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.

2026-01-07
Climacteric : the journal of the International Menopause Society 29(2)
- Alison Maunder
- Amelia K Mardon
- Vibhuti Rao
- Sophia Torkel
- Najwa-Joelle Metri
- Jing Liu
- Guoyan Yang
- Nora Giese
- Evangeline Mantzioris
- Nur K Abdul Jafar
- Geovanna E Rodrigues de Souza
- Ieman Al-Kanini
- Lorena Romero
- Nick Panay
- Hugo Pedder
- Carolyn Ee

PubMed: 41498229
DOI: 10.1080/13697137.2025.2584061

Study Design

Type: Systematic Review
Population: menopausal women
Methods: Systematic search of six databases (January 2022-December 2024) for RCTs and systematic reviews on complementary therapies for menopause; quality assessed using Cochrane RoB2, AMSTAR 2, and GRADE

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.

Research Insights

Black Cohosh→Reduced Vasomotor Symptom
moderate-certainty evidence supports black cohosh (vasomotor/menopausal symptoms)
Effect
Beneficial
Effect size
Small
Vitamin D→Reduced Fracture Risk
moderate-certainty evidence supports vitamin D (fracture risk)
Effect
Beneficial
Effect size
Small

Adverse Events Reported

Black Cohosh→Overall tolerability
Most complementary therapies are safe.
Finding
Reported
Vitamin D→Overall tolerability
High-certainty evidence supports vitamin D safety
Finding
Reported