Background : Menopause and its associated decline in oestrogen is linked to chronic conditions like cardiovascular disease and osteoporosis, that may be difficult to disentangle from the effects of ageing. Further, post-menopausal women exhibit increased cerebrovascular disease risk, linked to declines in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR), yet the direct understanding of the impact of the female menopause on cerebrovascular function is unclear. The aim of this systematic review and meta-analysis was to examine the available literature investigating CBF and CVR in pre- compared with post-menopausal women. Methods : Five databases were searched for cross-sectional studies assessing CBF or CVR in pre-and postmenopausal women. Meta-analysis examined the effect of menopausal status on middle cerebral artery velocity (MCAv), and GRADE assessed evidence certainty. Results : Nine studies (n=504) included cerebrovascular outcomes. Six studies (n=239) reported negligible differences in MCAv between pre- and post-menopausal women [2.11cm/s (95% CI: -8.94 to 4.73, p=0.54)], but with a “low” certainty of evidence. CBF was lower in post-menopausal women when MCAv was expressed as cerebrovascular conductance. CVR was lower in post- compared with pre-menopausal women in two of three studies, but high-quality evidence is lacking. Across outcomes, study methodology and reporting criteria for menopause were inconsistent.  Conclusions : MCAv was similar in post- compared with pre-menopausal women. Methodological differences in characterizing menopause, and inconsistent reporting of CBF outcomes make current comparisons difficult. Comprehensive assessments of cerebrovascular function of the intra- and extracranial arteries to determine the physiological implications of menopause on cerebral with healthy ageing is warranted.