The purpose of this systemic review was to assess the efficacy of Er-xian decoction (EXD), a formula of Chinese medicine, in relieving menopausal symptoms. The Chinese electronic databases include VIP Information, CBMdisc, and CNKI. The English electronic databases include AMED, CINAHL, Cochrane Library, and Medline. RCTs using EXD as a main intervention were included in the study selection. The quality of studies was assessed by Jadad scale and the criteria outlined in the Cochrane reviewers’ handbook. Two independent reviewers were responsible for data extraction and assessment. Discrepancies were rectified by referring to the original articles. The efficacy of EXD treatment for menopausal symptoms was evaluated by meta-analysis. There were 154 articles retrieved according to the search strategy, and 677 participants involved in the five studies that satisfied the selection criteria. Meta-analysis indicated that administration of EXD significantly relieved at least one menopausal symptom when compared to the control group at a 95% CI. The curing effect of EXD with all symptoms relieved was significant as compared with the control groups. The results also indicated that the efficacy of EXD was better than the other non-menopausal hormone therapy, while there was no significant difference between the EXD and menopausal hormone therapy groups. The EXD is effective in treating menopausal symptoms. However, owing to the low quality of the investigated studies, more RCTs are needed before evidence-based recommendation regarding the effectiveness of EXD in the management of menopausal symptoms can be provided.