Mindfulness, cognitive behavioural and behaviour‐based therapy for natural and treatment‐induced menopausal symptoms: A systematic review and meta‐analysis Original paper

What was studied?

This systematic review and meta-analysis investigated the effectiveness of psychological interventions, specifically mindfulness-based therapy (MBT), cognitive behavioral therapy (CBT), and behavior therapy (BT), in reducing vasomotor symptoms in women experiencing natural or treatment-induced menopause. The primary outcomes measured were the frequency and severity of hot flashes (referred to as “hot flush bother”), overall menopausal symptoms, and sexual functioning. The study included randomized controlled trials (RCTs) that assessed the impact of these psychological therapies compared to control groups, which typically consisted of waiting lists or general lifestyle advice.

Who was studied?

The review included data from twelve randomized controlled trials involving a total of 1,016 women. The participants were divided into two groups: those experiencing natural menopause and those with treatment-induced menopause, including survivors of breast cancer. These women were aged between 40 and 65 and had experienced hot flashes or other menopausal symptoms such as night sweats, vaginal discomfort, and sexual dysfunction. The women studied had varying baseline health conditions, including some who had undergone breast cancer treatments that induced early menopause.

Most important findings

The results of the meta-analysis revealed a significant reduction in hot flash bother, both in the short-term (less than 20 weeks) and medium-term (20 weeks or more), following psychological interventions. The standard mean difference (SMD) for hot flash bother was -0.54 for the short-term and -0.38 for the medium-term, indicating moderate reductions in the severity of hot flashes. The interventions also led to a reduction in overall menopausal symptoms (SMD = -0.34, short-term), but no significant effect was observed on hot flash frequency. The psychological therapies were particularly effective in the breast cancer survivor subgroup, who experience more severe and longer-lasting hot flashes than women undergoing natural menopause. No adverse effects were reported from these therapies, and sexual functioning was not significantly impacted by the interventions, though the data on sexual outcomes were limited.

Key implications

The findings suggest that mindfulness-based therapy, cognitive behavioral therapy, and behavior therapy can effectively reduce the severity and bother of hot flashes and overall menopausal symptoms, especially in women who cannot use hormone replacement therapy (HRT), such as breast cancer survivors. These therapies offer a promising non-hormonal treatment option and may improve the quality of life for women experiencing menopause, particularly for those with treatment-induced menopause. Although sexual functioning was not significantly improved in the studies, further research targeting this outcome could provide valuable insights. Clinicians should consider offering these psychological interventions to women seeking relief from menopausal symptoms, particularly those contraindicated for HRT. However, further studies with longer follow-up periods and a focus on sexual outcomes are needed to strengthen the evidence base.