Hormone replacement…therapy? Review says mindfulness, meditation and cognitive behavioral therapy can help menopausal women overcome the symptoms of the change
Meditation, yoga and talking therapies can be used alongside HRT to ease menopausal symptoms, a review of research suggests.
The alternative therapies have proven effective in relieving associated mood symptoms, memory and concentration problems in women going through menopause.
While hormone replacement therapy (HRT) remains the gold standard, doctors should consider suggesting it alongside pills and patches, experts say.
They could also be offered as an alternative to women who refuse to take the drugs, they suggest.
Researchers from University College London conducted an analysis of 30 studies involving 3,501 women from 14 countries, including the UK and US.
A review of research found that the alternative therapies were effective in relieving related mood symptoms, memory and concentration problems in women going through menopause. Although hormone replacement therapy (HRT) remains the gold standard, doctors should consider suggesting it in addition to pills and patches. They could also be offered as an alternative to women who refuse to take the drugs, they suggest
They found that mindfulness and cognitive behavioral therapy (CBT) can provide some relief, ranging from a small to moderate effect on symptoms.
Ten of the studies examined the impact of cognitive behavioral therapy on menopausal symptoms, while nine looked at mindfulness, a form of meditation in which people focus on being intensely aware of what they are observing and feeling at that moment.
Other studies looked at a range of interventions, including acceptance-based interventions, group counseling and marital support.
Women’s symptoms were measured using internationally recognized questionnaires, and included a lack of interest in doing things, sleep problems, low mood and anxiety.
The findings showed that women’s low mood ‘benefited significantly’ from cognitive behavioral therapy and mindfulness.
Data from 11 studies showed a small to moderate effect when it came to improving anxiety, the researchers said, meaning some relief from symptoms, although they wouldn’t be completely gone.
Individually, CBT had a small effect on anxiety, while mindfulness had a medium effect, according to the findings published in the Journal of Affective Disorders.
When it came to depression, cognitive behavioral therapy had a small to medium effect, while mindfulness had a small effect.
Overall, both interventions had a moderate to large effect on improving quality of life.
A small improvement in memory and concentration was found, although the researchers acknowledged that the data in this area was weak, while it was also unclear how long the effects might last in women.
Lead author, Professor Aimee Spector, said there is some evidence that mindfulness can be offered to women alongside HRT, adding that some NHS trusts are already offering it for depression.
She said: ‘The message we want to be very clear about is that we are in no way suggesting this as an alternative or recommending this in place of HRT.
‘My personal experience with HRT is extremely positive.
“I think what we know is that HRT doesn’t reach everyone and not everyone wants it, and not everyone qualifies for it, so we have to consider other things.”
The use of therapies could benefit groups of women who do not recommend HRT, such as breast cancer survivors, she said.
Certain ethnic groups, such as Southeast Asian and Afro-Caribbean populations, have lower uptake, while socially disadvantaged groups are often denied access to HRT.
She added: ‘So I think our message is that holistic interventions can provide options for people who may not be eligible, don’t want HRT, possibly in addition to HRT, and they can support the psychosocial aspects as well as the biological .’
About three in 10 women going through menopause experience a first episode of depression, anxiety is “very common” and half of women report tension, nervousness or irritability, they found.
It comes after draft guidance from the National Institute for Health and Care Excellence (Nice) recommended the use of talk therapy for menopause, while women need to better understand the risks and benefits of HRT.
HRT replaces the hormones oestrogen, progestin or both and can be administered using gels, creams, pessaries, tablets or sprays.
According to the NHS website, the risk of developing serious side effects from HRT is very low, although this may lead to a small increase in the risk of breast cancer.
Dr. Louise Newson, a GP and menopause specialist, said it was not surprising that the new study had found some improvements after mindfulness and cognitive behavioral therapy, but it is ‘important to remember that menopause is due to a hormone deficiency that affects the whole body ‘.
She said this deficiency causes many women to experience physical and psychological symptoms, while long-term health risks associated with low hormones include an increased risk of heart disease, dementia, diabetes, clinical depression, schizophrenia, osteoporosis and early death.
She said: ‘The first-line treatment of perimenopause and menopause for most women is to replace the missing hormones by prescribing the right dose and type of HRT.’