Effectiveness of non-pharmacological interventions for insomnia related to natural menopause: A meta-analysis of randomized controlled trials

Insomnia is common in the general population and is more prevalent in menopausal women. This meta-analysis synthesized and assessed the effect of non-pharmacological interventions for insomnia related to natural menopause. Comprehensive searches for randomized controlled trials were conducted across multiple databases from inception to February 2025, including PubMed, Web of Science, Embase, and the Cochrane Library. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index, and insomnia was evaluated with the Insomnia Severity Index. The risk of bias was evaluated with the revised Cochrane RoB 2 tool, and random effects models were used for meta-analyses. Twenty-two studies with a total of 1648 participants were analyzed. Non-pharmacological interventions significantly reduced PSQI and ISI scores. In a subgroup analysis, cognitive behavioral therapy, exercise, acupuncture, acupressure, and integrated interventions all improved low sleep quality in women after natural menopausal (cognitive behavioral therapy: MD -3.38, 95% CI -4.15 to −2.62, P < 0.01, heterogeneity I2 = 0%, P = 0.67; exercise: MD -1.17, 95% CI -1.88 to −0.47, P < 0.01; heterogeneity I2 = 24%, P = 0.27; acupuncture: MD -6.25, 95% CI -7.64 to −4.87, P < 0.01, heterogeneity I2 = 22%, P = 0.26; self-administered acupressure: MD -2.26, 95% CI -3.10 to −1.43, P < 0.01, heterogeneity I2 = 0%, P = 0.38; nurse-administered acupressure: MD -7.61, 95% CI -8.30 to −6.93, P < 0.01, heterogeneity I2 = 0%, P = 0.74; integrated interventions MD -2.89, 95% CI -3.67 to −2.12, P < 0.01, heterogeneity I2 = 33%, P = 0.19). The sensitivity analysis indicated that these findings are robust. They suggest that non-pharmacological interventions are preferred options for managing insomnia related to natural menopause and may be beneficial for patients who refuse to use hypnotic medications or hormone therapy, or who have contraindications. PROSPERO registration of review protocol: CRD420250652866.