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Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial

Ayers, Beverley DHealthPsych; Smith, Melanie DClinPsych; Hellier, Jennifer MSc; Mann, Eleanor DPhil; Hunter, Myra S. PhD

Menopause: The Journal of The North American Menopause Society: July 2012 - Volume 19 - Issue 7 - p 749–759
doi: 10.1097/gme.0b013e31823fe835
Original Articles

Objective The aim of this study was to examine the effectiveness of group cognitive behavioral therapy (CBT) and guided self-help CBT in reducing hot flush and night sweat (HF/NS) problem rating at 6 and 26 weeks after randomization.

Methods This was a randomized control trial of 140 women having 10 or more problematic HF/NS a week for at least a month. The primary outcome was HF/NS problem rating (1-10) at 6 weeks after randomization. Secondary outcomes were physiologically measured HF/NS at 6 weeks; HF/NS problem rating at 6 weeks; and frequency, mood (Women’s Health Questionnaire), and health-related quality of life (General Health Survey Short Form–36) at 6 and 26 weeks. Intention-to-treat analysis was used, and between-group differences were estimated using linear mixed models.

Results Baseline mean (SD) HF/NS weekly frequency was 63.15 (49.24), and problem rating was 5.87 (2.28). Group and self-help CBT both significantly reduced HF/NS problem rating at 6 weeks—group CBT versus no treatment control (NTC; adjusted mean difference, 2.12; 95% CI, 1.36-2.88; P < 0.001) and self-help CBT versus NTC (adjusted mean difference, 2.08; 95% CI, 1.29-2.86; P < 0.001)—and at 26 weeks—group CBT versus NTC (adjusted mean difference, 1.33; 95% CI, 0.54-2.13; P = 0.001) and self-help CBT versus NTC (adjusted mean difference, 1.19; 95% CI, 0.36-2.02; P = 0.005). Group and self-help CBT significantly reduced night sweat frequency at 6 and 26 weeks. There were improvements in mood and quality of life at 6 weeks and improved emotional and physical functioning for group CBT at 26 weeks.

Conclusions These results suggest that CBT delivered in group or self-help format is an effective treatment option for women during the menopause transition and postmenopause with problematic HF/NS.

In this study, both group and self-help cognitive behavioral therapy significantly reduced hot flush/night sweat problem rating and night sweat frequency. There were some improvements in mood and quality of life.

From the 1Department of Psychology (at Guy’s), Institute of Psychiatry, King’s College London, London, UK; and 2Mental Health and Neuroscience Clinical Trials Unit, Institute of Psychiatry, King’s College London, London, UK.

Received October 5, 2011; revised and accepted November 1, 2011.

Funding/support: This work was funded by the National Institute for Health Research Biomedical Research Centre for Mental Health, South London, and Maudsley National Health Service Foundation Trust and the Institute of Psychiatry, King’s College London.

Financial disclosure/conflicts of interest: None reported.

Authors’ contributions: B.A. was the trial coordinator on the study and generated the first draft of this manuscript based on the study protocol. M.S. was the clinical psychologist who conducted the group CBT and guided self-help. J.H. was the trial statistician. E.M. analyzed the physiological data, and M.S.H. was the principal investigator of this study and wrote the original protocol and supervised the intervention. All authors contributed to the final version of the manuscript.

Address correspondence to: Myra S. Hunter, PhD, Department of Psychology, Institute of Psychiatry, King’s College London, 5th Floor Bermondsey Wing, Guy’s Campus, London Bridge, London SE1 9RT, England. E-mail:

© 2012 by The North American Menopause Society.