Menopausal symptoms in peri- and postmenopausal women: systematic review and meta-analysis of prevalence, incidence, comorbidities, and clinical outcomes

Introduction: The global epidemiology of menopausal symptoms among middle-aged and elderly women remains unclear. Methods: Data on prevalence, comorbidities, incidence and outcomes of menopausal symptoms published up until March 1st 2019 were searched in PubMed, Embase and Cochrane databases. We used a random-effects model to compute point estimates of prevalence for 24 types of menopausal symptoms. We narratively summarized the patterns of the comorbidities, incidence and outcomes of menopausal symptoms due to limited data. Results: A total of 239 studies (n{approx}2.5 million middle-aged and elderly women) from 56 countries and regions were included in the analysis. The global pooled prevalence analysis revealed that hot flashes (48%) and night sweats (30%) were highly prevalent, alongside psychological symptoms like insomnia (47%), irritability (46%), anxiety (39%), and depression (30%). Physical symptoms including joint aches/pain (50%), backache (47%), and tiredness (61%) were also commonly reported. Heat intolerance showed the highest prevalence (76%), while symptoms like urinary incontinence (24%) and poor appetite (8%) were less frequent. These findings highlight the diverse and widespread impact of menopause on women globally, with significant variations across symptom types. Africa showed the highest pooled prevalence across a series of symptoms, compared with other continents. We observed high prevalence in developing countries, especially for psychological and physical symptoms; significant intra-Asian variation in vasomotor symptoms; hypertension and obesity as the most common comorbidities; joint pain, urinary incontinence, and vasomotor symptoms as the most incident complaints; and positive associations with cardiovascular disease in the psychological (depression and insomnia) and physical (joint pain) domains. Conclusion: This study highlights the global burden of menopausal symptoms, with significant differences across continents. The findings call for more inclusive research on underrepresented groups (particularly in Africa) and further investigation into drivers of this marked global heterogeneity in prevalence of menopausal symptoms and their comorbidities, incidence and outcomes.