(1) Background: The aim of this review was to evaluate the effects of manual therapy for musculoskeletal pain in menopausal women. (2) Methods: A comprehensive search of manuscripts published from inception until 29 February 2024 was conducted on PubMed, EBSCO Information Services (EBSCOhost), Physiotherapy Evidence Database (Pedro), Web of Science, Scientific Electronic Library Online (SciELO), Cochrane Central Register of Controlled Clinical Trials, and Scopus using Medical Subject Headings (MeSH) and free terms. Randomized controlled trials (RCT) investigating the effects of manual therapy for musculoskeletal pain in postmenopausal women were included. Articles published in non-English or non-Portuguese languages, case reports, expert opinions, dissertations, conference papers, and gray literature were excluded. Studies were screened for population, musculoskeletal pain, intervention, and pain outcome by two independent reviewers using an ad hoc data extraction form. (3) Results: A total of 5 RCTs (4 with high risk of bias and 1 with low risk of bias) were included (total sample = 245), addressing thumb carpometacarpal osteoarthritis, thoracic kyphosis, chronic neck and backache, knee osteoarthritis, and sternocostal joint pain. The combined results of these studies showed improved musculoskeletal pain in menopausal women; duration of the follow-up was between 4 weeks to 6 months. Conclusions: The majority of studies included in this systematic review were effective in reducing musculoskeletal pain in menopausal women. These results come mainly from studies with a high risk of bias with small sample sizes, and the most representative follow-up period was short-term. Therefore, the results of this systematic review should be interpreted with caution.

This study aimed to examine Portuguese osteopaths' perceptions, confidence and approaches to managing musculoskeletal conditions in menopausal women. A nationwide cross-sectional online survey was conducted among osteopaths registered with the Portuguese Central Administration of the Health System. A 36-item questionnaire, adapted from validated osteopathic instruments, assessed demographics, attitudes, clinical confidence, therapeutic strategies and barriers to menopause-related musculoskeletal management. The primary outcome measures were osteopaths' attitudes, confidence and therapeutic strategies regarding the relevance of menopause to musculoskeletal health. Data from 258 osteopaths were analyzed. Most respondents recognized menopause as relevant to musculoskeletal health (95%) and reported frequent clinical contact with menopausal women (58%). Mobilization, fascial and soft-tissue techniques were commonly used, whereas high-velocity low-amplitude thrusts were less frequent. Confidence in treatment and patient education was moderate to high, although 36% felt under-informed about menopause and musculoskeletal interactions. Lack of clinical guidelines (59%) and limited research availability (75%) were the main barriers. Most participants (81%) reported a need for advanced training in menopause management. Female osteopaths scored significantly higher than males in perceptions of menopause and musculoskeletal conditions (p = 0.015), clinical experience and therapeutic approaches (p = 0.001), and competences in osteopathic practice (p = 0.001). Portuguese osteopaths, particularly women, appear aware of and engaged in managing menopause-related musculoskeletal conditions, adapting manual therapy and educational approaches to patients' needs. However, limited knowledge and the absence of structured clinical guidance may hinder consistent, evidence-informed care. Targeted education and clinical protocols may strengthen osteopathic support for women's musculoskeletal health during midlife.