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 sizeable subset of midlife women, these symptoms can negatively affect sleep, mood, and quality of life.  While clinical guidelines suggest that menopausal vasomotor symptoms (VMS) typically last from 6 months to 2 years, recent research suggests that for many women, the duration of symptoms is much longer.

Several pharmacologic treatments for hot flashes, including hormone replacement therapy (HRT),  antidepressants, and gabapentin have been shown to reduce the frequency and intensity of hot flashes. However, some women prefer not to use HRT or other medications and seek alternative treatments, such as homeopathic or herbal remedies. Many of these alternative treatments have not yet been evaluated for safety or efficacy.

A while back, we wrote about a pilot study looking at the use of cognitive-behavioral therapy or CBT for the management of VMS in perimenopausal women.  Since that time, several large studies have documented the effectiveness of cognitive-behavioral therapy or CBT for the management of vasomotor symptoms in perimenopausal women.  CBT is a short-term, skills focused form of psychotherapy that concentrates on the interaction between thoughts, feelings, and behaviors. The goal of CBT is to teach women how to modify maladaptive behaviors and thoughts that may contribute to a particular problem.

Behaviors thought to contribute to vasomotor symptoms include low activity level, anxiety or stress, and the consumption of certain foods, such as foods that are spicy or contain caffeine. In addition, some women may make negative statements to themselves in response to a hot flash. These thoughts may increase a woman’s level of stress and may make the experience of the hot flash seem more severe.

Because VMS can be worsened by stress, these interventions also include psychoeducation and CBT strategies specifically designed to reduce stress in order to better manage hot flashes, night sweats, and sleep disruption.

Recognizing that women aged 45 to 54 years report more work-related stress than middle-aged men or women of any other age group, a team of researchers has developed a form of CBT which specifically addresses vasomotor symptoms in the work setting. MENOS@Work has examined the efficacy of an unguided, self-help CBT (SH-CBT) booklet specifically targeting the management of vasomotor symptoms in working women.

The self-help CBT booklet used in this study was adapted from the self-help booklet used in the MENOS2 trial.  The booklet contained four chapters, each with information, exercises and homework tasks, to be completed over 4 weeks. Chapters covered psychoeducation about menopause and vasomotor symptoms, stress management, breathing/relaxation, and learning cognitive and behavioral strategies to help manage VMS, stress, and sleep.

Women between the ages of 45 and 60 years, who reported having 10 or more problematic hot flashes or night sweats per week, were recruited and randomized to SH-CBT (n=60) or no treatment waitlist control (NTWC, n=64); 104 (84%) were assessed at 6 weeks and 102 (82%) at 20 weeks.

Compared to women receiving no treatment, women using the SH-CBT booklet experienced a recution in the severity of vaomonoror symtpoms at 6 weeks and at 20 weeks.   SH-CBT also significantly reduced the frequency of vasomotor symptoms, improved work and social adjustment, improved sleep, and reduced work impairment due to menopause-related presenteeism.

In some ways, it is interesting to see a study specifically targeting working women; however, it makes a great deal of sense given the recent studies measuring the impact of menopausal symptoms is by measuring their financial burden.  

Looking at health insurance claims from 60 self-insured Fortune 500 companies in the United States between 1999 and 2011 , researchers examined healthcare resource utilization, work productivity loss (disability + medically related absenteeism), and associated costs in women with and without menopausal symptoms.  Untreated menopause-associated vasomotor symptoms were associated with significant direct and indirect costs. The extra healthcare services added on average $1,336 per person per year compared to women without symptoms, and the indirect economic loss due to missed work was an extra $770 per woman per year.

While this study looked at work absenteeism, another study looked at presenteeism (the act of attending work while sick) among peri- and post-menopausal women.   Among employed women experiencing VMS, women with severe and moderate symptoms had presenteeism rates of 24.28% and 14.3%, versus 4.33% in women with mild symptoms.  This finding suggests that there may be additional losses in work productivity which are difficult to quantitate.

So if we do the math, that’s $2,116 per woman per year in additional direct and indirect costs.  Approximately 2 million American women become perimenopausal each year over the next decade. If we estimate that about 20% of those women will have moderate to severe vasomotor symptoms, untreated VMS will cost about $800 million per year.  

This study suggests that a relatively simple and inexpensive intervention — a brief, unguided SH-CBT booklet — could be a potentially effective management option for working women experiencing problematic vasomotor symptoms.

 

Ruta Nonacs, MD PhD

 

Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial.

Hardy C, Griffiths A, Norton S, Hunter MS.  Menopause. 2018 May;25(5):508-519.