Vasomotor symptoms of menopause have a profound negative effect on women
Beyond the physical discomfort that lends these symptoms their more common names (night sweats and hot flushes), women with VMS (N=381) have reported disrupted sleep (86%), irritable mood (75.6%), physical/mental exhaustion (82.4%) and impaired social function.1,2 The associations between VMS, mood and wider mental health are complex.3 Sleep disruption may account in part for the negative mood, decreased cognitive function and fatigue associated with VMS, but these may also be the result of other pathways, including neural mechanisms (Figure 1).3
VMS and mental health
Dr Juliana Kling (Mayo Clinic, Scottsdale, Arizona, USA) discusses the relationship between menopause-related VMS and mental health.
Figure 1. The various mental health burdens of vasomotor symptoms.1,2
Menopause, depression and anxiety
Menopause has been linked to an elevated risk of depression and anxiety in multiple studies.4 The risk of depression is significantly increased among perimenopausal women when compared with their premenopausal and postmenopausal counterparts.5 Risk of depression is even greater for perimenopausal women experiencing VMS: 4.39 times (95% CI, 1.40–13.83) more likely than for perimenopausal women without VMS in a study of 476 women.6
The association between VMS and depression is bidirectional: VMS increases the risk of recurrent episodes of depression; women with depressive symptoms are more likely to develop VMS.3,7 The association between VMS and anxiety is less clear and requires further research; there is evidence of an association between menopausal transition and increased anxiety.4
There is a complex and bidirectional relationship between VMS and mental health3
The negative effects of VMS on the mental wellbeing of women may translate into work-related difficulty or social impairment, further increasing socioeconomic burden and worsening quality of life.1
Treatment options and unmet needs for VMS
There is some evidence to support a positive effect of oestrogen-based hormone therapy on the mental health of women with menopause and related VMS.8,9 Current guidelines do not endorse the use of hormone replacement therapy to treat menopause-related mental health symptoms, with many suggesting a need for further research in this area.8,10-12
Addressing the mental health needs of women with VMS
Dr Kling explains how to address the mental health needs of women with VMS.
Cognitive behavioural therapy (CBT) has proven to be a viable, non-hormonal, non-pharmacological treatment option for people experiencing the psychological symptoms of VMS.9 CBT-Meno is a form of CBT developed specifically to address the symptoms of VMS.13 When compared with a waitlist control group, there were significantly greater improvements in women receiving CBT-Meno, including significant reductions in ‘bothersomeness’, depressive symptoms, sleep difficulties and sexual concerns, improving overall quality of life.13,14 More evidence is needed to assess the benefit of CBT-Meno for women with symptoms of anxiety.15
Beyond CBT, relaxation techniques can benefit women with VMS.9 Early findings suggest that mindfulness-based interventions incur greater economic cost while being less impactful than CBT.16
Treatments for the psychological impacts of VMS and menopause continue to develop, but more research is required to better understand the psychological impact of VMS and the ways in which these diverse psychological impacts can be treated.
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