November 26 2019

6 Mind-Body Approaches for Menopause

By Lindsay Taylor, PhD
9 Comments

As we covered in Parts I and II of this series, during perimenopause and menopause women can experience a complex web of physical, psychological, and social symptoms.

The treatment usually prescribed by doctors, hormone therapy (HT), is controversial and not appropriate for some women. I won’t get into the HT debate here—Mark did a great job covering the pros and cons recently. Suffice it to say that HT isn’t the answer for everyone, and it’s not a panacea by any means.

Whether or not they choose to go the HT route, many women desire additional support during perimenopause and beyond. For the sake of keeping this post from becoming a novella, I’m going to focus on mind-body therapies today.

This is not meant to be an exhaustive list of nonhormonal options, nor is it meant to try to dissuade you from trying HT. That’s a decision you have to make for yourself with your doctor. The approaches below can be used alone or in combination with other modalities, including HT.

As with any medical-adjacent tools, if you are considering any of the options here, take the time to educate yourself, talk to your doctor, and find qualified practitioners to help you implement these practices.

A Note Regarding Research Evidence…

Because so many women are interested in complementary or alternative approaches, there’s a fair amount of research into nonhormonal treatments. There are also important limitations.

A lot of the randomized control trials—experiments that are best for establishing causal effects—are small. There is considerable variability in research design, so it’s difficult to generalize across studies.

Participants in these studies tend to be white and well-educated. Since there are cross-cultural differences in the experience of menopause, we shouldn’t assume that the findings apply to all women. Likewise, a lot of the research focuses on women with a history of breast cancer because HT is generally contraindicated in this population. While the results of these studies probably generalize to other women, it would be great to have more data.

Finally, vasomotor symptoms—hot flushes and night sweats—are studied more than other types of symptoms. Though they are the most common complaint, many women do not experience debilitating vasomotor symptoms. They might, however, experience mood fluctuations, depression, sexual issues, memory problems, and more. We know less about how these approaches might help those women.

Nevertheless, I’ll highlight some of the potentially fruitful avenues you might explore. When possible, I’ll focus on systematic reviews and meta-analyses. They pool the results of multiple smaller studies to help a more reliable picture emerge.

Cognitive Behavioral Therapy (CBT)

In CBT, individuals are encouraged to explore how their thoughts (cognitions) affect feelings, behaviors, and physical symptoms. With help, they change their thoughts or beliefs about a situation to help manage their responses and improve coping skills.

Although there isn’t a ton of research on CBT for menopause, available studies are very promising. Whether or not CBT reduces the actual number of hot flushes—and the data here are mixed—CBT should work by changing women’s perceptions of their hot flushes. Multiple studies do find that after CBT women view their hot flushes as interfering less with daily life. As expected, they are also less bothered by them.

Women who see themselves as having less control over their hot flushes also tend to experience more distress. Changing their perceived control could be an effective intervention for improving quality of life. Indeed, in one study, 95 women received either group-based or self-help CBT. After therapy they reported feeling greater control over hot flushes and having better coping skills compared to women in a no-CBT control condition. Further analyses showed that women’s beliefs about control and coping predicted how problematic they found their hot flushes to be. (Having more positive beliefs about how hot flushes affect sleep also helped.)

Women who participated in CBT also experienced fewer sleep issues and insomnia as well as fewer depressive symptoms and sexual concerns.  They also noticed less impairment at work. Positive results were found with in-person therapy, self-help programs, and telephone-based therapy. When studies included a follow-up assessment, the beneficial effects of CBT persisted for at least six months.

Mindfulness, Meditation and Relaxation Training

A cross-sectional study of 1744 women found that women with higher scores on a mindfulness assessment tended to report less severe menopausal symptoms. For women with higher life stress, this association was especially strong. The idea here is that when women are able to be present-focused and observe their symptoms without judgment, they are protected against some of the distress, and possibly the physical symptoms, associated with menopause.

Although some of the women in that survey are probably mindful by nature—lucky them—mindfulness is also a skill that can be learned and cultivated. Among the many reasons to do so, mindfulness and meditation training can apparently lessen menopausal symptoms.

For example, researchers assigned 110 women to either an intensive eight-week mindfulness-based stress reduction program or a control group. The women who received mindfulness training reported having less bothersome hot flushes, better sleep quality, less anxiety and stress, and greater overall quality of life compared to the control group. When the researchers followed participants over the next 11 weeks, these results persisted or became even stronger.

A few other studies found that women who receive mindfulness or meditation training report fewer and less bothersome hot flushes, improved sleep, and better psychological functioning, though the results have not consistently endured over time. However, when looking at more general relaxation training and paced breathing techniques, effects are minimal, at least for hot flushes.

Yoga

An ethnographic study of nine female yogi masters concluded that they tend to skate fairly easily through menopause. The authors concluded that menopausal women should be encouraged to practice yoga. Of course, in addition to yoga, these yogi masters’ lifestyles included “healthy food habits, adequate sleep, and the use of nature cure techniques (i.e., fasting, detoxification, selection of suitable food products, and living in well-ventilated houses) that facilitated the art of living in tune with nature.” This sounds pretty great, but can we give really yoga all the credit here?

Probably not. However, two recent meta-analyses did conclude that yoga offers small but significant relief from symptoms of all types: vasomotor, psychological (including depression), somatic (including fatigue and sleep disturbances), and urogenital. Women also report better overall well-being and quality of life after receiving yoga training.

In one study, a group of breast cancer survivors received twelve weeks of yoga and meditation instruction, and they were encouraged to practice daily at home. Compared to women in a control group (no instruction), they reported fewer symptoms and improved quality of life at the end of the twelve weeks and again when asked three months later. A later analysis found that many of the effects were mediated by improved self-esteem in the yoga group.

Note that most of the individual studies are small, and they employ different types of yoga practices. This might be considered a strength insofar as different practices have been shown to work, or a weakness in that it’s not clear if one approach is particularly effective.

Exercise

Cross-cultural surveys find that women who are more active tend to have an easier time with menopause. For example, two large surveys of Swedish women found that women who exercised at least once per week reported less intrusive symptoms than women who never exercised, and women who exercised more than three hours per week were significantly less likely to experience severe symptoms than their less active counterparts. Sedentary women in this Finnish study experienced more vasomotor, psychological, and somatic/pain symptoms than women who were at least somewhat active.

While promising, experimental studies have not yielded such favorable results. When women were assigned to “physical activity” conditions (often walking), some studies report improvements, but others find no improvements or even worsening symptoms (perhaps depending on women’s baseline fitness). Multiple reviews have concluded that there is no systematic effect of exercise, particularly not for vasomotor symptoms.

Does that mean menopausal women shouldn’t exercise? Obviously no. It’s clear that being active—or at least not being sedentary—is important for overall health, and it probably helps menopausal women through the transition. However, there isn’t enough research to know what types of exercise are most effective and when. Do the types of movement you enjoy and that make your body feel good.

Acupuncture

A recent review concluded that acupuncture is effective for reducing vasomotor symptoms, both frequency and severity, as well as for improving quality of life. However, the reviewers also found that acupuncture was not reliably better than sham acupuncture where needles are inserted at points other than the prescribed pressure points and at a shallower depth—a placebo condition.

Hypnosis

A handful of studies have shown that clinical hypnosis can reduce hot flush frequency and distress among breast cancer patients. Another study of 187 women without breast cancer found that women who received hypnotherapy had fewer, less severe, and less bothersome hot flashes, as well as improved sleep. These results were evident at the end of the five-week treatment protocol, and they remained or got stronger in the six-week follow-up period.

The Experts Weigh In…

In 2015, the North American Menopause Society released a position statement on nonhormonal management of vasomotor symptoms. Of the approaches discussed here, the only ones NAMS recommended based on the strength of the available evidence were CBT and hypnosis. Mindfulness-based stress reduction earned a “recommend with caution,” which means, “We think it might work, but the evidence isn’t conclusive.”

The others—yoga, exercise, relaxation and paced breathing techniques, and acupuncture—were not recommended. This does not mean they are not worth trying! It simply means that based on their standards, the evidence was not strong enough for the committee to conclude that they are likely to be effective treatments for vasomotor symptoms specifically. This says nothing about other types of symptoms, nor about general well-being or quality of life.

Mind-Body Therapy Pros and Cons

So where does this leave us? Each of these therapies shows promise for alleviating at least some symptoms of menopause. Moreover, all these therapies have the potential to improve overall quality of life, sleep, stress, and general health. While reading these studies, I did wonder whether some of the women felt better simply because they were investing time and energy in taking care of themselves. If so, is that a problem? I don’t think so. They are low-risk interventions with a lot of potential upside.

That said, these aren’t quick solutions. The effective mindfulness/mediation trainings included six to eight weeks of classes and multiple hours per week. Women practiced yoga for two to four months during the study periods. Hypnotherapy was five weeks or longer. It’s not clear what the minimum time frame is for each of these therapies to be useful, but they’ll certainly involve a time commitment that might not be practical for all women. However, yoga, mindfulness/meditation, exercise, and even CBT can all be practiced at home once you know the proper technique.

As I said at the beginning, this is not an exhaustive list of nonhormonal therapies. There are also various supplements that might help, as well as lifestyle modifications that most of you Primal-savvy readers are probably already implementing: eating a variety of nutrient-dense foods, getting plenty of sunlight, practicing good sleep hygiene, and nurturing social connections.

Whatever you choose, be patient. Don’t just focus on one symptom; focus on the big picture. Pay attention to how you’re feeling more globally. Consider that while an intervention might not hit its desired mark, it might help you in ways you didn’t expect.

Have you used mind-body techniques (these or others)? What’s been your experience? Share your insights and questions below, and have a great week, everyone.

References:

Atapattu PM. Vasomotor symptoms: What is the impact of physical exercise? J SAFOMS. 2105 Jan-Jun;3(1):15-19.

Goldstein KM, et al. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric. 2017 Apr;20(2):178-182.

McMillan TL, Mark S. Complementary and alternative medicine and physical activity for menopausal symptoms. J Am Med Womens Assoc (1972). 2004 Fall;59(4):270-7.

Molefi-Youri W. Is there a role for mindfulness-based interventions (here defined as MBCT and MBSR) in facilitating optimal psychological adjustment in the menopause? Post Reprod Health. 2019 Sep;25(3):143-149

Moore TR, Franks RB, Fox C. Review of Efficacy of Complementary and Alternative Medicine Treatments for Menopausal Symptoms. J Midwifery Womens Health. 2017 May;62(3):286-297.

Sliwinski JR, Johnson AK, Elkins GR. Memory Decline in Peri- and Post-menopausal Women: The Potential of Mind-Body Medicine to Improve Cognitive Performance. Integr Med Insights. 2014;9:17–23.

van Driel CM, Stuursma A, Schroevers MJ, Mourits MJ, de Bock GH. Mindfulness, cognitive behavioural and behaviour-based therapy for natural and treatment-induced menopausal symptoms: a systematic review and meta-analysis. BJOG. 2019;126(3):330–339.

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9 thoughts on “6 Mind-Body Approaches for Menopause”

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  1. My experience (of menopause) was very uneventful. Very few symptoms and none of severity. I have never taken any sort of HRT, synthetic, natural or otherwise. I get moderate exercise (mostly walking and light jogging) on most days, some gentle stretching most days but no formal Yoga or other training. I am mildly overweight and have been my whole life, no matter which eating or exercise pattern I follow, and I believe I have tried them all in one form or another. Not a strict vegetarian, but not a heavy meat eater, either. Not too much dairy, always noticed it to be rather bothersome if consumed too much. I always had a positive attitude about the changes in my body and figured that if my great-grandmothers/grandmothers, etc. managed without too many “remedies”, then surely I would also be ok. Now, well past that time of life, I often feel better and have more energy than I did when I was younger. The best encouragement I received was from an older woman, when I was about 49. We were discussing symptoms and possible outcomes and she said ” Don’t worry about it. It doesn’t last too long and then you get your “second wind”. How wonderful! She was right and I never forgot her words. So great to hear that from another woman who has been there.

    1. Thanks for sharing your experience with us 🙂 I’m in my early twenties but am still interested! My Mema is 60 and claims to have not had a period since she got her tubes tied around 30 years old, with no experience of menopause. It’s such a varied and interesting topic.

  2. Thank you so much for this series, at 52 I still have a regular cycle but have noticed subtle changes over the last few years … sleep has always been my problem and that does seem to be the area being most affected, that and some days of extreme fatigue plus impaired word recollection (that probably drives me the most crazy, as a writer!). I do think mindset has a lot to do with it as well; I’ve been trying to hold a positive attitude toward this change since my mid 40s … still watching this space!

  3. I’m almost 51 and am still on birth control pills but am noticing the onset of menopause symptoms such as night sweats, trouble sleeping, memory issues. Night sweats, while annoying, are not nearly as troublesome as the memory issues and the things that pop out of my mouth these days – i.e. ‘wow, why did I just say that? That was blunt and a bit rude.’ Symptoms get way better when eating healthy and exercising, but when stress hits (and a lot of the healthy habits go out with it) it gets quite a bit worse. I’ve found yoga helps me a lot – out of my head and into my body.

  4. I confidently did pretty much all that’s suggested here and smugly thought to myself that I would sail through menopause when it came. In my experience these things were about as effective as telling someone with a broken leg to just try not to think about the pain.! My vasomotor symptoms were stopping me from sleeping and if you’ve read Matthew Walker then you know how important that is. I gave in and started bio identical HRT a few months ago and now I can sleep like a teenager and I don’t constantly ache all over from exercise classes that I’ve been doing for years. There was nothing ‘in my head’ about my symptoms as I hadn’t even realised they were due to menopause until they all disappeared with HRT.

    1. This is really helpful. I hadn’t thought about the problem with sleep being helped by HRT. Thank you for sharing your story.

  5. I have been an active and healthy person pretty much all my life, and my mother said that her menopause was pretty much a non-event. I expected to have a similar experience. WRONG!! I had horrible hot flashes, and began having difficulty sleeping. I had expected hot flashes, and I expected sleep disturbances, though not to the degree that they happened! However, I also began getting terrible muscle cramping – in my arms, my legs, and my abdomen and back also. My doctor finally told me that this was due to menopause.
    Worse than all of these, however, I got bladder spasms. I thought that I had a bladder infection, but my doctor and a urologist found no microbial culprit. The urologist prescribed an anti-cholinergic drug that put me to sleep while driving, causing an accident that luckily did not kill me… After many doctor visits, I finally realized that the “thinning tissues” that they said caused my bladder nerves to be over-sensitive were due to menopause. I then had to make an appointment to see my gynecologist to get HRT, since none of the others could or would prescribe it for me.
    HRT not only got rid of the bladder spasms, it got rid of all the other symptoms that were making life so difficult. I could sleep through most of the night!! I could wake up in the morning, and stretch! Without being seized by cramps! And I could deal with all sorts of work situations without suddenly getting hot, red, and sweaty in the middle of meetings and discussions.
    Hormone replacement therapy – HRT – gave me my life back. If I had not read so many articles like this one, I might have been more open to this solution before…

  6. Lupron seems to have stopped working for me in perimenopause. Once again I”m the opposite of the average person in reaction to drugs. Vitex is now helpful. DHEA continues to be helpful but I admit I”m not fully clear on why. And I’m still left to research Vitex and similar supplements myself. So frustrating and honestly, it’s disappointing that there’s a wall of silence around supplements.