Menopause, characterized by declining ovarian function and cessation of menstruation, often leads to neuropsychological symptoms due to fluctuating sex hormones. Anxiety and depression are prevalent during this period, with a reported 12.62% and 25.99% probability, respectively, potentially three times higher than pre-menopause. These psychological challenges significantly impact the physical and mental well-being of menopausal women, affecting their quality of life. Psychological interventions, particularly mindfulness-based interventions (MBIs), are increasingly used as a first-line treatment due to their fewer adverse effects and better long-term results compared to pharmacotherapy. MBIs encompass a range of mindfulness-centered interventions, such as MBSR, MBCT, DBT, ACT, and mindfulness yoga, aiming to facilitate a non-judgmental focus on the present moment. While several studies have explored MBIs' effectiveness in menopausal women, the existing evidence is inconsistent regarding their impact on anxiety, depression, stress, and mindfulness. This systematic review and meta-analysis aimed to comprehensively integrate available evidence to clarify the effectiveness of MBIs in this population.

Existing research on the use of MBIs in menopausal women shows mixed results. Some studies demonstrate significant reductions in anxiety, depression, and stress scores, while others report no statistically significant effects. Similarly, findings on the impact of MBIs on mindfulness scores are inconsistent, with some studies showing significant enhancement and others showing no effect. This lack of consistency highlights the need for a systematic review to integrate the available evidence and clarify the effectiveness of MBIs in improving various psychological outcomes among menopausal women.

This systematic review and meta-analysis followed PRISMA guidelines and the Cochrane Handbook. The PROSPERO Registry (CRD42022319349) registered the study. A comprehensive search of PubMed, Embase, Web of Science, the Cochrane Library, CNKI, and Wanfang databases (before March 13, 2022) was conducted. Inclusion criteria were based on PICOS principles, including menopausal women as participants (P), MBIs as interventions (I), different interventions as controls (C), anxiety, depression, stress, or mindfulness as outcomes (O), and randomized controlled trials (RCTs) as study designs (S). Exclusion criteria included repeated publications, inaccessible full texts, incomplete data, and non-English or non-Chinese publications. Two independent reviewers screened titles and abstracts, followed by full-text evaluation of potentially eligible studies. The Cochrane Systematic Review Manual's risk of bias assessment tool evaluated the quality of included studies. RevMan 5.4 performed statistical analysis, using a fixed-effects model if heterogeneity was low (p ≥ 0.10 and I² < 50%) and a random-effects model otherwise. Standard mean difference (SMD) with 95% CI was the effect size indicator. Subgroup analyses explored continent and intervention length as moderators. Publication bias assessment was attempted if ≥10 studies were included in a meta-analysis.

The initial search yielded 374 articles, with 13 RCTs ultimately included in the meta-analysis, involving 1138 menopausal women. The included studies exhibited variations in sample size (27-197 participants), intervention types, intervention duration (8-12 weeks), control group types (wait-list, routine healthcare, etc.), and outcome measures. Risk of bias assessment revealed varied levels across studies. Meta-analysis results indicated that MBIs significantly reduced stress scores (SMD = −0.84, 95% CI: −1.64 to −0.05, p = 0.04), representing a high effect size. However, no significant effects were observed for anxiety, depression, or mindfulness scores. Subgroup analysis revealed significant differences in the effect of MBIs on anxiety based on continent (significant in Asia, not in Europe). Intervention length (8 vs 12 weeks) showed no significant difference for anxiety or depression, but a 16-week intervention showed significant improvement in mindfulness compared to an 8-week intervention.

The significant reduction in stress scores observed in this meta-analysis suggests that MBIs may be an effective intervention for managing stress in menopausal women. However, the lack of significant effects on anxiety, depression, and mindfulness requires further investigation. The heterogeneity among the included studies, stemming from variations in sample size, intervention types, duration, control groups, outcome measures, and cultural background, likely contributed to the inconsistent findings. While MBIs are theoretically posited to improve emotional regulation and reduce stress reactivity, their effectiveness may be influenced by factors such as participant compliance, cultural context, and the duration of the intervention. The differences in the effect size observed between Asian and European studies might be attributed to cross-cultural variations in the understanding and practice of mindfulness. The relatively short intervention durations in most studies might also limit the effectiveness in changing deeply ingrained thought patterns and emotional responses.

This meta-analysis demonstrates that MBIs are effective in reducing stress in menopausal women but provides inconclusive evidence regarding their impact on anxiety, depression, and mindfulness. Future research should focus on larger, high-quality studies with standardized protocols to address the limitations identified in this review. Investigating the influence of cultural factors and exploring longer intervention durations could yield further insights into MBIs' effectiveness in menopausal women.

This meta-analysis has several limitations. The included studies varied in methodological rigor, particularly in terms of randomization and blinding procedures. The relatively small number of included studies limited the power of subgroup analyses and the ability to assess publication bias comprehensively. Heterogeneity among studies, due to differences in intervention types, duration, and outcome measures, influenced the interpretation of results. The lack of a standardized measurement instrument for each outcome might also impact the results' generalizability.