Conclusions
For a subset of women with low anxiety premenopausally, the risk for high anxiety is greater during or after the menopausal transition than before the menopausal transition, independent of frequent VMS and other established risk factors. However, among women with premenopausal anxiety, the risk for high anxiety remains high, irrespective of the menopausal transition and frequent VMS, with which it is consistently associated. The identification of a subgroup of women for whom the transition poses an increased risk of high anxiety points to the need for further research to determine the specific aspects of the transition that confer such vulnerability, the extent to which anxiety persists, and the history and circumstances of women who develop high anxiety. Additional research on midlife women who report high anxiety premenopausally is also warranted. The findings also have implications for clinicians, suggesting that it is useful for healthcare providers to obtain information from women presenting with high anxiety about its onset and duration, as well as about bleeding patterns and VMS. Women with anxiety may benefit from treatment of the anxiety or referral to a mental health practitioner.