The menopausal transition significantly impacts a women’s health and quality of life due to hormonal fluctuations, particularly estrogen. Although hormonal therapies are considered the most effective for managing menopause symptoms - particularly vasomotor - some women cannot use them due to medical contraindications or personal choice (1, 2). Dietary interventions show promise for managing menopausal symptoms, but inconsistent evidence limits their inclusion in clinical guidelines (3). Clinicians need comprehensive knowledge of evidence-based, non-hormonal alternatives to help patients manage menopausal symptoms (1). This systematic review aims to evaluate the effectiveness of dietary interventions in managing vasomotor, psychological, and cognitive symptoms in menopausal women. A systematic review of 15 randomized controlled trials (RCTs), involving 1,952 participants, was conducted following Cochrane methods and PRISMA guidelines (PROSPERO: CRD42024610754). Searches were conducted in CINAHL, Cochrane, Embase, PubMed, and PsycINFO. Eligible studies included women aged 40-65 experiencing menopause, perimenopause, or postmenopausal symptoms, or reporting relevant outcomes even if "menopause" was not explicitly stated. These studies assessed dietary interventions, including whole food-based changes and structured dietary patterns targeting vasomotor, psychological, and cognitive outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Interventions included soy, low-fat vegan, flaxseed, lacto-ovo-vegetarian, reduced-calorie, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), DASH and intermittent fasting diets. Meta-analysis of six trials revealed that soy-based reduced vasomotor symptoms (SMD = –0.50; 95% CI [–0.76 to –0.25], I² = 84%), particularly hot flash severity and frequency (SMD = –0.59; 95% CI [–0.88 to –0.31], I² = 69%), and improved overall psychological wellbeing (SMD = –0.25; 95% CI [–0.50, –0.01], I² = 0%). Narrative synthesis of remaining studies showed that dietary interventions, including flaxseed had inconsistent effects on vasomotor symptoms. Small improvements in depressive symptoms were observed with DASH and lacto-ovo-vegetarian diets. The MIND diet showed cognitive benefits, while soy-based interventions and intermittent fasting showed minimal benefit. Overall, limitations include high heterogeneity, short intervention durations (6–16 weeks), and reliance on self-reported outcomes. Whilst soy-based dietary interventions show promise in alleviating menopausal symptomology, further research is needed to evaluate effects of whole dietary patterns and long-term adherence benefits especially in women seeking complementary or natural alternative therapies.