Dietary Interventions for Menopausal Symptoms: A Systematic Review.

BACKGROUND: Menopausal transition significantly affects women's health and quality of life largely driven by declining estrogen. While pharmacological therapies remain first-line treatment, interest in dietary interventions as accessible, non-pharmacological strategies is growing. OBJECTIVE: To systematically evaluate effectiveness of dietary interventions on vasomotor, psychological, and cognitive symptoms in menopausal women. METHODS: This systematic review included 15 randomized controlled trials (n=1,952 participants) conducted according to Cochrane methodology and PRISMA guidelines (PROSPERO: CRD42024610754). Databases searched included CINAHL, Cochrane, Embase, PubMed, and PsycINFO. Eligible studies included women aged 40-65 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 GRADE. Random-effects meta-analyses were conducted where appropriate. RESULTS: Twelve trials included postmenopausal women, two included peri- and postmenopausal women, one included all menopausal stages, and one did not specify status. Soy-based interventions may reduce hot flash frequency and severity (SMD = -0.79; 95% CI -1.34 to -0.23; I2 = 69%; n = 206, 4 trials (5 comparisons)), but not overall vasomotor symptoms (SMD = -0.43; 95% CI -1.12 to 0.26; I2 = 86%; n = 259, 3 trials) or psychological outcomes (SMD = -0.21; 95% CI (-0.470 to 0.05); I2 = 0%; n = 236, 3 trials); overall certainty was very low. Other dietary patterns (e.g., DASH, lacto-ovo-vegetarian, MIND) suggested modest benefits for mood and cognition in narrative synthesis. Evidence for flaxseed is inconsistent and intermittent fasting for cognition limited. CONCLUSIONS: Soy-based dietary interventions may modestly improve vasomotor and psychological symptoms; however, 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. Registry and registry number for systematic reviews or meta-analyses: PROSPERO: The Impact of Dietary Interventions on Menopausal Symptoms: A Systematic Review (CRD42024610754).