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Cognitive behavior therapy for menopausal symptoms (CBT-Meno)

a randomized controlled trial

Green, Sheryl M. PhD1,2; Donegan, Eleanor PhD2; Frey, Benicio N. MD, PhD1,2,3; Fedorkow, Donna M. MD4; Key, Brenda L. PhD1,3,5; Streiner, David L. PhD1; McCabe, Randi E. PhD1,5

doi: 10.1097/GME.0000000000001363
Original Study: PDF Only

Objective: To evaluate the effectiveness of cognitive behavioral therapy for menopausal symptoms (CBT-Meno) compared with a waitlist condition (no active intervention). A randomized controlled trial was conducted with 71 perimenopausal or postmenopausal women who were seeking treatment for menopausal symptoms.

Methods: Blind assessments were conducted at baseline, 12 weeks postbaseline, and 3 months post-treatment. An intention-to-treat analysis was conducted. CBT-Meno sessions included psychoeducation, and cognitive and behavioral strategies for vasomotor and depressive symptoms, anxiety, sleep difficulties, and sexual concerns. Primary outcomes were scores on the Hot Flash Related Daily Interference Scale (HFRDIS) and Beck Depression Inventory (BDI-II). Secondary outcomes were scores assessing vasomotor and sexual concerns on the Greene Climacteric Scale (GCS-vm, GCS-sex), the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI), and the Female Sexual Function Index (FSFI).

Results: There were significantly greater improvements in CBT-Meno compared with waitlist in vasomotor symptom interference (HFRDIS; P < 0.001, η2P = 0.21) and “bothersomeness” (GCS-vm; P = 0.04, η2P = 0.06), depressive symptoms (BDI-II; P = 0.001, η2P = 0.15), sleep difficulties (PSQI; P = 0.001, η2P = 0.17), and sexual concerns (GCS-sex; P = 0.03, η2P = 0.07). These results were found even when controlling for menopausal staging and medication use. Gains were maintained at 3 months post-treatment.

Conclusions: CBT-Meno was particularly effective in improving self-reported vasomotor symptoms, depressive symptoms, sleep difficulties, and sexual concerns. Although future studies will be needed to confirm the impact of CBT-Meno on anxiety symptoms, these results suggest that this protocol is effective in targeting commonly reported menopausal symptoms.

Video Summary: Supplemental Digiatl Content 1,

1Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

2Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada

3Mood Disorders Program, St. Joseph's Healthcare Hamilton, Ontario, Canada

4Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada

5Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Ontario, Canada.

Address correspondence to: Sheryl M. Green, PhD, Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton; 100 West 5th Street, Hamilton, ON L8N 3K7, Canada. E-mail:

Received 15 January, 2019

Revised 3 April, 2019

Accepted 3 April, 2019

Results from this RCT were initially presented as a poster presentation at the following conference: Green, S.M., Donegan, E., Frey, B.N., Fedorkow, D.M., Key, B., Streiner, D.L., McCabe, R.E. (2018, November). Final results from a randomized controlled trial evaluating the CBT-Meno program. Poster presented at the annual 2018 conference of the Association for Behavioral and Cognitive Therapies, Washington, DC.

Author contributions: Dr Green and Dr Donegan had full access to all data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. Study concept and design: Drs Green, Frey, Fedorkow, Key, Streiner, and McCabe. Acquisition, analysis, or interpretation of data: Drs Green, Donegan, Frey, Fedorkow, Key, Streiner, and McCabe. Drafting of manuscript: Drs Green, Donegan, Frey, Fedorkow, Key, Streiner, and McCabe. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Drs Green, Donegan, and Streiner.

Trial Registration: Identifier: NCT02480192.

Funding/support: Funding for this study was obtained by Drs Green (PI), Frey, Fedorkow, and McCabe, from the Ontario Mental Health Foundation (Type A Grant).

Financial disclosure/conflicts of interest: None reported.

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© 2019 by The North American Menopause Society.