Frontiers in medicine · 2026
Efficacy of hormone therapy and phytoestrogens on the psychological symptoms of menopausal women: a systematic review, meta-analysis, and trial sequential analysis.
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Shou Mengna, Ye Mengfei, Lou Chunhua, Chen Xinyi, Yao Yiying, Yan Junwei, Zhou Wenchao, Fu Zimu, Liu Zheng
Аннотация
BACKGROUND: The efficacy of hormone therapy and phytoestrogens in reducing psychological symptoms of menopausal women has generated substantial debate. We aimed to evaluate the effectiveness of hormone therapy and phytoestrogens for psychological symptoms.
METHODS: We conducted a comprehensive search of multiple academic databases, including EMBASE, Cochrane Library, Web of Science, PubMed, and PsycINFO. The inclusion criteria were limited to randomized controlled trials (RCTs) published up to March 1, 2026. Hedge's g was utilized as the standardized between-group effect size, and a random-effects model was applied. Trial sequential analysis was performed to gauge the statistical reliability of the data in the cumulative meta-analysis.
RESULTS: We analyzed the participant data from 51 RCTs of hormone therapy (n = 41,821) and 16 RCTs of phytoestrogens (n = 1,191). The study found hormone therapy and phytoestrogens were associated with the alleviation of psychological symptoms in menopausal women, particularly in mood and anxiety. Trial sequential analysis confirmed the robustness of those findings, while some significant outcomes failed correction and require further validation. In addition, Tibolone showed a significant improvement in depression (SMD 0.93, 95% CI 0.62-1.24). Compared with perimenopausal women, post-menopausal women showed a greater beneficial effect of hormone therapy on sleep quality and of phytoestrogens on depression and anxiety.
CONCLUSION: Hormone therapy and phytoestrogens alleviated psychological symptoms in menopausal women, but their effects differed by symptoms. The therapeutic strategy should be adopted based on individual patient's specific characteristics.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, Identifier: CRD42024533658.
METHODS: We conducted a comprehensive search of multiple academic databases, including EMBASE, Cochrane Library, Web of Science, PubMed, and PsycINFO. The inclusion criteria were limited to randomized controlled trials (RCTs) published up to March 1, 2026. Hedge's g was utilized as the standardized between-group effect size, and a random-effects model was applied. Trial sequential analysis was performed to gauge the statistical reliability of the data in the cumulative meta-analysis.
RESULTS: We analyzed the participant data from 51 RCTs of hormone therapy (n = 41,821) and 16 RCTs of phytoestrogens (n = 1,191). The study found hormone therapy and phytoestrogens were associated with the alleviation of psychological symptoms in menopausal women, particularly in mood and anxiety. Trial sequential analysis confirmed the robustness of those findings, while some significant outcomes failed correction and require further validation. In addition, Tibolone showed a significant improvement in depression (SMD 0.93, 95% CI 0.62-1.24). Compared with perimenopausal women, post-menopausal women showed a greater beneficial effect of hormone therapy on sleep quality and of phytoestrogens on depression and anxiety.
CONCLUSION: Hormone therapy and phytoestrogens alleviated psychological symptoms in menopausal women, but their effects differed by symptoms. The therapeutic strategy should be adopted based on individual patient's specific characteristics.
SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, Identifier: CRD42024533658.