Complementary therapies for management of menopausal symptoms: a systematic review to inform the update of the International Menopause Society recommendations on women's midlife health.

OBJECTIVE: Menopausal hormone therapy is standard treatment, but some women use complementary therapies. This review examines complementary therapies for menopause to inform International Menopause Society (IMS) recommendations. METHOD: A systematic search of six databases (January 2022-December 2024) identified randomized controlled trials (RCTs) and systematic reviews on complementary therapies for menopause. Outcomes included menopausal, vasomotor, genitourinary, cardiometabolic, sleep symptoms, bone health and safety. The study quality and certainty of evidence were evaluated using Cochrane Risk of Bias (RoB2), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2) and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS: From 3187 citations, 158 studies were included: one overview, 36 meta-analyses, seven systematic reviews and 114 RCTs. While promising evidence was found for acupuncture, Chinese herbal medicine (CHM), herbs, nutrients, mind-body/touch therapies for a variety of symptoms, most was of low/very low certainty. High-certainty evidence supports vitamin D safety; and moderate-certainty evidence supports black cohosh (vasomotor/menopausal symptoms), CHM (menopausal symptoms, sleep, blood pressure), acupuncture + CHM (sleep) and vitamin D (fracture risk). Most complementary therapies are safe. CONCLUSION: Vitamin D, black cohosh, CHM and acupuncture + CHM may improve some menopausal symptoms, but overall evidence remains limited. More rigorous research is needed on the efficacy and safety of complementary therapies for menopause. Menopausal hormone therapy is the main treatment for menopause symptoms, but many women also use complementary therapies alongside conventional care. This review summarizes the available research on different complementary therapies used by women during and after menopause.Six databases were searched and 158 studies included, such as clinical trials, systematic reviews and meta-analyses on complementary therapies used by menopausal women. Overall, the quality of these trials and reviews was low.Many complementary therapies showed promising results, such as acupuncture, Chinese herbal medicine, herbal medicines, vitamin and nutrient supplements, and mind–body approaches; however, most are supported by low-quality evidence. The strongest evidence supported the safety of vitamin D, while moderate evidence suggested benefits from black cohosh for hot flushes and menopausal scores; Chinese herbal medicine for menopausal scores, sleep quality and blood pressure; acupuncture combined with Chinese herbal medicine for sleep quality; and vitamin D for reducing fracture risk.In summary, complementary therapies including vitamin D, black cohosh and Chinese herbal medicine may help some menopausal symptoms, but more high-quality research is needed to understand how effective and safe these treatments truly are. In general, most complementary therapies appeared safe, with few serious side effects reported. However, more high-quality research on complementary therapies is required to confirm the benefits and risks to menopausal women.