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

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 126; no. 3; pp. 330 - 339
• Main Authors: Driel, CM, Stuursma, A, Schroevers, MJ, Mourits, MJ, Bock, GH
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.02.2019; John Wiley and Sons Inc
• Subjects: Behavior modification; Behavior Therapy - methods; Behavioural therapy; Breast cancer; Breast Neoplasms; Cancer Survivors; Cognitive ability; Cognitive Behavioral Therapy - methods; cognitive behavioural therapy; Cognitive therapy; Contraindications, Drug; Data processing; Estrogen Replacement Therapy; Evidence-based medicine; Female; Hormone replacement therapy; Hot Flashes - psychology; Hot Flashes - therapy; Humans; Menopause; Menopause - physiology; Menopause - psychology; Meta-analysis; mindfulness; Mindfulness - methods; Reviews; Sexual Dysfunction, Physiological - psychology; Sexual Dysfunction, Physiological - therapy; sexual functioning; Systematic Review; Systematic Reviews; vasomotor symptoms; sexual functioning; menopause; vasomotor symptoms; Behavioural therapy; mindfulness; cognitive behavioural therapy
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.15153

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