Several recent articles suggest that the burden of menopausal symptoms is greater than generally perceived.  About 80% of women experience vasomotor symptoms (VMS) – hot flashes and night sweats — as they transition into the menopause phase.  For most, the symptoms are manageable, but for a sizable subset of midlife women, these symptoms can negatively affect sleep, mood, cognitive abilities, sexual functioning, and overall quality of life.  While clinical guidelines suggest that menopausal vasomotor symptoms (VMS) typically last from 6 months to 2 years, new research suggests that for many women, the duration of symptoms is much longer.

For the management of menopausal symptoms, there are various pharmacologic options.  Traditionally hormone replacement therapy (HRT) would be considered; however, concerns regarding the long term use of hormone therapy has made this option less attractive.  Serotonergic antidepressants can be used to manage mood symptoms and anxiety; they may also help to relieve vasomotor symptoms and improve the quality of sleep. Other options for the management of vasomotor symptoms include gabapentin and clonidine.   Nonetheless, many perimenopausal women would prefer to avoid the use of medications and ask about nonpharmacologic strategies for the management of menopausal symptoms. 

In a single-blind randomized controlled trial, researchers evaluated the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention) in 71 perimenopausal or postmenopausal women seeking treatment for menopausal symptoms. CBT-Meno sessions included psychoeducation, and cognitive and behavioral strategies for the management of vasomotor symptoms, depression, anxiety, sleep difficulties, and sexual complaints.  

Assessments were conducted at baseline, 12 weeks post-baseline, and 3 months post-treatment.  The following instruments were used to assess the severity of symptoms: Hot Flash Related Daily Interference Scale (HFRDIS), Beck Depression Inventory (BDI-II), Greene Climacteric Scale (GCS for VMS and sexual complaints), Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI), and the Female Sexual Function Index (FSFI).

Compared to women in the waitlist group, women in the CBT-Meno group experienced greater improvements in vasomotor symptom interference, depressive symptoms, sleep difficulties, and sexual concerns. These improvements were significant even after controlling for menopausal staging and medication use. Furthermore, the gains were maintained at 3 months post-treatment.

This report also includes a VIDEO summarizing the findings of the study.  

Ruta Nonacs, MD PhD

Green SM, Donegan E, Frey BN, Fedorkow DM, Key BL, Streiner DL, McCabe RE  Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial.  Menopause. 2019 Sep;26(9):972-980.