Foot Reflexology for Managing Menopausal Symptoms in Women: A Systematic Review and Meta-Analysis

Background: Menopause can cause a variety of unpleasant symptoms, such as hot flashes, night sweats, mood swings, and sleep disturbances. Although hormone replacement therapy is frequently utilized to help manage these issues, long-term use of this treatment approach carries certain potential risks. Objective: This study aims to examine the effects of foot reflexology, a type of massage therapy that focuses on applying pressure to specific reflex points on the feet, on menopausal symptoms (primary outcome) and anxiety, fatigue, and depression (secondary outcomes). Methods: A systematic electronic search for relevant studies was conducted in PubMed, Scopus, Web of Science, the Cochrane Library, SID, Magiran, and Google Scholar until September 21, 2023. In addition to the electronic database searches, manual searches were also performed. This manual search process included scanning the reference lists of the included studies and handsearching key journals in the topic area. The risk of bias was assessed via the RoB 2.0 and ROBIN-I tools. Heterogeneity was evaluated via the I² statistic, and in cases of high heterogeneity, a random effects model was used instead of a fixed effects model. Subgroup analyses were performed for the primary outcome on the basis of menopausal symptoms (vasomotor/psychosocial/physical/sexual). The certainty of evidence was assessed via the GRADE approach. Results: A total of 186 articles were retrieved from database searches, and an additional 9 articles were identified through manual searches. Ultimately, 8 studies were included in the systematic review, and 6 studies were included in the meta-analysis. The meta-analysis revealed that foot reflexology had a significant effect on menopausal symptoms, with an average reduction of 3.41 points on the associated measurement scale (95% confidence interval (CI): -4.81 to -2.01; low-certainty evidence). It also significantly reduced fatigue, with an average reduction of 5.84 points (95% CI: - 11.61 to -0.06; very low-certainty evidence). However, there was no significant impact on anxiety (SMD: -0.89, 95% CI: -1.96--0.18; very low-certainty evidence) or depression (SMD: -0.73, 95% CI: -1.80--0.34; very low-certainty evidence) compared with the control group. Conclusion: The present study demonstrated that the use of foot reflexology as a nonhormonal and noninvasive intervention led to a significant reduction in menopausal symptoms and fatigue among women. Given the limited number of studies available in this area and the low to very low-level certainty of the evidence for the desired outcomes, further research with appropriate methodologies to ensure accurate conclusions in this field is strongly recommended.