Mass General Hospital

Harvard Medical School

CBT is Effective for Menopausal Vasomotor Symptoms

Cognitive Behavioral Therapy or CBT is a type of psychotherapy that has been shown to be effective for the treatment of depression, anxiety, and sleep problems.  Recently, several randomized controlled trials have demonstrated that CBT is effective for managing vasomotor symptoms in menopausal women.

The first study to test the effectiveness of CBT for vasomotor symptoms was MENOS1, a randomized controlled trial (RCT) which included women with breast cancer who developed vasomotor symptoms as a result of their treatment.  96 women were randomly assigned to group CBT (n=47) or usual care (n=49).  Group CBT consisted of weekly 90 minute session for 6 weeks, and included psycho-education, paced breathing, and cognitive and behavioral strategies for managing vasomotor symptoms. At 9 weeks, women receiving group CBT had significantly reduced symptom ratings as compared to the women receiving usual care; these improvements were maintained at 26 weeks.

The MENOS 2 study included peri- and post-menopausal women with problematic vasomotor symptoms (10 or more hot flashes or night sweats per week).  In this randomized controlled trial, 140 women were assigned to group CBT (n=48), self-help CBT (n=47), or no treatment (n=45). After 6 weeks, women receiving group and self-help CBT both had significantly reduced symptom ratings at 6 weeks compared to women in the no treatment control group.  In both groups there were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning at 26 weeks for the women who received group CBT.

In order to determine which women are most likely to benefit from CBT, researchers performed a secondary analysis of the 140 women included in the MENOS 2 trial.   CBT was effective for reducing complaints of vasomotor symptoms regardless of age, body mass index, menopause status, or psychological factors at baseline.  The greatest improvement at 6 weeks was related to fully reading the manual and completing most homework assignments.  The researchers determined that the positive effects of CBT on vasomotor symptoms were mediated by changes in cognitions (beliefs about coping with and control of hot flushes, beliefs about night sweats and sleep) but not by changes in mood.

Given the efficacy and safety of this intervention, it should be offered to all women who are suffering from vasomotor symptoms related to menopause or breast cancer treatment.  The problem, however, is finding treaters who are familiar with CBT and its use for menopausal symptoms.  The MENOS 3 study – now in progress – attempts to specifically address this issue:

MENOS 3 aims to make CBT interventions more widely accessible to women who are unable to attend groups or other meetings with us, e.g. women who live too far away/outside London or they are unable to attend meetings due to family, work or other commitments.

In MENOS 3, women are offered a Self-Help CBT booklet which includes weekly exercises, homework tasks and daily diaries that they complete over a four-week period. We have used this Self-Help intervention in the past and we found that this intervention significantly improved women’s experiences of their symptoms (Ayers, Smith, Hellier, Mann & Hunter, 2012). In a recent study using a self help booklet and brief telephone support was a beneficial way to deliver the CBT resulting in improvement in the experience of hot flushes (Stefanopoulou &  Hunter,  Maturitas, 2014).

This research group published a 4 week self-help guide which is available on Amazon.   They are also planning to publish a manual specifically for clinicians interesting in using group CBT to manage menopausal symptoms.

Ruta Nonacs, MD PhD

Ayers B, Smith M, Hellier J, Mann E, Hunter MS. Effectiveness of group and self-help cognitive behaviour therapy to reduce problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause. 2012; 19(7):749-759.

Hunter MS, Smith M. Managing Hot Flushes and Night Sweats: A Cognitive Behavioural Self-help Guide to Menopause. London: Routledge, 2013.

Mann E, Smith MJ, Hellier J, Balabanovic JA, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial.  Lancet Oncol. 2012; 13(3):309-18.

Norton S, Chilcot J, Hunter MS.  Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats): moderators and mediators of treatment effects.  Menopause. 2014 Jun;21(6):574-8.

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