Menopausal symptoms, including sleep disturbances, anxiety, and mood changes often persist for years and negatively affect women’s quality of life. Acceptance and Commitment Therapy (ACT) targets mental health and has demonstrated efficacy across a range of mental health conditions. Self-guided online formats may provide an accessible modality to deliver ACT-based interventions during the menopausal transition.

This RCT evaluated the feasibility, acceptability, and preliminary outcomes of a 4-week self-guided online ACT program for perimenopausal and menopausal women. Forty-nine participants (M = 49.8 years) were randomly assigned to an ACT intervention or WLC. Feasibility and acceptability were the primary outcomes. Primary clinical outcomes were anxiety and depressive symptoms, while secondary outcomes included psychological flexibility and menopause-related quality of life. Analyses were conducted using both intention-to-treat and per-protocol approaches.

Recruitment and adherence supported feasibility: 84% completed post-intervention assessments, and 48% completed all modules. Satisfaction ratings were favorable, particularly for perceived usefulness and program quality. Intention-to-treat analyses showed no significant group effects on primary clinical outcomes. However, per-protocol analyses revealed significant improvements in anxiety (partial η ²  = 0.03) and psychological flexibility (partial η ²  = 0.02). No significant effects were observed for depressive symptoms or quality of life.

A brief self-guided ACT program is feasible and acceptable for midlife women, with preliminary evidence suggesting improvements in anxiety and psychological flexibility among completers. These findings support the potential role of psychological flexibility as a relevant therapeutic target in this population. Further research with larger samples is needed to confirm efficacy and optimize engagement.