25% reporting frequent irritability or nervousness. Compared with premenopausal women, perimenopausal women have a greater risk for each symptom of anxiety. However, studies have reported conflicting results concerning the extent to which the prevalence of anxiety symptoms varies during different stages of the menopausal transition, with some studies indicating no statistically significant differences by menopausal stage and with others finding that early or late perimenopausal women have significantly higher rates of anxiety symptoms than premenopausal women. Thus, whether the menopausal transition is a period of increased risk for anxiety is unclear.
The absence of consistent findings regarding associations between anxiety and menopause status is probably caused by the assessment of different symptoms, study designs, and populations studied. Anxiety is a general term that refers to varying symptoms characterizing different anxiety disorders such as panic disorder (eg, suddenly feeling fearful for no reason), social phobia (eg, fear of social or performance situations), or generalized anxiety (eg, excessive and uncontrollable worry, irritability). Such heterogeneity in anxiety symptoms and disorders is reflected in the literature, most of which include diverse measures of individual anxiety symptoms such as "irritability" or "feelings of panic," making it difficult to compare studies and to draw conclusions.
Compared with depression, anxiety symptoms and disorders have generated far less attention in studies of midlife women despite the prevalence of anxiety and their association with distress, impaired quality of life, and vasomotor symptoms (VMS). Indeed, studies that focus on anxiety symptoms or syndromes usually focus on their association with VMS rather than on their association with menopause status. Nevertheless, a greater understanding of the unique influence of the menopausal transition on the occurrence of anxiety symptoms and syndromes is important because anxiety is not only prevalent in community populations but is also a problem frequently reported to healthcare providers by midlife women.
Analysis of cross-sectional baseline data from the Study of Women’s Health Across the Nation (SWAN) found that the odds of frequent (≥6 d in the past 2 wk) irritability (odds ratio [OR], 1.33) and nervousness (OR, 1.54), adjusted for multiple covariates, were significantly higher among early perimenopausal women than among premenopausal women. However, conclusions about the increased risk of anxiety associated with the menopausal transition based on these data are limited by the cross-sectional design, lack of late perimenopausal and postmenopausal women in the sample, and assessment of individual symptoms.
Importantly, anxiety has been consistently and significantly associated with VMS (hot flashes/night sweats) in studies of the menopausal transition. Because VMS are highly prevalent during the transition, it is difficult to determine if VMS underlie an observed association between anxiety and menopausal stage. Thus, it is unclear whether the transition from premenopause to postmenopause is a time of increased risk for high anxiety, independent of VMS. If so, what are the characteristics of women at greatest risk?
An individual symptom, although potentially distressing or bothersome, is not informative of its underlying condition or disorder and may be one of the reasons that studies do not report consistent findings. Therefore, in the current report, we aimed to extend the research on anxiety in three ways: (1) by assessing anxiety as a cluster of four symptoms; (2) by determining the association between menopausal stage and high anxiety during 10 years of follow-up of 2,956 women enrolled in SWAN; and (3) by evaluating whether the risk for high anxiety is different between women with high anxiety at study entry and women without high anxiety at study entry. We used the new measure to test the hypothesis that a cluster of anxiety symptoms—specifically irritability, tension/ nervousness, feeling fearful for no reason, and heart racing or pounding—would be more likely to occur during or after the menopausal transition than before the menopausal transition, independent of demographic factors, psychosocial factors, health factors, and VMS.