Hormonal changes associated with menopause increase the risk of hypertension. Post-exercise hypotension (PEH) is an important tool in the prevention and management of hypertension; however, menopause may alter this response. The aim of this systematic review and meta-analysis (PROSPERO CRD42023297557) was to evaluate the effect of exercise modalities (aerobic, AE; resistance, RE; and combined exercise, CE: AE+RE) on PEH in women, according to their menopausal status (premenopausal or postmenopausal). We searched controlled trials in PubMed, Web of Science, EBSCO, and Science Direct published between 1990 and March 2023. Inclusion criteria were normotensive, pre- and hypertensive, pre- and postmenopausal women who performed an exercise session compared with a control session and reported systolic (SBP) and diastolic (DBP) blood pressure (BP) for at least 30 minutes after the sessions. Methodological quality was assessed using the PEDro scale. Standardized mean differences (Hedge's g) and their 95% confidence intervals (CI) were calculated, and Q-test and z-test were conducted to assess differences between moderators. 41 trials with 718 women (474 menopausal) were included. Overall, we found with moderate evidence that SBP and DBP decreased significantly after exercise session (SBP g -0.69, 95%CI -0.87 to -0.51; DBP g -0.31, 95%CI -0.47 to -0.14), with no difference between premenopausal and postmenopausal women. Regarding exercise modalities, RE is more effective than AE and CE in lowering BP in women regardless of menopausal status. In conclusion, women's menopausal status does not influence the magnitude of PEH, and the best modality to reduce BP in women seems to be RE.

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