Hot flashes are a common and distressing symptom of menopause, affecting approximately 60-70 % of women undergoing the menopausal transition. Several pharmacologic treatments for hot flashes, including hormone replacement therapy (HRT) and some antidepressants, have been shown to reduce the frequency and intensity of hot flashes. However, some women prefer not to use HRT or antidepressants and seek alternative treatments, such as homeopathic or herbal remedies. Many of these alternative treatments have not yet been evaluated for safety or efficacy.
In a recent paper, Allen and colleagues report on the success of cognitive behavioral therapy (CBT) for the treatment of menopausal hot flashes in two women. CBT is a short-term, skills focused form of psychotherapy that concentrates on the interaction between thoughts, feelings, and behaviors. The goal of CBT is to teach people how to modify maladaptive behaviors and thoughts that may contribute to a problem, such as hot flashes. Behaviors thought to contribute to hot flashes include low activity level, anxiety or stress, and the consumption of certain foods, such as foods that are spicy or contain caffeine. In addition, some women may make negative statements to themselves in response to a hot flash. These thoughts may increase a woman’s level of stress and may make the experience of the hot flash seem more severe.
Using a modified version of CBT, Allen and colleagues attempted to teach women how to identify triggers for hot flashes and to help them modify their behaviors to decrease the likelihood of a hot flash occurring. They taught women relaxation and assertiveness strategies to help manage stress, and to cope with hot flashes when they did occur. They also attempted to teach women how to identify negative thoughts that occur in response to hot flashes (e.g., “I can’t take this anymore!”) and to replace them with more adaptive ways of thinking (e.g.. “This is unpleasant, but I know it will pass in a few moments.”).
Women’s menopause related quality of life (using the Menopause Quality of Life Scale), level of depressive symptomatology (using the Hamilton Rating Scale for Depression), and level of anxiety (using the Hamilton Rating Scale for Anxiety) were assessed before beginning the treatment, immediately after treatment, and six months after the conclusion of treatment. Immediately after treatment, women reported a reduction in the number of hot flashes experienced, as well as improvements in quality of life, depression, and anxiety. Some of these benefits were still evident at the six month assessment.
While these findings are encouraging and suggest that non-pharmacologic strategies may be used to manage hot flashes, the use of CBT to treat hot flashes associated with menopause requires further study before drawing conclusions. Future studies will help to clarify the effectiveness of this modality compared with standard pharmacologic interventions. In the interim, women should review the data on the efficacy, safety, and side effects of treatments with their physicians when making decisions related to the treatment of hot flashes.
Christina Psaros, PhD
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