Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis

Abstract

Background: During menopause women experience vasomotor and psychosexual symptoms that cannot entirely be alleviated with hormone replacement therapy (HRT). Besides, HRT is contraindicated after breast cancer.

Objectives: To review the evidence on the effectiveness of psychological interventions in reducing symptoms associated with menopause in natural or treatment-induced menopausal women.

Search strategy: Medline/Pubmed, PsycINFO, EMBASE and AMED were searched until June 2017.

Selection criteria: Randomised controlled trials (RCTs) concerning natural or treatment-induced menopause, investigating mindfulness or (cognitive-)behaviour-based therapy were selected. Main outcomes were frequency of hot flushes, hot flush bother experienced, other menopausal symptoms and sexual functioning.

Data collection and analysis: Study selection and data extraction were performed by two independent researchers. A meta-analysis was performed to calculate the standardised mean difference (SMD).

Main results: Twelve RCTs were included. Short-term (<20 weeks) effects of psychological interventions in comparison to no treatment or control were observed for hot flush bother (SMD -0.54, 95% CI -0.74 to -0.35, P < 0.001, I² = 18%) and menopausal symptoms (SMD -0.34, 95% CI -0.52 to -0.15, P < 0.001, I² = 0%). Medium-term (≥20 weeks) effects were observed for hot flush bother (SMD -0.38, 95% CI -0.58 to -0.18, P < 0.001, I² = 16%). [Correction added on 9 July 2018, after first online publication: there were miscalculations of the mean end point scores for hot flush bother and these have been corrected in the preceding two sentences.] In the subgroup treatment-induced menopause, consisting of exclusively breast cancer populations, as well as in the subgroup natural menopause, hot flush bother was reduced by psychological interventions. Too few studies reported on sexual functioning to perform a meta-analysis.

Conclusions: Psychological interventions reduced hot flush bother in the short and medium-term and menopausal symptoms in the short-term. These results are especially relevant for breast cancer survivors in whom HRT is contraindicated. There was a lack of studies reporting on the influence on sexual functioning.

Tweetable abstract: Systematic review: psychological interventions reduce bother by hot flushes in the short- and medium-term.

Keywords: Behavioural therapy; cognitive behavioural therapy; menopause; mindfulness; sexual functioning; vasomotor symptoms.

Figure 1

Flow diagram of study selection.

Figure 2

Forrest plot of hot flush frequency, hot flush bother, menopausal symptoms and sexual functioning for both short‐term (<20 weeks) and medium‐term (≥20 weeks) results, split for mean and median outcomes. CI, confidence interval; IV, inverse variance; SD, standard deviation; Std, standardized. [Correction added on 9 July 2018, after first online publication: Figure 2 was incorrect and has been replaced in this version.]