• Kristen E Ullman, Susan Diem, Mary L Forte, Kristine Ensrud, Catherine Sowerby, Nicholas Zerzan, Maylen Anthony, Adrienne Landsteiner, Nancy Greer, Mary Butler, Timothy J Wilt, and Elisheva R Danan.
• Center for Care Delivery and Outcomes Research, VA Health Care System, Minneapolis, Minnesota (K.E.U., C.S., N.Z., M.A., A.L., N.G.).
• Ann. Intern. Med. 2024 Oct 1; 177 (10): 138913991389-1399.

BackgroundWomen seeking nonhormonal interventions for vulvovaginal, urinary, and sexual symptoms associated with genitourinary syndrome of menopause (GSM) may seek out complementary and alternative medicine or therapies (CAMs).PurposeTo summarize published evidence of CAMs for GSM.Data SourcesOvid MEDLINE, EMBASE, and CINAHL from inception through 11 December 2023.Study SelectionRandomized controlled trials (RCTs) 8 weeks or more in duration that evaluated the effectiveness or harms of CAMs for postmenopausal women with GSM and reported 1 or more outcomes of interest, with sample sizes of 20 or more participants randomly assigned per group.Data ExtractionData were abstracted by 1 reviewer and verified by a second.Data SynthesisAn evidence map approach was used to organize and describe trials. Studies were organized by type of intervention, with narrative summaries for population, study characteristics, interventions, and outcomes. Fifty-seven trials were identified that investigated 39 unique interventions. Studies were typically small (n < 200), and most were done in Iran (k = 24) or other parts of Asia (k = 9). Few trials evaluated similar combinations of populations, interventions, comparators, or outcomes. Most studies (k = 44) examined natural products (that is, herbal or botanical supplements and vitamins), whereas fewer reported on mind and body practices (k = 6) or educational programs (k = 7). Most studies reported 1 or 2 GSM symptoms, mainly sexual (k = 44) or vulvovaginal (k = 30). Tools used to measure outcomes varied widely. Most trials reported on adverse events (k = 33).LimitationsOnly English-language studies were used. Effect estimates, risk of bias, and certainty of evidence were not assessed.ConclusionThere is a large and heterogeneous literature of CAM interventions for GSM. Trials were small, and few were done in North America. Standardized population, intervention, comparator, and outcomes reporting in future RCTs are needed.Primary Funding SourceAgency for Healthcare Research and Quality and Patient-Centered Outcomes Research Institute. (PROSPERO: CRD42023400684).

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