OBJECTIVES: OBJECTIVES: Menopause may cause hot flashes, night sweats, mood swings and other symptoms.  Although hormone replacement therapy (HRT) is prescribed in severe cases, it is not suitable for all women, and increasing numbers of women refuse or discontinue HRT because of side effects, or real or perceived health risks. The use of complementary and alternative medicine (CAM) in menopause has been increasing, with women perceiving CAM as safer than HRT, but this is not supported by clinical evidence.  Biased decisions occur when an individual’s cognition is affected by factors that include attitudes, preferences, and moods. Cognitive bias affecting women’s perception of CAM can impact on decisions and ultimately CAM usage in the menopause. Yet, no validated questionnaire exists to measure attitudes towards CAM in menopause, in line with accepted patient reported outcome (PRO) methodology. Our aim was to develop a conceptual framework of attitudes to CAM in the menopause to inform the development of a PRO tool.  METHODS: A systematic review of the literature was conducted April-May 2010 using Medline and PsycINFO databases with the MESH terms attitude, menopause, complementary therapy, and perception.  A total of 122 papers were retrieved, with 91 excluded on the basis of abstract review and 13 after full-text analysis, resulting in 19 studies suitable for inclusion.  The papers were analysed in line with qualitative review methodology to produce a number of themes that were later grouped together to produce the dominant categories.  RESULTS: A conceptual framework was developed to reflect attitudes to CAM in the menopause. The dominant categories of perception related to menopausal symptoms, optimism about CAM, pessimism about HRT, cure-control with CAM, and relationship with physician.  CONCLUSIONS: This research has identified key domains relevant to women’s attitudes towards CAM in the menopause, from which a relevant PRO instrument could be developed.