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Clinician Article

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



  • van Driel CM
  • Stuursma A
  • Schroevers MJ
  • Mourits MJ
  • de Bock GH
BJOG. 2019 Feb;126(3):330-339. doi: 10.1111/1471-0528.15153. Epub 2018 Mar 15. (Review)
PMID: 29542222
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7
  • Gynecology
    Relevance - 5/7
    Newsworthiness - 3/7

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.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

There are two factors that limit relevance and newsworthiness of these under-recognized findings. The first is that these BTs are not widely available for patients. The second is that the findings are short term and do not assess sexual functioning hindering their practical significance.

Gynecology

I don't feel the data support the conclusions; the interventions barely met statistical significance and as mentioned, there were no placebo arms to compare to.

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