Mindfulness and cognitive behavioural therapy (CBT) could be effective in treating non-physiological symptoms of the menopause, such as brain fog and mood problems, according to a new study.
Researchers from University College London (UCL) analysed data from over 3,000 menopausal women and found that all psychosocial treatments improved quality of life, regardless of the type of intervention.
In line with recent NICE drafted updated guideline recommendations, CBT was found to be effective at treating menopausal symptoms, including anxiety and depression.
The findings, published in the Journal of Affective Disorders, provide evidence that non-medical interventions could offer GPs and healthcare workers a range of alternative therapies to successfully treat menopausal symptoms.
Menopause is now a prioritised topic in public health. Menopausal symptoms can have a significant impact on women’s well-being and quality of life. Currently, most treatment options focus on hormone replacement therapy (HRT), aiming to treat the physical symptoms of menopause, such as hot flushes. In November 2023, NICE drafted updated guideline recommendations which stated that CBT should be considered alongside or as an alternative to HRT.
To examine the impact of alternative therapies, the researchers conducted a meta-analysis of 30 studies involving 3,501 women who were going through the menopause in 14 countries, including the UK, USA, Iran, Australia, and China. The studies examined how several different kinds of therapies affected menopausal symptoms, including mood and cognition, as well as affecting overall quality of life.
Ten of the studies analysed the impact of CBT interventions on menopausal symptoms. The interventions included educating women about the psychological symptoms of the menopause alongside cognitive and behavioural strategies, relaxation techniques, and symptom monitoring.
Nine studies looked at the impact of Mindfulness-Based Interventions (MBI), which aimed to focus on the present experiences of women and foster a non-judgemental understanding of symptoms. The remaining 11 studies examined Acceptance and Commitment Therapy (ACT), group counselling, marital support, health promotion coaching, and emotional freedom techniques.
In all the studies, menopausal symptoms were measured using standardised, internationally recognised self-report instruments, including the Patient Health Questionnaire PHQ-9 and the GAD7 questionnaire. These surveys consider factors such as a lack of interest in activities, sleep issues, feelings of low mood and anxiety.
The analysis showed that all psychosocial interventions implemented across the studies effectively improved quality of life, regardless of their type.
Menopausal women treated with CBT or MBI experienced statistically significant improvements in symptoms of anxiety and depression when compared to women who had no treatment or other forms of non-medical intervention, which equated to small to medium changes in everyday life. CBT and group-based psychosocial interventions also effectively reduced memory and concentration difficulties.
Compared to other forms of therapy, CBT was found to offer the most cost-effective alternative intervention for the management of menopausal symptoms, since it requires a shorter course of treatment, usually around 12 hours in total.
Professor Aimee Spector, lead author of the study from UCL, said: ‘Most studies of menopause symptom management focus on hormonal replacement therapy and physiological symptoms. This restricts treatment options for women who are concerned about the risks of hormone replacement therapy and overlooks the well-being of women with non-physiological symptoms, such as brain fog and mood problems, which are highly prevalent.’
Zishi Li, a master’s graduate at UCL and co-author, added: ‘This study provides encouraging evidence to support the use of psychosocial interventions for managing non-physiological menopausal symptoms. This is in line with the NICE Menopause guidelines, updated in 2023 and currently in the consultation phase, which promote CBT as a treatment option.’
The researchers hope the study illuminates the value of therapy for menopausal symptoms, offering healthcare professionals alternative treatment options alongside conventional medical approaches.
