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Multiple studies have been performed to evaluate the effectiveness of Cognitive Behavioral Therapy ("CBT") for various menopausal symptoms. While the studies have been structured differently and have looked at different outcomes, including CBT’s effect on the number of hot flashes and night sweats ("vasomotor symptoms" or “VMS”), severity of VMS, mood, sleep, quality of life, sexual function, etc., overall the study results are positive vs the control groups used in the studies. Different CBT treatment modalities also have been studied, including group, individual, self guided, telephone, and internet-based CBT therapy.

 

The following is a summary of the primary studies that have been conducted over the past several years. We begin with two summary articles describing the overall data that were authored by Hello Therapeutics' Chief Medical Officer, Dr. Myra Hunter.

Review: Cognitive Behavioral Therapy for Menopausal Symptoms

Author: Dr. Myra Hunter

Summary: A summary article that describes cognitive behavioral therapy (CBT) for women with problematic menopausal symptoms, and provides the evidence from clinical trials of women going through the menopause, women with breast cancer treatment-induced symptoms, and women with problematic symptoms in a work context. The CBT focus is primarily on vasomotor symptoms, but it also targets stress, low mood and sleep problems.

Excerpt: "CBT is a brief therapy (four to six sessions) that is theory- and evidence-based; it is acceptable to women and effectively reduces the impact of VMS, improves sleep and has benefits to quality of life. VMS frequency is also reduced significantly in some trials but not others. CBT has been found to be consistently effective when delivered in groups, self-help book and on-line formats (with or without additional support). The MENOS 1 and MENOS 2 CBT protocols are recommended for the treatment of VMS by the North American Menopause Society (2015); CBT has been recommended for the treatment of anxiety and depression for women during the menopause transition and post menopause (NICE, 2015); and telephone CBT has been shown to be an effective treatment for insomnia.”

Link to Article

Editorial: Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms?

Authored by: British Journal of Health Psychology (2021)

Overview: This editorial describes the development and evaluation of a cognitive behavioural intervention for women with problematic VMS, and it outlines the series of clinical trials which have shown the effectiveness of the CBT delivered in various formats to women, and men, in different contexts.

Link to Editorial

MENOS 1: CBT for menopausal symptoms following breast cancer treatment

Lead Researcher: Dr. Myra Hunter

Modality: Group Therapy; N=96

Summary from the Article: “Group CBT significantly reduced HFNS problem rating at 9 weeks after randomisation compared with usual care (mean difference and improvements were maintained at 26 weeks).”

Conclusion from the Article: “Group CBT seems to be a safe and effective treatment for women who have problematic HFNS after breast cancer treatment with additional benefits to mood, sleep, and quality of life. The treatment could be incorporated into breast cancer survivorship  programmes and delivered by trained breast cancer nurses.”

Source: ‘Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial.’  Mann et al, The Lancet Oncology, 2012

Link to Article

MENOS 1 Qualitative Review: Women’s experiences of Group Cognitive Behaviour Therapy for hot flushes and night sweats following breast cancer treatment: An interpretative phenomenological analysis

Modality: In-depth semi-structured interviews with trial participants to explore how they experienced the intervention and its effects. N=20

Summary from the Article: “The analysis revealed four superordinate themes: Making sense of symptom change; new ways of coping and regaining control; tailoring the treatment to meet individual needs and resources; and valuing the group context, social support and social comparisons. All the women found Group CBT improved their ability to cope with their HF/NS, while also developing an appreciation of the role of psychological factors in their symptom experience. Through the knowledge and understanding acquired, women developed a more accepting stance to their symptoms, as well as gaining a ‘sense of control’.”

Conclusion from the Article: ““The results are consistent with the main RCT outcomes which showed that Group CBT led to a clinically significant reduction in ‘HF/NS problem rating’ relative to ‘treatment as usual’, as well as improvements in mood and physical and social functioning. The results complement the trial outcomes by illuminating women’s experience of different components of the intervention and highlighting possible mechanisms of change.”

Source: ‘Women’s experiences of Group Cognitive Behaviour Therapy for hot flushes and night sweats following breast cancer treatment: An interpretative phenomenological analysis.’ Balabanovic et al, Maturitas, 2012

Link to Review

MENOS 2: The MENOS 2 study compared the effectiveness of group CBT, self-help CBT, to a no treatment control (NTC) in well women (i.e. women without breast cancer).

Lead Researcher: Dr. Myra Hunter

Modality: Group, Self Help, No Treatment:  N= 140

Summary from the Article: “Group and self-help CBT both significantly reduced HF/NS problem rating at 6 weeks and at 26 weeks. . Group and self-help CBT significantly reduced night sweat frequency at 6 and 26 weeks. There were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning for group CBT at 26.”

Conclusions from the Article: These results suggest that CBT delivered in group or self-help format is an effective treatment option for women during the menopause transition and post-menopause with problematic HF/NS.”

Source: ‘Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial.  Ayers et al. Menopause: The Journal of the North American Menopause Society, 2012.

Link to Abstract

MENOS@WORK: The aim of the study was to examine the efficacy of an unguided, self-help cognitive behavior therapy (SH-CBT) booklet on hot flash and night sweat (HFNS) problem rating, delivered in a work setting

Lead Researcher: Dr. Myra Hunter

Modality: Unguided self help; N=124

Summary from the Article: “SH-CBT significantly reduced HFNS problem rating at 6 weeks and at 20 weeks. SH-CBT also significantly reduced HFNS frequency, improved work and social adjustment; sleep, menopause beliefs, HFNS beliefs/behaviors at 6 and 20 weeks; improved wellbeing and somatic symptoms and reduced work impairment due to menopause-related presenteeism at 20 weeks, compared with the NTWC (no treatment waitlist control).”

Source: ‘Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial.’ Hardy et al. Menopause: The Journal of the North American Menopause Society, 2018.

Link to Abstract

MENOS4: The aim of the study is to investigate whether group CBT, delivered by breast care nurses (BCNs), can reduce the impact of HFNS.

Lead Researcher: Dr. Myra Hunter

Modality: Group CBT or Usual Care; N= 130

Summary from the Article: “We found a 46% reduction in the mean HFNS problem rating score from randomisation to 26 weeks in the CBT arm and a 15% reduction in the UC (usual care) arm.... Secondary outcomes, including frequency of HFNS, sleep, anxiety and depression all improved significantly.”

Conclusion from the Article: “Our results suggest that specialist nurses can be trained to deliver CBT effectively to alleviate troublesome menopausal hot flushes in women following breast cancer in the NHS setting.”

Source: ‘Effectiveness of nurse-led group CBT for hot flushes and night sweats in women with breast cancer: Results of the MENOS4 randomised controlled trial.’  Fenlon et al. Psycho-Oncology. 2020.

Link to Paper

Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial

Lead Researcher: Dr. Vera Atema based on the underlying work of Dr. Hunter

Modality: Internet Based CBT self guided/or with therapist support; N=254

The Dutch Study: Evaluated the effect of Internet-based cognitive behavioral therapy (iCBT), with or without therapist support, on the perceived impact of hot flushes and night sweats (HF/NS) and overall levels of menopausal symptoms (primary outcomes), sleep quality, HF/NS frequency, sexual functioning, psychological distress, and health-related quality of life in breast cancer survivors with treatment-induced menopausal symptoms.

Summary from the Article: “Compared with the control group, the guided and self-managed iCBT groups reported a significant decrease in the perceived impact of HF/NS and improvement in sleep quality.  The guided group also reported significant improvement in overall levels of menopausal symptoms and NS frequency. At longer-term follow-up (24 weeks), the effects remained significant.”

Conclusion from the Article: “iCBT, with or without therapist support, has clinically significant, salutary effects on the perceived impact and frequency of HF/NS, overall levels of menopausal symptoms, and sleep quality.”

Source: ‘Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial.’ Atema et al.  Journal of Clinical Oncology, 2019,

Link to Abstract

CBT-Meno: Evaluates the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention).

Lead Researcher: Dr. Sheryl M. Green

Modality: Group CBT; N=71

Summary from the Article: “There were significantly greater improvements in CBT-Meno compared with waitlist in vasomotor symptom interference, depressive symptoms and sexual concerns (These results were found even when controlling for menopausal staging and medication use. Gains were maintained at 3 months post-treatment.”

Conclusion from the Article: “CBT-Meno was particularly effective in improving self-reported vasomotor symptoms, depressive symptoms, sleep difficulties, and sexual concerns.”

Source: ‘Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial’ Green et al. Menopause: The Journal of the North American Menopause Society, 2019

Link to Abstract

MSFlash4: To evaluate the treatment efficacy of telephone-based cognitive behavioral therapy for insomnia (CBT-I) versus menopause education control (MEC).

Lead Researcher: Dr. Susan M. McCurry, PhD

Modality: Individual telephone sessions; N=106

Summary from the Article: “At 8 and 24 weeks, 70% and 84% of women in CBT-I had ISI scores in the no-insomnia range compared to 24% and 43% of MEC women, respectively. Women in CBT-I also had greater improvements in diary-reported sleep latency, wake time, and sleep efficiency. There were no differences between groups in daily hot flash frequency, but hot flash interference was significantly decreased at 8 and 24 weeks for CBT-I compared to MEC.”

Conclusions from the Article: Telephone delivered CBT-I was effective for improving sleep in peri- and postmenopausal women with insomnia and hot flashes. Results support further development and testing of centralized CBT-I programs for treatment of midlife insomnia in Women.”

Source: ‘Telephone Delivered Cognitive-Behavior Therapy for Insomnia in Midlife Women with Vasomotor Symptoms: An MsFLASH Randomized Trial.’ Mc.Curry et al. JAMA Intern Medicine, 2017

Link to Summary

MSFlash Pooled Analysis: The Menopause Strategies: Finding Lasting Answers for Symptoms and Health Trials

Description: The MSFlash network conducted three randomized clinical trials (RCTs) testing six interventions (escitalopram 10 to 20 mg/d; yoga/aerobic exercise; 1.8 g/domega-3-fatty acids; oral 17-beta-estradiol 0.5 mg/d; venlafaxine XR 75 mg/d; and cognitive behavioral therapy for insomnia (CBT-I), and also collected menopause-related quality of life (QOL) measures. A fourth RCT assessed an intervention for insomnia symptoms among women with VMS. We describe these seven interventions’ effects on menopause-related QOL relative to control in women with VMS.

Modality: Varied, N=1005

Summary from the Article: “Significant improvements in total Menopause-specific Quality of Life from baseline were observed with estradiol, escitalopram, CBT-I, and yoga, with mean decreases of 0.3 to 0.5 points relative to control. The largest improvement in the vasomotor subscale was observed with estradiol (1.2 points), with more modest but significant effects seen with escitalopram, yoga, and CBT-I. Significant improvements in the psychosocial subscale were observed for escitalopram, venlafaxine, and CBT-I. For the physical subscale, the greatest improvement was observed for CBT-I and exercise, whereas for the sexual subscale, the greatest improvement was observed for CBT-I, with yoga and estradiol demonstrating smaller effects.”

Conclusions from the Article: “These results suggest that for menopause-related QOL, women have a variety of treatment strategies to choose from and can select an approach based on most bothersome symptoms and individual preferences.”

Source: ‘Effects of pharmacologic and nonpharmacologic interventions on menopause-related quality of life: a pooled analysis of individual participant data from four MsFLASH trials ‘. Diem et al. Menopause: The Journal of the North American Menopause Society, 2020

Link to Study Summary

We turn to robust clinical studies for inspiration.
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