Digital health interventions for managing menopausal symptoms: A systematic review

BACKGROUND: Menopausal symptoms significantly impair women's quality of life, and conventional menopausal hormone therapy carries risks of clinical contraindications and adverse effects. Digital health interventions (DHIs) are gaining attention as a promising non-pharmacological alternative for sustained symptom management. This study aimed to comprehensively evaluate the clinical efficacy of DHIs for peri- and postmenopausal women. METHODS: We searched 6 databases for eligible clinical studies from inception to May 2025. The methodological quality of randomized controlled trials (RCTs) was assessed using the Cochrane Risk of Bias 2. For non-randomized studies, the Risk Of Bias In Non-randomized Studies of Interventions and the National Institutes of Health Quality Assessment Tool were used. The certainty of evidence for outcomes reported by RCTs was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: A total of 8 studies involving 17,420 participants were included. DHIs utilized various mechanisms, including cognitive behavioral therapy, hypnotherapy, biofeedback-based pelvic floor muscle training, cognitive training, behavior change and self-care models, and personalized healthcare. Overall, DHIs were associated with improvements in vasomotor symptoms, psychological distress, pelvic floor dysfunction, and cognitive decline. However, there was high methodological heterogeneity and study design limitations; both RCTs were rated as having "some concerns" regarding risk of bias. According to the GRADE assessment, the certainty of evidence was low for Menopause Rating Scale (MRS) and very low for Midlife Women's Symptom Index (MSI). CONCLUSION: DHIs demonstrate clinical potential as a non-pharmacological alternative for managing menopausal symptoms. Large-scale, well-designed RCTs with longer follow-up are needed. Trial registration/Protocol registration: PROSPERO (CRD420251042496).