Factors associated with menopause symptoms: a systematic review and meta-analysis

Journal article : Review

Background
Menopause, marked by hormonal decline and menstrual cessation, is associated with various symptoms. Socio-demographic and behavioural factors may influence symptomtype and severity. Understanding these associations can inform better symptom management.
Objectives
To identify factors associated with the presence and severity of menopausal symptoms through systematic review and meta-analysis.
Search Strategy
We searched Medline, Embase, CINAHL, and Cochrane for studies on demographic, behavioural, or health factors linked to vasomotor, vaginal dryness, and joint symptoms in women aged 40–60.
Selection Criteria
Studies reporting odds ratios or raw numbers for symptom presence or severity were included.
Data Collection and Analysis
Studies were combined for meta-analysis, reporting odds ratios and 95% confidence intervals. Quality assessment was performed to quantify the risk of bias.
Results
Of 9,228 screened articles, 61 were meta-analysed. Compared with White women, Black women had higher odds of vasomotor symptom presence (OR 1.65,1.41-1.94) and severity (OR 1.91,1.10-3.29), and vaginal dryness presence (OR 1.27,1.10-1.47), while Asian had lower vasomotor symptom presence and severity (OR 0.40,0.22-0.72; OR 0.55,0.53-0.56). Higher education (OR 1.31,1.09–1.56), high income (OR 1.41,1.01–1.97), and depression (OR 2.36,1.51–3.70) were associated with increased presence of vasomotor symptoms. Smoking and obesity were associated with both presence (OR 1.63,1.30-2.04 and 1.35,1.02-1.78) and severity (OR 1.56,1.07-2.27 and 1.42,1.11-1.83) of vasomotor symptoms.
Conclusion
Socio-demographic and behavioural factors, including ethnicity, education, income, smoking, obesity, and depression, influence menopausal symptoms, highlighting the need for personalised care.
Funding
National Institute for Health and Care Research, Research for Patient Benefit (Reference NIHR204901).
Registration
CRD42023459154

Authors: Hoang, J; Halliday, K; Allen, D; Mtika, W; Tranter, E

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: BJOG: An International Journal of Obstetrics and Gynaecology
• Publication date: 2026-05-06
• Acceptance date: 2026-04-22
• DOI: 10.1111/1471-0528.70257
• EISSN: 1471-0528
• ISSN: 1470-0328
• Language: English
• Keywords: meta-analysis; menopause; symptoms; disparities; systematic review
• Subtype: Review