Dietary interventions for menopausal symptoms: a systematic review

Background: Menopausal transition significantly affects females’s health and quality of life, largely driven by declining estrogen. Although pharmacological therapies remain the first-line treatment, interest in dietary interventions as accessible, nonpharmacological strategies is growing. Objectives: This study aims to systematically evaluate the effectiveness of dietary interventions on vasomotor, psychological, and cognitive symptoms in menopausal females. Methods: This systematic review included 15 randomized controlled trials (n = 1952 participants) conducted according to Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [International Prospective Register of Systematic Reviews: CRD42024610754]. Databases searched included CINAHL, Cochrane, Embase, PubMed, and PsycINFO. Eligible studies included females aged 40–65 y experiencing menopause-related symptoms (or reporting relevant outcomes) and evaluated whole food–based interventions, structured dietary patterns, or energy restriction, excluding supplement-only trials. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Random-effects meta-analyses were conducted where appropriate. Results: Twelve trials included postmenopausal females, 2 included peri- and postmenopausal females, 1 included all menopausal stages, and 1 did not specify status. Soy-based interventions may reduce hot flash frequency and severity [standardized mean difference (SMD) = –0.79; 95% confidence interval (CI): –1.34, –0.23; I2 = 69%; n = 206, 4 trials (5 comparisons)], but not overall vasomotor symptoms (SMD = –0.43; 95% CI: –1.12, 0.26; I2 = 86%; n = 259, 3 trials) or psychological outcomes (SMD = –0.21; 95% CI: –0.470, 0.05; I2 = 0%; n = 236, 3 trials); overall certainty was very low. Other dietary patterns [e.g., Dietary Approach to Stop Hypertension (DASH), lactoovovegetarian, Mediterranean-DASH Intervention for Neurodegenerative Delay] suggested modest benefits for mood and cognition in narrative synthesis. Evidence for flaxseed is inconsistent, and evidence for intermittent fasting for cognition is limited. Conclusions: Soy-based dietary interventions may modestly improve vasomotor and psychological symptoms; however, the certainty of evidence is very low. Dietary modification represents a feasible, low-risk approach, but larger, high-quality trials with standardized protocols and longer follow-up are required.This trial was registered at PROSPERO: The Impact of Dietary Interventions on Menopausal Symptoms: A Systematic Review as CRD42024610754. The Authors This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/