Nonpharmacological Intervention Effects on Middle-Aged Women with Menopausal Symptoms: A Systematic Review and Meta-Analysis

<b>Background:</b> Middle-aged women frequently experience diverse physical and psychological symptoms, including depression, anxiety, sleep disturbances, vasomotor symptoms, and reduced quality of life, during menopause. With increasing concerns regarding the side effects of hormone therapy, nonpharmacological interventions have emerged as safer alternatives for symptom management. <b>Purpose:</b> This systematic review and meta-analysis evaluated the effectiveness of nonpharmacological interventions for menopausal symptoms in middle-aged women. <b>Methods:</b> Thirty-two randomized controlled trials were selected from eight international and domestic databases. Interventions were categorized as nutritional or herbal, psychological, exercise-based, and complementary therapies. Risk of bias was assessed using the Cochrane risk of bias tool, and meta-analyses were performed using a random effects model. Results: Nonpharmacological interventions significantly reduced symptoms of depression (standardized mean difference (SMD) = -1.10), anxiety (-0.82), sleep disturbances (-0.90), menopausal symptoms (-1.18), and hot flashes (-0.34). Improvement in quality of life was observed, but it was not statistically significant (SMD = 1.40). Subgroup analyses revealed that nutritional and herbal interventions had the most consistent effects, and psychological and exercise-based interventions were particularly effective for improving sleep outcomes and emotional well-being. <b>Conclusions:</b> Nonpharmacological interventions effectively improve menopausal symptoms and quality of life, with tailored and multifaceted approaches showing the greatest impact. Nurse-led, community-based programs are key delivery platforms, and sustainable outcomes require standardized protocols, cultural responsiveness, and ongoing evaluation.