ISSN 0300-9092 (Print)
ISSN 2412-5679 (Online)

Comorbid anxiety in women with menopause of various etiology

Yureneva S.V., Averkova V.G.

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia

The high prevalence of anxiety disorder, its significant negative impact on the quality of life of patients, as well as the frequent combination of pathological anxiety with somatic diseases define the importance of elaboration unified approaches to the diagnosis, routing and treatment of this type of mental disorder for doctors of any specialty. Comorbid anxiety is a common problem in obstetrical and gynecologal practice. The peri- and postmenopausal periods are characterized by significant physiological, psychological, and social changes in a woman's life, which can predispose her to anxiety disorders. Timely management for comorbid syndromic anxiety can not only improve a woman's quality of life but also increase her compliance with treatment for the underlying condition. 
Conclusion: It is of high importance to pay special attention to the identification of anxiety disorders in order to create a precise diagnostic algorithm, provide active treatment and define preventive measures.

Authors’ contributions: Yureneva S.V. – study concept and design, research data analysis, manuscript editing; Averkova V.G. – material collection and processing, manuscript composition. All authors made an equal contribution to the article.
Conflicts of interest: The authors declare no conflicts of interest.
Funding: The study had no sponsorship support.
Patient Consent for Publication: Prior to inclusion in the study, all patients provided informed consent for the publication of their data.
For citation: Yureneva S.V., Averkova V.G. Comorbid anxiety in women with menopause of various etiology.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (12): 169-176 (in Russian)
https://dx.doi.org/10.18565/aig.2025.368

Keywords

anxiety disorder
menopause
climacteric syndrome
premature ovarian failure

References

  1. World Health Organization. Mental health atlas 2024. Geneva: World Health Organization; 2025. Available at: https://iris.who.int/handle/10665/375820
  2. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022; 9(2): 137-50. https://dx.doi.org/10.1016/S2215-0366(21)00395-3
  3. Wang J., Guan X., Tao N. GBD: incidence rates and prevalence of anxiety disorders, depression and schizophrenia in countries with different SDI levels, 1990-2021. Front. Public Health. 2025; 13: 1556981. https://dx.doi.org/10.3389/fpubh.2025.1556981
  4. Fan Y., Fan A., Yang Z., Fan D. Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the global burden of disease study 2021. BMC Psychiatry. 2025; 25(1): 486. https://dx.doi.org/10.1186/s12888-025-06932-y
  5. Collaborators C-MD. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet. 2021; 398(10312): 1700-12. https://dx.doi.org/10.1016/S0140-6736(21)02143-7
  6. Daly M., Sutin A.R., Robinson E. Longitudinal changes in mental health and the COVID-19 pandemic: evidence from the UK household longitudinal study. Psychol. Med. 2022; 52(13): 2549-58. https://dx.doi.org/10.1017/S0033291720004432
  7. Brown L., Hunter M.S., Chen R., Crandall C.J., Gordon J.L., Mishra G.D. et al. Promoting good mental health over the menopause transition. Lancet. 2024; 403(10430): 969-83. https://dx.doi.org/10.1016/S0140-6736(23)02801-5
  8. Maeng L.Y., Milad M.R. Sex differences in anxiety disorders: interactions between fear, stress, and gonadal hormones. Horm. Behav. 2015; 76: 106-17. https://dx.doi.org/10.1016/j.yhbeh.2015.04.002
  9. Burani K., Nelson B.D. Gender differences in anxiety: the mediating role of sensitivity to unpredictable threat. Int. J. Psychophysiol. 2020; 153: 127-34. https://dx.doi.org/10.1016/j.ijpsycho.2020.05.001
  10. Li S., Jia Z., Zhang Z., Li Y., Ding Y., Qin Z. et al. Effect of gender on the association between cumulative cardiovascular risk factors and depression: results from the US National Health and Nutrition Examination Survey. Gen. Psychiatr. 2023; 36(4): e101063. https://dx.doi.org/10.1136/gpsych-2023-101063
  11. Rubinow D.R., Schmidt P.J. Sex differences and the neurobiology of affective disorders. Neuropsychopharmacology. 2019; 44(1): 111-28. https://dx.doi.org/10.1038/s41386-018-0148-z
  12. Koller D., Pathak G.A., Wendt F.R., Tylee D.S., Levey D.F., Overstreet C. et al. Epidemiologic and genetic associations of endometriosis with depression, anxiety, and eating disorders. JAMA Netw. Open. 2023; 6(1): e2251214. https://dx.doi.org/10.1001/jamanetworkopen.2022.51214
  13. DeJean D., Giacomini M., Vanstone M., Brundisini F. Patient experiences of depression and anxiety with chronic disease: a systematic review and qualitative meta-synthesis. Ont. Health Technol. Assess Ser. 2013; 13(16): 1-33.
  14. Wen J., Wang W., Liu K., Sun X., Zhou J., Hu H. et al. The psychological side of menopause: evidence from the comorbidity network of menopausal, anxiety, and depressive symptoms. Menopause. 2024; 31(10): 897-904. https://dx.doi.org/10.1097/GME.0000000000002406
  15. Cyranowski J.M., Schott L.L., Kravitz H.M., Brown C., Thurston R.C., Joffe H. et al. Psychosocial features associated with lifetime comorbidity of major depression and anxiety disorders among a community sample of mid-life women: the SWAN mental health study. Depress. Anxiety. 2012; 29(12): 1050-7. https://dx.doi.org/10.1002/da.21990
  16. Alblooshi S., Taylor M., Gill N. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australas. Psychiatry. 2023; 31(2): 165-73. https://dx.doi.org/10.1177/10398562231165439
  17. Kalra B., Kalra S., Bhattacharya S., Dhingra A. Menopause distress: a person centered definition. J. Pak. Med. Assoc. 2020; 70(12(B)): 2481-3.
  18. Andreescu C., Lee S. Anxiety disorders in the elderly. Adv. Exp. Med. Biol. 2020; 1191: 561-76. https://dx.doi.org/10.1007/978-981-32-9705-0_28
  19. Министерство здравоохранения Российской Федерации. Клинические рекомендации. Генерализованное тревожное расстройство. 2024. [Ministry of Health of the Russian Federation. Clinical Guidelines. Generalized Anxiety Disorder. 2024. (in Russian)].
  20. Shawon M.S.R., Hossain F.B., Hasan M., Rahman M.R. Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: analysis of nationally representative survey data. Glob. Ment. Health. (Camb). 2024; 11: e46. https://dx.doi.org/10.1017/gmh.2024.37
  21. Васенина Е.Е. Гендерные особенности тревожных расстройств. Журнал неврологии и психиатрии им. С.С. Корсакова. 2023; 123(10): 48-53. [Vasenina E.E. Gender characteristics of anxiety disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2023; 123(10): 48-53 (in Russian)]. https://dx.doi.org/10.17116/jnevro202312310148
  22. Altemus M., Sarvaiya N., Neill Epperson C. Sex differences in anxiety and depression clinical perspectives. Front. Neuroendocrinol. 2014; 35(3): 320-30. https://dx.doi.org/10.1016/j.yfrne.2014.05.004
  23. Farhane-Medina N.Z., Luque B., Tabernero C., Castillo-Mayén R. Factors associated with gender and sex differences in anxiety prevalence and comorbidity: a systematic review. Sci. Prog. 2022; 105(4): 368504221135469. https://dx.doi.org/10.1177/00368504221135469
  24. MacKenzie G., Maguire J. The role of ovarian hormone-derived neurosteroids on the regulation of GABAA receptors in affective disorders. Psychopharmacology (Berl). 2014; 231(17): 3333-42. https://dx.doi.org/10.1007/s00213-013-3423-z
  25. Fidecicchi T., Giannini A., Chedraui P., Luisi S., Battipaglia C., Genazzani A.R. et al. Neuroendocrine mechanisms of mood disorders during menopause transition: A narrative review and future perspectives. Maturitas. 2024; 188: 108087. https://dx.doi.org/10.1016/j.maturitas.2024.108087
  26. Sun Q., Li G., Zhao F., Dong M., Xie W., Liu Q. et al. Role of estrogen in treatment of female depression. Aging (Albany NY). 2024; 16(3): 3021-42. https://dx.doi.org/10.18632/AGING.205507
  27. Есин О.Р., Маштакова А.И., Есин Р.Г. ГАМКергическая система – физио­логическая роль и клиническое значение. Медицинский совет. 2025; 19(3): 118-26. [Esin O.R., Mashtakova A.I., Esin R.G. GABAergic system – physiological role and clinical significance. Medical Council. 2025; 19(3): 118-26 (in Russian)]. https://dx.doi.org/10.21518/ms2025-106
  28. Карева Е.Н., Олейникова О.М., Панов В.О., Шимановский Н.Л., Скворцова В.И. Эстрогены и головной мозг. Вестник РАМН. 2012; 67(2): 48-59. [Kareva E.N., Oleynikova О.M., Panov V.О., Shimanovskiy N.L., Skvortsova V.I. Estrogens and brain. Bulletin of the Russian Academy of Medical Sciences. 2012; 67(2): 48-59 (in Russian)]. https://dx.doi.org/10.15690/vramn.v67i2.122
  29. Fidecicchi T., Chedraui P., Luisi S., Battipaglia C., Genazzani A.R., Simoncini T. et al. Neuroendocrine mechanisms of mood disorders during menopause transition: a narrative review and future perspectives. Maturitas. 2024; 188: 108087. https://dx.doi.org/10.1016/j.maturitas.2024.108087
  30. Domonkos E., Hodosy J., Ostatníková D., Celec P. On the role of testosterone in anxiety-like behavior across life in experimental rodents. Front. Endocrinol. (Lausanne). 2018; 9: 441. https://dx.doi.org/10.3389/fendo.2018.00441
  31. Musial N., Ali Z., Grbevski J., Veerakumar A., Sharma P. Perimenopause and first-onset mood disorders: a closer look. Focus (Am. Psychiatr. Publ.). 2021; 19(3): 330-7. https://dx.doi.org/10.1176/appi.focus.20200041
  32. Yue H., Yang Y., Xie F., Cui J., Li Y., Si M. et al. Effects of physical activity on depressive and anxiety symptoms of women in the menopausal transition and menopause: a comprehensive systematic review and meta-analysis of randomized controlled trials. Int. J. Behav. Nutr. Phys. Act. 2025; 22(1): 13. https://dx.doi.org/10.1186/s12966-025-01712-z
  33. Juang K.D., Wang S.J., Lu S.R., Lee S.J., Fuh J.L. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas. 2005; 52(2): 119-26. https://dx.doi.org/10.1016/j.maturitas.2005.01.005
  34. Wang S.J., Feng X., Zhang W., Sun G.Y., Fang H., Jing H. et al. Depression and anxiety in patients with breast cancer receiving radiotherapy: a longitudinal study. Ther. Adv. Med. Oncol. 2025; 17: 17588359251345930. https://dx.doi.org/10.1177/17588359251345930
  35. Lee S., Jang M., Kim D., Kim K. Association between menopausal women's quality of life and aging anxiety: the role of life satisfaction and depression. Medicina (Kaunas). 2024; 60(8): 1189. https://dx.doi.org/10.3390/medicina60081189
  36. Гаспарян С.А., Чотчаева А.М., Карпов С.М. Когнитивные и психоэмоциональные нарушения у женщин периода менопаузального перехода: возможности медикаментозной коррекции. Проблемы Эндокринологии. 2023; 69(1): 86-95. [Gasparyan S.A., Chotchaeva A.M., Karpov S.M. Cognitive and psychoemotional changes in menopausal transition: The possibility of medical correction. Problems of Endocrinology. 2023; 69(1): 86-95. (in Russian)]. https://dx.doi.org/10.14341/probl13205
  37. Acar Ö., Goksel G., Ozan E., Altunbaş A.A., Karakaya M.S., Ekinci F., Erdoğan A.P. The psychosocial burden of breast cancer: a cross-sectional study of associations between sleep quality, anxiety, and depression in Turkish women. J. Clin. Med. 2025; 14(19): 6773. https://dx.doi.org/10.3390/jcm14196773
  38. Penberthy J.K., Stewart A.L., Centeno C.F., Penberthy D.R. Psychological aspects of breast cancer. Psychiatr. Clin. North Am. 2023; 46(3): 551-70. https://dx.doi.org/10.1016/j.psc.2023.04.010
  39. Fortin J., Leblanc M., Elgbeili G., Cordova M.J., Marin M.F., Brunet A. The mental health impacts of receiving a breast cancer diagnosis: a meta-analysis. Br. J. Cancer. 2021; 125(11): 1582-92. https://dx.doi.org/10.1038/s41416-021-01542-3
  40. Panay N., Anderson R.A., Bennie A., Cedars M., Davies M., Ee C. et al. Evidence-based guideline: premature ovarian insufficiency. Climacteric. 2024; 27(6):510-20. https://dx.doi.org/10.1080/13697137.2024.2423213
  41. Аверкова В.Г., Юренева С.В. Оценка качества жизни пациенток с преждевременной недостаточностью яичников, принимающих заместительную гормональную терапию. Акушерство и гинекология. 2023; 5: 50-8. [Quality of life in patients with premature ovarian insufficiency treated with hormone replacement therapy. Obstetrics and Gynecology. 2023; (5): 50-8 (in Russian)]. https://dx.doi.org/10.18565/aig.2023.16
  42. Feng P., Lin L., Wang Y., Chen L., Min J., Xie Y. et al. Impacts of menopause hormone therapy on mood disorders among postmenopausal women. Climacteric. 2022; 25(6): 579-85. https://dx.doi.org/10.1080/13697137.2022.2026915
  43. Sullivan S.D., Sarrel P.M., Nelson L.M. Hormone replacement therapy in young women with primary ovarian insufficiency and early menopause. Fertil Steril. 2016; 106(7): 1588-99. https://dx.doi.org/10.1016/j.fertnstert.2016.09.046
  44. Nuss P., Ferreri F., Bourin M. An update on the anxiolytic and neuroprotective properties of etifoxine: from brain GABA modulation to a whole-body mode of action. Neuropsychiatr Dis Treat. 2019; 15: 1781-95. https://dx.doi.org/10.2147/NDT.S200568
  45. Шнайдер Н.А., Макаров Е.А., Кидяева A.B., Гречкина В.В., Петрова М.М., Насырова Р.Ф. Селективные ингибиторы обратного захвата серотонина: проблема безопасности (систематический обзор). Забайкальский медицинский вестник. 2024; 4: 133-49. [Shnayder N.A., Makarov E.A., Kidyaeva A.V., Grechkina V.V., Petrova M.M., Nasyrova R.F. Selective serotonin reuptake inhibitors: a safety issue (systematic review). Transbaikalian Medical Bulletin. 2024; 4: 133-49 (in Russian)]. https://dx.doi.org/10.52485/19986173_2024_4_133
  46. Poisbeau P., Gazzo G., Calvel L. Anxiolytics targeting GABAA receptors: Insights on etifoxine. World J. Biol. Psychiatry. 2018; 19(sup1): S36-45. https://dx.doi.org/10.1080/15622975.2018.1468030
  47. Stein D.J. Etifoxine versus alprazolam for the treatment of adjustment disorder with anxiety: a randomized controlled trial. Adv. Ther. 2015; 32(1): 57-68. https://dx.doi.org/10.1007/s12325-015-0176-6
  48. do Rego J.L., Vaudry D., Vaudry H. The non-benzodiazepine anxiolytic drug etifoxine causes a rapid, receptor-independent stimulation of neurosteroid biosynthesis. PLoS One. 2015; 10(3): e0120473. https://dx.doi.org/10.1371/journal.pone.0120473
  49. Vicente B., Saldivia S., Hormazabal N., Bustos C., Rubí P. Etifoxine is non-inferior than clonazepam for reduction of anxiety symptoms in the treatment of anxiety disorders: a randomized, double blind, non-inferiority trial. Psychopharmacology (Berl). 2020; 237(11): 3357-67. https://dx.doi.org/10.1007/s00213-020-05617-6
  50. Nguyen N., Fakra E., Pradel V., Jouve E., Alquier C., Le Guern M.E. et al. Efficacy of etifoxine compared to lorazepam monotherapy in the treatment of patients with adjustment disorders with anxiety: a double-blind controlled study in general practice. Hum. Psychopharmacol. 2006; 21(3): 139-49. https://dx.doi.org/10.1002/hup.757
  51. Deplanque D., Machuron F., Waucquier N., Jozefowicz E., Duhem S., Somers S. et al. Etifoxine impairs neither alertness nor cognitive functions of the elderly: A randomized, double-blind, placebo-controlled crossover study. Eur. Neuropsychopharmacol. 2018; 28(8): 925-32. https://dx.doi.org/10.1016/j.euroneuro.2018.05.011
  52. Торшин И.Ю., Громова О.А., Федотова Л.Э., Громов А.Н. Эффекты этифоксина (хемореактомное моделирование). Неврология, нейропсихиатрия, психосоматика. 2016; 8(2): 44-9. [Torshin I.Y., Gromova O.A., Fedotova L.E., Gromov A.N. Effects of etifoxine: Chemoreactome simulation. Neurology, neuropsychiatry, psychosomatics. 2016; 8(2): 44-9 (in Russian)]. https://dx.doi.org/10.14412/2074-2711-2016-2-44-49

Received 10.12.2025

Accepted 18.12.2025

About the Authors

Svetlana V. Yureneva, Dr. Med. Sci., Professor, Deputy Director for Research of the Institute of Oncogynecology and Mammology, Professor at the Department of Obstetrics and Gynecology of the Institute of Vocational Education, Head of the Scientific Advisory Diagnostic Department of Outpatient Oncological Care, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(916)179-74-00, syureneva@gmail.com, https://orcid.org/0000-0003-2864-066X
Victoria G. Averkova, PhD, Researcher at the Scientific Advisory Diagnostic Department of Outpatient Oncological Care, obstetrician-gynecologist, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Ac. Oparina str., 4, +7(915)259-08-10, buch1202@mail.ru, https://orcid.org/0000-0002-8584-5517

Similar Articles