OBJECTIVES: Menopausal symptoms associated with reduction in the levels of oestrogen can be alleviated through the use of pharmacotherapy.  A systematic review and meta-analysis were conducted to compare the relative efficacy/safety of conjugated oestrogens (CE) 0.45mg/bazedoxifene (BZA) 20mg with other available treatments for management of postmenopausal symptoms (PMS). METHODS: MEDLINE, EMBASE and Cochrane databases were systematically searched (December 2014) to identify randomised controlled trials evaluating CE/BZA, tibolone, oestradiol (E2)/(micronised) progestin combinations and placebo in this indication. Eligible trials included women with an intact uterus and at least 12 months since last menses. Vasomotor symptoms (VMS, number of “moderate/severe” hot flushes [HF]) at 4 weeks and the rate of uterine bleeding (UB) were analysed via Bayesian network meta-analysis (NMA) with results presented as weighted mean difference (WMD) and hazard ratios (HR), respectively, along with 95% credible intervals (Crls). A direct pairwise meta-analysis was conducted on the number of “moderate/severe” HF at 12 weeks and severity at 4 and 12 weeks, expressed as WMD and 95% confidence intervals (CIs). Data were validated by Abacus International. RESULTS: Twenty-two studies met the inclusion criteria for the meta-analysis. CE/BZA significantly lowered the daily number of “moderate/severe” HF compared with placebo at both 4 weeks (WMD:-3.10 [95% CrI:-4.34, -1.88]) and 12 weeks (WMD:-3.21 [95% CI:-4.30, -2.12; p<0.05]). The HF severity score was significantly lower in patients treated with CE/BZA versus placebo at both 4 weeks (WMD:-0.39 [95% CI:-0.58, -0.20]; p<0.05) and 12 weeks (WMD:-0.66 [95% CI:‑0.89, ‑0.44]; p<0.001). The rate of UB with CE/BZA was not significantly different versus placebo (HR: 0.81 [95% CrI: 0.30, 2.20]) and was significantly less than tibolone 2.5mg (HR: 0.28 [95% CrI: 0.08, 0.93]).  CONCLUSIONS: CE/BZA demonstrates a favourable risk-benefit profile for management of PMS. CE/BZA treated patients reported a significant improvement in VMS with no increased risk of UB versus placebo.