Emerging research in the management of menopausal symptoms

No two women have an identical menopause, so treatment is rarely ‘one size fits all’. While menopausal hormone therapy (MHT) is a game changer for many women, it is not always the choice for others who might prefer non-hormonal interventions or might not be a suitable candidate for MHT.

Here, Jean Hailes Endocrinologist Dr Sonia Davison highlights two new studies that suggest that yoga and resistance training might ameliorate menopausal symptoms and boost emotional wellbeing for some women. She also points to cognitive behaviour therapy (CBT) as an emerging intervention which has been shown to be effective in treating women with problematic vasomotor symptoms.

Yoga

A 2022 randomised controlled trial investigated the effects of yoga on menopausal symptoms and sleep quality across menopause statuses. The study participants were based in Indonesia, consisting of 208 women aged between 45 and 60 years. A third were premenopausal, a third perimenopausal and the remainder were postmenopausal. Those in the intervention group practised a lot of yoga – three sessions for 75 minutes per week for 20 weeks.

“Not surprisingly, the premenopausal group had no difference in sleep quality”, says Dr Davison. “But for the peri and postmenopausal groups, there was an improvement in sleep quality, more magnified for women in the postmenopausal stage.”

While she thinks the duration of yoga in the trial may have been excessive, she believes clinicians could consider encouraging their patients to try yoga for better sleep.

Interestingly, the trial revealed improvements in the women’s depression, anxiety and stress scores across all the age groups. There was also an improvement in menopausal symptoms, including hot flushes and sweating for women at the perimenopause and postmenopause stages, and this was despite no changes to the group’s social circumstances.

Resistance training

In this 2021 open randomised controlled trial, researchers looked at the impact of a 15-week resistance training programme on the quality of life of 65 postmenopausal women with vasomotor symptoms. Their average age was 55 years and they had a mean BMI that was just a little overweight – 27 kg/m². They had at least four moderate-to-severe vasomotor symptoms a day.

The training programme was aimed at activating major muscle groups, consisting of eight exercises – including chest presses, leg presses, crunches and back raises. To minimise the risk of injury, the exercises were performed with lighter loads and in 15-20 repetitions for the first three weeks. Then, from weeks four to 15, heavier weights were gradually added, and exercises were performed in two sets of 8-12 repetitions.

“There were significant improvements in the women’s vasomotor symptoms and sleep problems in the exercise group, but not in the control group”, says Dr Davison. “Their general health was better – probably because they were fitter and stronger.

“My message here is that we can make a change to women’s lives by healthy measures. Women can do this. We just need to encourage them and tell them what to do and where to do it. Some specific guidance or suggestions can be helpful – you can say, ‘go to this place, it’s close to you’, or ‘go to this website for further advice on what you should be doing – like Healthy Bones Australia’.”

Cognitive behaviour therapy (CBT)

This type of psychological therapy has a growing body of evidence to support its effectiveness in reducing the impact of menopausal symptoms.

A 2021 paper co-authored by Professor Myra Hunter – Emeritus Professor of Clinical Health Psychology at King’s College in London and an expert in CBT and menopause – points out that cognitive reactions (such as feeling embarrassed about a hot flush or avoiding social situations) can exacerbate distress and vasomotor symptoms.

The research paper describes CBT as a brief therapy – four to six sessions – comprising eight hours in total and delivered by a clinical health psychologist. The focus of the intervention is primarily on vasomotor symptoms, but it also targets stress, low mood and sleep problems. In addition to being acceptable to women, it increases resilience and coping skills, and carries benefits for quality of life.

Women are given information and advice designed to monitor and modify hot flush triggers or precipitants, to reduce stress and to improve wellbeing, and to explore the impact of unhelpful cognitions (thoughts, beliefs, and attitudes) to menopause, ageing and vasomotor symptoms.

Professor Hunter is also the joint author of the book ‘Living Well through the Menopause: An Evidence-Based Cognitive Behavioural Guide’.

A wrap-up

Given these lines of emerging research, should health professionals and GPs be prescribing all these therapies for everyone? Certainly not, says Dr Davison. Further research and larger studies are needed to add weight and robustness to the data.

Their evidence base for symptom relief may not be as strong as pharmacotherapies, but since they do no harm, they may potentially benefit women who are challenged by midlife and menopause.

“We’ve got to take these findings with a grain of salt and a little bit of interest. And use them in the way that we see fit”, says Dr Davison.

As with MHT, these therapies may not be suitable for all women. They do, however, boost the arsenal of non-hormonal treatments available to clinicians, and may provide additional quality-of-life benefits beyond vasomotor symptom relief. For this reason, it is research worth keeping an eye on.