An essential part of aging is menopause, which corresponds with the final phase of the female reproductive cycle. It is estimated that 1.2 billion women are expected to reach postmenopause by 2030. Women may be more susceptible to depression and anxiety during periods of hormonal fluctuations, such as puberty, pregnancy, the postpartum phase, and the perimenopause stage. Women were also found to have a higher incidence of both depressive and anxiety disorders than men because of menopause (1–12). During this phase of women life, menopause causes a number of complex changes, including emotional and social alterations (4).

Postmenopausal women, who are increasingly common, represent an important area of focused research. The natural aging process of reproduction is linked to several signs. Mental discomfort is significant because it worsens throughout the menopause transition. As a result of biological aging, the shift from a potentially reproductive to a non-reproductive state typically takes years and is neither instantaneous or abrupt (5, 6). Because there may be a connection between age at natural menopause and the likelihood of developing certain diseases, this is an interesting area of research (4). Studies show that during the menopausal transition, anxiety (7) and depression (8) are more common in women and that anxiety (9) and depression (10) are approximately twice as prevalent in women as in men. Depression is a major worldwide public health concern. Middle-aged women who suffer from depression may experience problems with resilience, sleep, sexual activity, and general quality of life. It also increases the risk of other health problems such as low bone density, osteoporotic fractures, coronary heart disease, metabolic syndrome, and cognitive impairment (11, 12). Recent meta-analyses have confirmed a strong association between increased menopausal age and depression, anxiety, and stress (13). Early detection and treatment of depression are essential to preventing major consequences. Many longitudinal and cross-sectional studies that have looked at depression in women in their midlife have found that the prevalence of depressive symptoms and depression disorders during the menopause phase is higher than those experienced during the premenopausal period, specifically among women who have a history of depression (14).

However, little is known about the prevalence of postmenopausal depression. Little research on anxiety in midlife women, and those conducted have typically examined the connection between stress and vasomotor symptoms as compared with menopausal symptoms. According to the results of Women’s Health Across the Nation (SWAN), a notable community-based, multiethnic, longitudinal study on ovary aging, anxiety is prevalent during the menopause phase of menopause and in the early postmenopausal period (9). Nevertheless, more investigation is needed to comprehend the connection between anxiety and the menopausal stage completely. The objective of this research was to assess anxiety and depressive symptoms among menopausal women in Asir region, Saudi Arabia.

Of the 396 menopausal women, 42.9% were under 50 years old, 23.2% were between 50 and 54 years old, 16.2% were between 55 and 59 years old, and 17.7% were over 60 years old. Among the study population, 31.1% were illiterate and 68.9% were literate. Additionally, 71% were married, and 29% were widowed or separated. Only 42.2% were married at age < 18, whereas 57.8% got married at age 18 or older. Regarding parity, 19.9% had a parity <3, 49.5% had a parity of 3–5, and 30.6% had a parity ≥6. A total of 47.7% of participants were ≥50 years old at menopause, 38.1% were aged 45–49 years, and 14.1% were <45 years old (Table 1).

In terms of menopausal symptoms, 67.7% experienced hot flushes; 63.6% had night sweats; 55.6% reported sleep issues; 51.5% had dry or sore vagina; 61.6% experienced decreased sexual desire; 59.6% had aching or painful joints; 47.5% had headaches; 42.7% reported sore breasts; 39.9% had nocturia; 46% felt more irritable; 64.6% reported irritability; and 54.3% experienced memory problems. Details are provided in Table 2.

Overall, 65.2% reported depression symptoms and 52.02% reported anxiety symptoms. Among the participants, 13.38% reported no depression; 21.46% reported mild depression; 23.23% reported moderate depression; 32.83% reported moderately severe depression; and 9.09% reported severe depression (Table 3). In terms of marital status, married (OR = 0.317; 95% CI = 0.182–0.551, p = 0.000) are less likely to have depression compared to widowed/separated individuals. This difference is statistically significant (p < 0.05). Literate (OR = 0.518; 95% CI = 0.309–0.868, p = 0.013), are less likely to have depression compared to illiterates, and this difference is statistically significant (p < 0.05). That is, among the independent variables, the regression results show that marital status and women’s literacy status have significant effects on depression levels (Table 4).

According to the GAD-7 scale, 18.94% reported no anxiety; 29.04% reported mild anxiety; 36.36% reported moderate anxiety; and 15.66% reported severe anxiety (Table 3). Individual responses for each questions were given in Tables 5, 6 for depression (PHQ-9) and anxiety (GAD-7). Literates (OR = 0.271; 95% CI = 0.165–0.443, p = 0.000), are less likely to have anxiety compared to illiterates and this difference is statistically significant (p < 0.05). The regression results show that women’s literacy status has significant effects on anxiety levels. The following independent variables age, marital status, age at marriage (years), parity, age at menopause (years) have no significant effects on anxiety levels (p > 0.05) (Table 4).

Our study aimed to find the depression and anxiety symptoms among menopausal women. Out of 396 menopausal women, the majority reported experiencing depression and anxiety symptoms. The most common menopausal symptoms included hot flushes, night sweats, sleep issues, vaginal dryness, decreased sexual desire, joint pain, headaches, sore breasts, nocturia, irritability, and memory problems. Over half of the participants had severe menopausal symptoms. Similar findings were reported by Ahlawat et al. (20), with hot flushes, sweating, joint pain, depressed mood, and irritability being the most prevalent. According to Sharma’s study (21), joint and muscular discomfort was the most prevalent symptom at 78.42%, whereas vaginal dryness was among the least prevalent at 39.5%. In contrast, our study found a higher prevalence of vaginal dryness at 51.5%, indicating a difference from Sharma’s findings. Additionally, in our study, the mean score was elevated for physical and mental tiredness but lower for vaginal dryness and nocturia. Similar to our findings, another study reported that a significant proportion of women experience menopausal symptoms. Most research participants indicated experiencing anxiety, followed by heart-related issues, joint and muscular discomfort, sleep disturbances, and overall tiredness, both physical and mental. Irritation was also commonly reported. Hot flashes, recognized as the most prevalent symptom, were noted by a considerable number of women. Additionally, mean scores for symptoms like hot flashes, sweating, and joint discomfort showed statistically significant differences (22).

Inversely, less menopausal symptoms were seen in other research (23). This is supported by additional research that indicates women who have hot flashes are more prone than those who do not to suffer from depression (24). Moreover, the available data indicate a clear correlation between high prevalence of anxiety and depressive symptoms in postmenopausal women. These results corroborate findings from a few previously published studies (25, 26). Interestingly, anxiety has been frequently and strongly linked to vasomotor symptoms (VMS) (hot flashes and/or night sweats) in studies around the menopause transition.

Of the menopausal women studied, a notable number reported experiencing varying levels of depression. A significant portion indicated mild depression, while others reported moderate and moderately severe depression. Additionally, some women experienced severe depression. The menopause marks the passage from fertility to old age. At this point, a woman’s ovarian function starts to progressively deteriorate, resulting in menopausal syndrome and, frequently, a host of psychological disorders. Age-related changes in the family and social environment led to an increase in physical strain. Sleeplessness, excessive concern, anxiety, and negative psychological issues are common among menopausal women. This exacerbates the depressive symptoms experienced by menopause syndrome patients (27). Similar to our findings, a study by Polisseni et al. found that 36.8% of women experienced depression during menopause (20, 28). Afshari et al.’s (29) study, which was smaller than the current study, reported that the prevalence of depression in postmenopausal women was 59.8%, with 39.8, and 16% of the women having mild depression and moderate depression, respectively. In contrast to our research, another study discovered that 24.76% of females had clinical depression and 21.9% of females had moderate anxiety scores (30). In a Chandigarh study, Khatak et al. (31) found that 61% of peri and postmenopausal women experienced minimum depression, mild depression (38.5%), significant depression (0.5%), and mild anxiety (0.5%). Furthermore, mild anxiety symptoms were reported by 29.5% of the women and moderate anxiety symptoms by 1% of the women (31).

Based on the GAD-7 scale, many participants reported mild anxiety, with a notable number also experiencing moderate anxiety. Furthermore, some women reported severe or extremely severe anxiety. Similar to our research, another study found that anxiety disorders were common in postmenopausal women and that the severity of the disorder was correlated with the severity of the menopausal syndrome (27). This was consistent with previous study results (32). It is challenging to ascertain if vasomotor symptoms (VMS) are the cause of the observed correlation between anxiety and menopausal stage because VMS are very common during the transition (33, 34).

Our findings are corroborated by Yadollahi et al. (35), who suggest that improving health literacy is associated with changing behavior and actively participating in decision-making. An adequate degree of health literacy and quality of life have already been found to positively correlate among Iranian research participants (36). Our study has a number of limitations because of its self-administered survey and cross-sectional methodology, including the possibility for recall bias during data collection. Moreover, because of the approach of the study, there is limited generalizability of the results obtained.

The study found that a significant percentage of menopausal women had depression and anxiety. These results emphasize the significance of screening and assessing women experiencing anxiety and depression symptoms throughout the menopausal transition. To alleviate menopausal symptoms, it is also suggested to conduct activities to educate menopausal women, such as a health awareness program in shopping centers and other public places, etc.