Effectiveness of digital interventions for menopausal symptoms and cardiometabolic outcomes among women undergoing the menopausal transition: A systematic review and meta-analyses.

The menopausal transition is characterised by bothersome menopausal symptoms and increased cardiometabolic risks, yet access to evidence-based non-pharmacological support remains limited. Digital health interventions offer an accessible and scalable approach to symptom management, but their effectiveness remains uncertain. This systematic review and meta-analysis evaluated the effectiveness of digital health interventions in women undergoing the menopausal transition. Eleven databases were searched from inception to August 2025. Eighteen randomised controlled trials involving 1926 participants were included. Random-effects meta-analyses using the Hartung-Knapp-Sidik-Jonkman adjustment were performed and two reviewers independently assessed methodological quality and certainty of evidence. Digital health interventions reduced hot-flash frequency (standardised mean difference - 0.30, 95% confidence interval - 0.57 to -0.03), improved sleep quality (mean difference - 3.38, 95% confidence interval - 5.56 to -1.19) and reduced waist circumference (mean difference - 2.23 cm, 95% confidence interval - 3.37 to -1.09). For depressive symptoms, the pooled estimate favoured digital health interventions but did not reach statistical significance (standardised mean difference - 1.30, 95% confidence interval - 2.67 to 0.07) and was not robust in sensitivity analysis excluding high-risk-of-bias studies. No significant pooled effects were observed for night sweats, body weight, body fat percentage, body mass index, blood pressure, lipid profiles, heart rate or glycaemic outcomes. Certainty of evidence was moderate for hot-flash frequency, very low for sleep quality and low for depressive symptoms and waist circumference, while evidence for broader cardiometabolic benefits remained limited. Future trials should evaluate longer-duration interventions in clearly defined menopausal populations using standardised and objective outcome measures where feasible.