Objective <p>Ensuring therapies align with women’s expectations can improve adherence and is crucial for the effectiveness and safety of menopausal treatments, especially in light of the concerns raised after the Women’s Health Initiative study. This systematic review aims to provide an overview of studies reporting data on women’s preferences for menopausal symptoms and treatments to better guide research and development of therapies.</p> Design <p>A systematic literature review was conducted on Medline (via Ovid) and Embase. This review used a structured search strategy to identify all quantitative stated-preference evidence on menopausal symptoms or treatments, including conjoint analysis, discrete choice experiment, best-worst scaling, or quantitative preference survey, published before April 2025. A manual search complemented the process. The quality of the included conjoint analyses was assessed using the Discrete Choice Experiments Reporting Checklist (DIRECT), and quantitative surveys were evaluated using the Consensus-Based Checklist for Reporting of Survey Studies (CROSS) checklist. The whole conduct of the systematic review was performed in adherence to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 statement (PROSPERO registration no. CRD42024614218).</p> Results <p>In total, 606 references were screened after removing duplicates, and 7 studies were included (4 conjoint analyses and 3 quantitative surveys). Five studies were conducted in the USA, one in Sweden, and another was conducted across five European countries and the USA. Two main topics were covered: (1) preferences regarding menopausal symptoms and treatments and (2) preferences toward local estrogen therapies. First, regarding preferences for menopausal treatment, the most important attribute categories were efficacy and long-term safety. Limited data were provided on other treatment characteristics. Studies reported that women are dissatisfied with their current therapeutic options. Second, two studies focused on local estrogen therapies and revealed a preference for vaginal tablets with applicators over other treatment modalities.</p> Conclusions <p>Research on menopausal treatment preferences is currently limited. Diverse study designs hampered the comparison and synthesis of the results. There is a need to conduct further conjoint analyses, such as discrete choice experiments (DCE), to better understand women’s preferences and improve patient management and treatment options.</p>