Purpose <p>Menstrual cycle symptoms, such as discomfort, fatigue, and mood swings, are prevalent among women and can significantly diminish quality of life. Many women employ non-clinical, self-management strategies to mitigate symptoms, yet the supporting evidence for these strategies is equivocal. This systematic review sought to identify, evaluate and synthesise existing evidence from randomised controlled trials (RCTs) for non-clinical, self-management strategies for menstrual cycle symptoms.</p> Methods <p>A systematic literature search was performed in PubMed, Scopus, Web of Science, and Cochrane Library in March 2025 and updated in December 2025. The review adhered to PRISMA principles. Eligible studies comprised double- and triple-blinded RCTs published from 2000 onwards that examined non-clinical, self-management strategies including physical activity, nutrition, heat treatment, sleep, stress management, education, and over-the-counter medications for alleviating menstrual cycle symptoms in females aged 18 years and older. The JBI Critical Appraisal Checklist for RCTs was utilised for quality assessment.</p> Results <p>Of the 13,208 screened records, 39 were included in the final synthesis, comprising 42 treatment interventions and 3,806 participants. This provided categories of physical activity strategies (<i>n</i> = 5), nutritional strategies (<i>n</i> = 26), other self-management strategies (<i>n</i> = 7), and combined strategies (<i>n</i> = 4). Physical activity, especially yoga, consistently showed improvements in menstrual discomfort, exhaustion, and mood. The most researched strategies were nutritional, including vitamin and mineral supplementation, and demonstrated varied yet predominantly positive results. Some of the other self-management strategies, including low light therapy, listening to music and drawing, also reduced total PMS scores. Some of the combined strategies, investigating two or more strategies in combination, reduced menstrual cycle symptoms and menstrual pain intensity. Methodological shortcomings were prevalent, including small sample sizes and inconsistent outcome measurements.</p> Conclusions <p>Data from 39 RCTs indicate that strategies including physical activity, nutrition, other self-management strategies and combined strategies may effectively alleviate menstrual cycle symptoms. There are limitations in the evidence base due to limited research and methodological inconsistencies, and publication bias may have skewed the results to being predominantly positive. Future research ought to evaluate common strategies that are yet to be investigated using blinded RCTs, and the long-term efficacy of existing self-management strategies.</p> Trial registration <p> CRD420250612937.</p>