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Cognitive behavioral therapy improves hot flashes, depression in menopause
Perimenopausal and postmenopausal women assigned to a cognitive behavioral therapy program targeting a broad range of common symptoms for 12 weeks reported an improvement in bothersome hot flashes, sleep problems, depressive symptoms and sexual concerns compared with women assigned to a waitlist, according to findings published in Menopause.
“Many women experience adverse symptoms during the menopausal transition, including hot flashes or night sweats, depression, sleep difficulties, anxiety, urogenital complaints and sexual concerns,” Sheryl Green, PhD, CPsych, a clinical and health psychologist with St. Joseph’s Healthcare and assistant professor in the department of psychiatry and behavioral neurosciences at McMaster University in Ontario, Canada, told Endocrine Today. “Pharmacological treatments (eg, hormone therapy, antidepressants) are effective but can have side effects or health risks, and effective nonpharmacological interventions are needed.”
Green and colleagues analyzed data from 71 perimenopausal or postmenopausal women who were seeking treatment for menopausal symptoms, including distressing vasomotor symptoms and at least mild depressive symptoms (mean age, 53 years). Researchers randomly assigned women to cognitive behavioral therapy for menopause (CBT-Meno; n = 37; 48.6% taking psychoactive medication) or to a waitlist (no intervention; n = 34; 35.3% taking psychoactive medication) for 12 weeks, with menopausal symptom assessments completed at baseline, 12 weeks and 3 months after treatment. Intervention was offered in 12 weekly, 2-hour sessions led by a PhD-level licensed clinical psychologist in a small-group format, reinforced with weekly between-session exercises. Participant progress was reviewed each week in the group setting.
Compared with women assigned to a waitlist, those who received CBT-Meno reported greater improvements in vasomotor symptom interference (P < .001) and a measure of how bothered women were by hot flashes (P = .04), as well as a greater improvement in depressive symptoms (P = .001), sleep difficulties (P = .001) and sexual concerns (P = .03).
At baseline, 70.3% of women assigned to CBT-Meno and 70.6% of women assigned to a waitlist met diagnostic criteria for a current depressive disorder. At 12 weeks after baseline, 32.4% of women in the CBT-Meno group and 61.8% of women assigned to the waitlist met criteria for a mood disorder (P = .01), according to researchers.
Results persisted after adjusting for menopause stage and medication use. Symptom improvements were maintained 3 months after treatment, according to researchers.
“This is one of the first studies demonstrating that a cognitive behavioral therapy program that directly targets a broad range of common menopausal symptoms, including depression, can be effective,” Green said. “Importantly, the program was effective whether or not women were also taking medication for their symptoms (eg, hormone therapy, antidepression or anxiety medication) and regardless of where they were in the menopausal transition (ie, perimenopause, postmenopause or surgically induced menopause). These findings suggest that the CBT-Meno program has broad clinical utility and can address the concerns of a range of women seeking treatment during menopause.”
Green said more research is needed to identify the mechanisms that help predict symptom reduction during treatment and to identify those who might be more likely to benefit. “Another future area of research will be to directly compare the relative effectiveness of a program like CBT-Meno and medication,” Green said. – by Regina Schaffer
For more information:
Sheryl M. Green, PhD, CPsych , can be reached at Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, 100 W. Fifth St., Hamilton, Ontario, L8N 3K7, Canada; email: sgreen@stjoes.ca.
Disclosures: The Ontario Mental Health Foundation funded this study. The authors report no relevant financial disclosures.