The effectiveness of psychosocial interventions on physiological symptoms of menopause: a systematic review and meta-analysis

Abstract

Background Menopause is a transitional life stage marked by the end of menstruation, during which approximately 80–90% of women experience persistent symptoms such as vasomotor symptoms, musculoskeletal pain, fatigue, and sleep disturbance. While menopausal hormone therapy is effective for some symptoms, non-pharmacological psychosocial interventions are increasingly recommended as alternatives or adjuncts. This review evaluates the efficacy of psychosocial interventions for managing physiological menopausal symptoms.

Methods Six databases were systematically searched from inception to October 2024 for randomised controlled trials evaluating psychosocial interventions for menopausal women with physiological symptoms. Outcomes were grouped into nine categories, including sleep quality, insomnia, pain, fatigue, urogenital symptoms, sexual functioning, and vasomotor symptoms (classified as frequency, bothersomeness, and severity). Primary analyses used post-intervention data, with sensitivity analyses based on change scores. Effect sizes were expressed as Hedges’ g. The protocol was preregistered on PROSPERO, CRD42024572869.

Results 28 randomised controlled trials involving 2,887 women were included, of which 24 were included in the meta-analysis and four synthesised narratively. Psychosocial interventions produced medium-to-large reductions in the bothersomeness of hot flushes and night sweats at short-term follow-up (Hedges’ g = − 0.60 to − 0.87) and medium-term follow-up (g = − 0.50 to − 0.77), while effects on symptom frequency and severity were smaller. Significant improvements were observed in sleep quality (short-term: g = − 0.77 to − 1.04; medium-term: g = − 0.46) and insomnia (short-term: g = − 1.77 to − 2.48; medium-term: g = − 1.56 to − 1.79). Psychosocial interventions did not demonstrate improvements on sexual functioning or urogenital symptoms. Intervention dose varied across studies, and retention rates were high (mean = 86.7%), indicating good feasibility.

Conclusion Psychosocial interventions, particularly cognitive behavioural therapy, were associated with improvements in menopausal symptoms, with the strongest and most consistent effects observed for vasomotor symptom bothersomeness and sleep outcomes. These findings support psychosocial approaches as valuable non-pharmacological options, either alone or alongside pharmacological treatments. Future research should focus on tailoring interventions to individual needs, assessing whether benefits are maintained long-term, and examining whether effectiveness varies across different stages of menopause.