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.