Psychologic symptoms are common across the menopausal transition, with depression, anxiety, and insomnia affecting a substantial proportion of perimenopausal and postmenopausal women worldwide, particularly when measured with screening tools. These study findings were published in General Hospital Psychiatry.
Researchers conducted a systematic review and meta-analysis to examine the prevalence and incidence of anxiety, insomnia, and depressive symptoms in women with postmenopausal and perimenopausal status.
Using 3 databases, including EMBASE, SCOPUS, and MEDLINE, researchers identified relevant studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Researchers examined the point prevalence, period prevalence, incidence of depressive, anxiety, and insomnia symptoms among perimenopausal and postmenopausal women, and differences by assessment method and menopausal stage, including early vs late postmenopause. To assess for risk for bias, researchers used the Newcastle-Ottawa Scale (NOS). Random-effects meta-analyses were performed.
In low-resource settings, brief, validated instruments such as Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, and Insomnia Severity Index may be employed during every midlife consultation at general clinics, family planning visits, cervical cancer screening clinics, non-communicable diseases clinics, or community outreach clinics.
A total of 1,141,955 individuals were included in the analysis. Of the studies included for analysis, 82 were cross-sectional, and 20 were cohort studies. Studies spanned Asia (52), Europe (21), North America (15), Africa (6), South America (5), and Australia (3), with sample sizes ranging from 30 to 217,454 participants. Most studies used screening tools (n=91), with fewer using unstructured (n=9) or structured (n=2) interviews. Study participants were women with perimenopausal or postmenopausal status.
Depressive symptoms were common, with a pooled point prevalence of 30% in postmenopausal (95% CI, 27%-34%; n=179,398) and 32% in perimenopausal (95% CI, 26%-37%; n=4105) groups.
Period prevalence for postmenopausal vs perimenopausal was 19% and 24%, respectively, while incidence was 5% (n=136,112) and 13% (n=38,382), respectively.
Anxiety prevalence was 39% in postmenopausal (95% CI, 22%-57%; n=99,244) and 29% in perimenopausal women (95% CI, 15%-45%; n=2673), with a 14% period prevalence in postmenopausal women.
Insomnia showed the highest burden, with a point prevalence of 42% in postmenopausal (95% CI, 34%-50%; n=102,648) and 27% in perimenopausal (95% CI, 19%-37%; n=5575), and a 72% period prevalence in postmenopausal women (n=143,188).
In subgroup and sensitivity analyses, screening-based vs structured interviews were generally associated with higher point prevalence. In screening-based studies vs structure interview studies, the point prevalence for depressive symptoms was 31% vs 32% for postmenopausal, and 13% vs 28% for perimenopausal, respectively.
There was a higher point prevalence in early vs late postmenopausal for depressive (28% vs 15%, respectively) and anxiety (18% vs 12%, respectively) symptoms within 5 years.
Study limitations include publication bias for postmenopausal depression and insomnia, lack of more than 2 studies assessing early vs late menopausal point prevalence for depressive and anxiety symptoms, and the absence of a quantitative synthesis of factors associated with psychologic morbidity.
“[N]early one in three women experience depressive, anxiety or insomnia symptoms around menopausal transition. Given such a high prevalence, routine screening and support should be offered to all women undergoing menopausal transition,” the study authors concluded. “In low-resource settings, brief, validated instruments such as Patient Health Questionnaire-9, Generalised Anxiety Disorder-7, and Insomnia Severity Index may be employed during every midlife consultation at general clinics, family planning visits, cervical cancer screening clinics, non-communicable diseases clinics, or community outreach clinics.”
