Mind-body therapies for sleep disturbances, depression, and anxiety in menopausal women: a systematic review and meta-analysis of randomized controlled trials.

The short version

This meta-analysis of 18 randomized controlled trials with 1,572 perimenopausal and postmenopausal women explored whether mind-body therapies improve three common menopausal complaints: poor sleep, depressed mood and anxiety. Mind-body therapies are practices that work through the links between brain, mind, body and behavior, and aim to build coping skills and self-care; here they included yoga, mindfulness programs, Pilates, Qigong (a Chinese movement and breathing practice), music therapy, dance and Reiki (a hands-on energy practice). Ovarian aging during menopause alters brain chemistry and is linked to sleep disturbance, low mood and anxiety, and hormone therapy carries risks such as breast cancer, stroke and clotting, which is why the authors looked at non-drug options. Searches of four databases through October 2025 identified 18 trials from nine countries. Participants were midlife and older women without other underlying medical conditions. Programs ran from 4 to 24 weeks, with sessions of 15 to 60 minutes, for example weekly mindfulness classes with home practice, yoga two to three times a week, or twice-daily music listening. Control groups received usual care, health education or nothing. Sleep, depression and anxiety were scored with standard questionnaires, and the authors pooled the results as standardized mean differences, where larger negative numbers mean greater improvement. Sleep quality improved with a pooled effect of -0.91 (a large benefit) across 13 trials, depression with -0.79 (moderate to large) across 12 trials, and anxiety with -1.13 (large) across 9 trials. Music therapy had the biggest sleep effect (-1.29), and dance had the biggest effects on depression (-1.61) and anxiety (-1.41), though each rests on one or two trials. Yoga and Qigong gave smaller but steady sleep gains (-0.70 and -0.56). Mindfulness reduced depression (-0.58) and anxiety (-0.84), Pilates reduced anxiety (-1.08), and Reiki, tested in one trial, reduced depression (-0.81). Yoga's effects on depression and anxiety were not statistically significant. Studies from Asia reported larger sleep effects than studies elsewhere (-1.59 vs -0.35), and statistical tests found no sign of publication bias, while removing studies one at a time left the results stable. The authors suggest that different mind-body therapies may suit different symptoms, but the evidence has clear limits. Results varied widely between trials (heterogeneity above 85%), outcomes were self-reported by participants who knew their group, fourteen of 18 trials had some risk-of-bias concerns, and several therapies were represented by a single trial. Trials with some concerns showed larger effects than low-risk trials. The authors call for larger preregistered multicenter trials with objective measures and long-term follow-up before guidelines adopt these therapies.

Key findings

• A meta-analysis (a study that combines results from many trials) of 18 randomized trials with 1,572 women around or after menopause found that mind-body therapies were linked to better sleep quality, with a pooled standardized mean difference (SMD, a unit-free measure of effect size) of -0.91, a large benefit.
• The same analysis found lower depression scores (SMD -0.79 across 12 trials) and lower anxiety scores (SMD -1.13 across 9 trials) compared with usual care or no intervention.
• Different therapies performed differently: music therapy had the largest sleep effect (SMD -1.29), dance the largest depression and anxiety effects (-1.61 and -1.41), while yoga's effects on depression and anxiety were not statistically significant; several therapies rested on only one or two trials.
• Results varied widely between trials (heterogeneity, I2, of 85 to 92%), 14 of 18 trials had some risk-of-bias concerns, and the outcomes were self-reported, so the authors call for larger, better-controlled trials with long-term follow-up.

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