{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:16:28Z","timestamp":1783664188082,"version":"3.55.0"},"reference-count":110,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011498","name":"Shaoxing Bureau of Science and Technology","doi-asserted-by":"publisher","award":["No. 2025A14005"],"award-info":[{"award-number":["No. 2025A14005"]}],"id":[{"id":"10.13039\/501100011498","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>g<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We analyzed the participant data from 51 RCTs of hormone therapy (\n                      <jats:italic>n<\/jats:italic>\n                      = 41,821) and 16 RCTs of phytoestrogens (\n                      <jats:italic>n<\/jats:italic>\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\u20131.24). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , Identifier: CRD42024533658.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1855845","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:39:34Z","timestamp":1783661974000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of hormone therapy and phytoestrogens on the psychological symptoms of menopausal women: a systematic review, meta-analysis, and trial sequential analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Mengna","family":"Shou","sequence":"first","affiliation":[{"name":"Department of Women's Health, Shaoxing Maternity and Child Healthcare Hospital, Maternity and Child Healthcare Affiliated Hospital, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengfei","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Shaoxing Seventh People's Hospital, Affiliated Mental Health Center of Shaoxing University","place":["Shaoxing, Zhejiang, China"]},{"name":"Shaoxing Key Laboratory of Diagnosis and Treatment Psychiatic Disorders","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Women's Health, Shaoxing Maternity and Child Healthcare Hospital, Maternity and Child Healthcare Affiliated Hospital, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiying","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junwei","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Blood Transfusion, Affiliated Hospital of Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenchao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Cixi People's Hospital, Wenzhou Medical University","place":["Ningbo, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zimu","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Women's Health, Shaoxing Maternity and Child Healthcare Hospital, Maternity and Child Healthcare Affiliated Hospital, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Medicine, Shaoxing University","place":["Shaoxing, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e72612","DOI":"10.1136\/bmj-2022-072612","article-title":"Management of perimenopausal and menopausal symptoms","volume":"382","author":"Duralde","year":"2023","journal-title":"BMJ."},{"key":"B2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.maturitas.2022.07.014","article-title":"Psychological and social health outcomes of physical activity around menopause: a scoping review of research","volume":"164","author":"Hybholt","year":"2022","journal-title":"Maturitas."},{"key":"B3","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1002\/wps.20319","article-title":"Does menopausal transition really influence mental health? 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