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Mind Over Menopause Symptoms - Cognitive-Behavioral Therapy Helps

By February 20, 2012

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Menopause is a natural life passage for all women - but it may come sooner, or feel stronger, for breast cancer patients. When a premenopausal woman starts chemo, she may not know it, but the drugs may send her into medical menopause at top speed. She may start having classic symptoms of "The Change," before she's ready! Menstrual periods may cease (sometimes this is temporary), and mood swings, trouble sleeping, vaginal dryness, low libido, and fatigue may set in. Most us expect the terrible twins of menopause --  hot flashes and night sweats -- but when these symptoms rudely tag along with side effects of chemo and hormonal therapies, it can all seem just too much! Women who are already in menopause may start having increased hot flash and fatigue symptoms during chemo or Tamoxifen therapy - how unfair is that?

How nice it would be, if we could just wish it away - the cancer, the treatments, and those pesky hot flashes. Well, I would take classes in "Wishing Therapy" if that would do the job, but it seems there is something more effective.  Cognitive-Behavioral Therapy (CBT) does help tame the symptoms of menopause in women who have been treated for breast cancer. Two studies have just been published by a group of researchers in Great Britain on the success of CBT on menopausal symptoms. The studies are called MENOS 1 and MENOS 2 and both were led by Professor Myra Hunter from the Institute of Psychiatry at King's College London. Cognitive-Behavioral Therapy is a safe, psychotherapeutic technique that employs a support group setting, talk therapy, self-discovery, and changes in behavior.  There are no drugs to take, most importantly - no hormones involved in CBT. That's very important for those of us who were diagnosed with estrogen-positive breast cancer - we can't take hormone replacement therapy to make up for lower estrogen levels.

In each study, participants were divided into groups. Some groups were given professional instruction in CBT, another group was given a self-help manual for CBT, and another group was wait-listed (no therapy given).  All participants were evaluated at the end of therapy and six months later. Women who had any Cognitive-Behavioral Therapy - regardless of how they received it - reported benefits such as: less intense hot flashes, lower stress levels, more optimistic view, better self-esteem, improved sleep and more positive perception of their body image.  The women who had no CBT reported no improvements in their menopausal symptoms.

Cognitive-Behavioral Therapy could be used along with a healthy diet and a regular dose of exercise to speed recovery from breast cancer treatments or from natural menopause. Just keep in mind that as with any psychotherapeutic program, you must be willing to take a good look at your own habits, make some changes, and stick to your new, healthy resolutions. Having some accountability and even a buddy involved might boost your odds of making CBT work in your favor, and put your hot flashes on ice!

Source: Ayers B, Mann E, Hunter MS. A randomised controlled trial of cognitive-behavioural therapy for women with problematic menopausal hot flushes: MENOS 2 trial protocol. BMJ Open 2011;1:e000047. doi:10.1136/bmjopen-2010- 000047

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February 22, 2012 at 9:06 am
(1) Roberta Butler says:

I was diagnosed with breast cancer just as I was starting menopause. I ended up needing a mastectomy after my results from my lumpectomy were reported. So for me, it is hard to say whether the hot flashes I experienced were stronger than they would have been once I started Tamoxiphen. What I remember is that until on Tamoxiphen my hot flashes seemed to be dissapating and I seemed to be only experiencing them later in the day. Once on Tamoxiphen, I had them any time and frequently. It was hard to get used to. In the summer I sweat from morning until night when the temperature went close to the 80 degree mark. That was unbearable. However, I have been on Tamoxiphen for three years now and other than at night sometimes, I am no longer feeling hot flashes. So for those who have just started Tamoxiphen, know it will get better in time!
What I don’t understand is how behavioural therapy can help. Menopause whether it comes naturally or not, is a real physical change in your body. It is not in your mind. Your hormones are dropping and sometimes drastically. I can see that it might help you change your attitude if it is bad. I am sure that applying cool cloths to your neck or having a cool bath before bedtime might help or wearing light PJ’s if you wear them. These are all helpful behaviours I guess. Wishing you all the best.

February 23, 2012 at 8:03 pm
(2) Carolynn says:

I too question how CBT can help actual hot flashes, and I teach the stuff in my work everyday as a counselour!

CBT is what I call “a ten dollar word” for changing one’s feelings by changing one’s thinking. I doubt very much that my hot flashes which returned with the start of Tamoxifen (I was post-menopausal when diagnosed) have anything to do with my feelings. Perhaps the beneficial effect of CBT in these studies came from realizing there are things one can do such as wearing layers of clothing to peel off, turning down the thermostat especially at night, or following good health practices for weight management as I believe obesity raises not only the recurrence rate of cancer but also frequency of hot flashes, as does alcohol intake. It may help one to take actions/change behaviours to decrease hot flashes. CBT can change despairing self-talk.. I doubt it can change hot flashes.

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