Mood Changes in Menopausal Women: A Focus on Anxiety

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Menopausal status should be considered when assessing women with anxiety.
Menopausal status should be considered when assessing women with anxiety.

Psychosocial Interventions

Psychotherapy has been found to be helpful in treating geriatric anxiety.14 Cognitive behavioral therapy has demonstrated success and should be considered as a first-line therapeutic approach.2 Interpersonal and psychodynamic therapies have also demonstrated effectiveness, especially in patients experiencing “distress related to role transitions and conflicts associated with aging.”2 Mindfulness meditation may be a helpful adjunctive treatment.2,15 


“When evaluating midlife women, gynecologists, internal medicine physicians, and psychiatrists should keep depression and anxiety in mind—the symptoms as well as the disorders,” Dr Bromberger emphasized. Psychiatrists should inquire about menopausal status. She acknowledged that it can “be difficult to disentangle all the various symptoms that can occur during the menopausal transition.”

Dr Mathews agreed, adding that multidisciplinary collaboration is essential. “I always collaborate with a gynecologist when I am treating a woman whose symptoms may be related to perimenopause, especially when hormone therapy may be an option.”


1.      Shifren JL, Gass ML; NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical care of midlife women. Menopause. 2014;21(10):1038-1062.

2.      Siegel AM, Mathews SB. Diagnosis and treatment of anxiety in the aging woman. Curr Psychiatry Rep. 2015 Dec;17(12):93.

3.      World Health Technical Report Series. Research on the Menopause in the 1990's. Geneva, Switzerland: World Health Organization; 1996.

4.      Bromberger JT, Assmann SF, Avis NE, et al. Persistent mood symptoms in a multiethnic community cohort of pre- and perimenopausal women. Am J Epidemiol. 2003;158(4):347-356.

5.      Toffol E, Heikinheimo O, Partonen T. Hormone therapy and mood in perimenopausal and postmenopausal women: a narrative review. Menopause. 2015;22(5):564-578.

6.      Bromberger JT, Kravitz HM, Chang Y, et al. Does risk for anxiety increase during the menopausal transition? Study of women's health across the nation. Menopause. 2013;20(5):488-495.

7.      Amin Z, Gueorguieva R, Cappiello A, et al. Estradiol and tryptophan depletion interact to modulate cognition in menopausal women. Neuropsychopharmacology. 2006;31(11):2489-2497.

8.      Walf AA, Frye CA. A review and update of mechanisms of estrogen in the hippocampus and amygdala for anxiety and depression behavior. Neuropsychopharmacology. 2006;31(6):1097-1111.

9.      Vink D, Aartsen MJ, Schoevers RA. Risk factors for anxiety and depression in the elderly: a review. J Affect Disord. 2008;106(1-2):29-44.

10.  Hanisch LJ, Hantsoo L, Freeman EW, et al. Hot flashes and panic attacks: a comparison of symptomatology, neurobiology, treatment, and a role for cognition. Psychol Bull. 2008;134(2):247-269.

11.  Genazzani AR, Gambacciani M, Simoncini T, Schneider HP. Hormone replacement therapy in climacteric and aging brain. International Menopause Society Expert Workshop, 15-18 March 2003, Pisa, Italy. Climacteric. 2003;6(3):188-203.

12.  Dennerstein L, Guthrie JR, Clark M, et al. A population-based study of depressed mood in middle-aged, Australian-born women. Menopause. 2004;11(5):563-568.

13.  Posadzki P, Lee MS, Moon TW, et al. Prevalence of complementary and alternative medicine (CAM) use by menopausal women: a systematic review of surveys. Maturitas. 2013;75(1):34-43.

14.  Hollon SD, Jarrett RB, Nierenberg AA, et al. Psychotherapy and medication in the treatment of adult and geriatric depression:  which monotherapy or combined treatment? J Clin Psychiatry. 2005;66(4):455-468.

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