Women going through menopause may benefit from psychological interventions such as mindfulness, cognitive behavioural and behaviour-based therapies, to help manage their symptoms, finds a review of the available evidence published online in BJOG: An International Journal of Obstetrics and Gynaecology today.
Psychological treatments were shown to reduce the bother felt by women suffering from hot flushes and other menopausal symptoms such as, irritability, forgetfulness, joint pain and vaginal dryness. The findings apply to women who go through the menopause naturally and to those who go through premature menopause induced from treatments, such as chemotherapy.
These findings are particularly important for women for whom hormonal replacement therapy (HRT) may not be appropriate, such as those with a recent history of breast cancer, or for those who prefer a non-medicated approach to managing their symptoms.
Women who experience treatment-induced menopause often experience more severe and distressing menopausal symptoms, compared to women who experience menopause naturally. However, women with a history of breast cancer often do not choose to treat menopausal symptoms with HRT because evidence shows it can increase the risk of breast cancer recurrence.
Non-hormonal treatments to reduce hot flushes include lifestyle changes and psychological interventions, such as cognitive behavioural therapy (CBT), behavioural therapy (BT) and mindfulness-based therapies (MBT). This review analysed 12 studies on the effectiveness of these psychological interventions in reducing menopausal symptoms.
The findings reveal that women experienced less bother from hot flushes in the short term (less than 20 weeks) and the medium term (more than 20 weeks) when engaging in one of these psychological interventions. 74% of the women who received psychological therapies experienced less bother by hot flushes than the average woman who did not receive psychological therapy.
The frequency of hot flushes was not reduced, however. The authors suggest that the reduction of bother from hot flushes was greater than the frequency reduction because psychological interventions help to increase the coping skills of women, and thereby reduced the experienced bother caused by hot flushes.
In addition, the review found a lack of studies reporting on post-menopausal sexual functioning in women. The authors found only two of the 12 studies included reported on sexual outcomes.
Ms Catheleine van Driel, lead author of the review and PhD student at the Department of Obstetrics and Gynaecology, University of Groningen, The Netherlands, said:
“The findings of this review are encouraging and suggest that psychological interventions can be a safe and effective treatment for managing hot flushes during menopause. These treatments offer women a wider range of non-hormonal options to help them manage their menopausal symptoms.”
"This review also highlights the staggering lack of research on sexual functioning in women experiencing menopause. Around 79% of women with menopause experience sexual dysfunction and it is crucial that future research focuses on the effects of psychological interventions on sexual outcomes in women.”
Professor Mary Ann Lumsden, Consultant Gynaecologist and Senior Vice President at the Royal College of Obstetricians and Gynaecologists, said:
“This review considers evidence on the use of psychological interventions in reducing hot flushes and sexual dysfunction, which are two symptoms associated with menopause and can be debilitating for some women, particularly those with premature menopause. These results could help women make more informed decisions when it comes to their own treatment. Not every woman chooses or can have hormone replacement therapy and there is a real need for a safe and non-hormonal alternative treatments for managing menopausal symptoms.”
Mr Michael Marsh, Acting Editor-in-Chief of BJOG, said:
“This review is the first to focus solely on the effectiveness of psychological interventions on menopausal symptoms. The findings can support health providers recommending psychological interventions, particularly for women for whom hormone replacement therapy may not be advisable, for example, those women with a recent diagnosis of breast carcinoma”
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Public link to paper
Please cite this article as:
Van Driel CMG, Stuursma AS, Schroevers MJ, Mourits MJE, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis.
DOI: BJOG 2018; https://doi.org/10.1111/1471-0528.15153
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