Elsevier

Maturitas

Volume 66, Issue 2, June 2010, Pages 135-149
Maturitas

Review
Mind-body therapies for menopausal symptoms: A systematic review

https://doi.org/10.1016/j.maturitas.2010.01.016Get rights and content

Abstract

Objective

To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms.

Methods

To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria.

Results

Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N = 719), 1 non-randomized controlled trial (N = 58), and 5 uncontrolled trials (N = 105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings.

Conclusions

Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms.

Introduction

An estimated 75–85% of women experience some or all symptoms of menopause [1], [2], including vasomotor disturbances (hot flashes/night sweats), fatigue, sleep impairment, mood disturbances, cognitive difficulties, musculoskeletal pain, and headaches [3], [4], [5]. Symptoms typically begin at least 1 year prior to menstrual period cessation and persist for several years post-menopause; for example, findings from a recent meta-analysis indicate that approximately 50% of women continue to experience vasomotor symptoms 4 years after their final menstrual period [6] with reported average duration of vasomotor symptoms ranging from 3.8 [7] to over 7 years [6]. Approximately 10–30% of post-menopausal women will continue to experience symptoms throughout their lives; in breast cancer survivors, symptoms are often more frequent or severe due to endocrine therapy and chemotherapy-induced menopause [8], [9]. Symptoms can result in significantly reduced quality of life that for some can be debilitating [10], prompting an estimated 60% of women to seek medical treatment [11]. Given that there are over 50 million women in the US aged 50 or older [12], with at least 1.5 million reaching menopause every year, the financial, social, and psychological burden of menopause is considerable [13], [14].

While hormone replacement therapy (HRT) has long been prescribed to alleviate hot flashes and other menopausal symptoms, HRT use has fallen dramatically in both the US and Europe due to evidence from recent large clinical trials that HRT increases risk for breast and endometrial cancer, coronary artery disease, stroke, and thromboembolism [14], [15], [16], [17], [18]. An increasing number of women are turning to complementary and alternative therapies to help manage menopausal symptoms [19], with current estimates ranging from 40% to over 70% of women in the peri- and post-menopausal period [19], [20], [21]. Among the more commonly chosen therapies are mind-body practices, including active disciplines such as yoga and tai chi, as well as specific relaxation and other stress management techniques [19], [20]. Given that menopausal symptoms both contribute to and are exacerbated by psychosocial stress [22], [23], and a growing body of literature suggests mind-body practices can reduce perceived stress and stress reactivity, enhance mood and well being, and improve sleep [24], [25], [26], [27], mind-body therapies may have promise for the management of menopausal complaints. Moreover, several mind-body therapies (including yoga, meditation, qigong, tai chi, and several relaxation techniques) have been reported to decrease indices of sympathetic activation [25], [28], [29], [30], factors that characterize and may in part underlie the development and exacerbation of vasomotor and other menopausal symptoms [7]. These factors may also play an important etiologic role in the development of insulin resistance, dyslipidemia, hypertension, and other atherogenic changes associated with menopause [25].

In this systematic review, we critically evaluate available evidence from the published scientific literature regarding the effects of self-administered mind-body therapies on common menopausal symptoms. We also briefly discuss possible mechanisms that may underlie observed benefits, outline major limitations in the current literature, and detail directions for future research.

Section snippets

Methods

Included in this review are original clinical trials published in the peer-reviewed scientific literature regarding the effects of any self-administered mind-body therapy (representing a broad range of relaxation and stress-reduction therapies, including, among others, biofeedback, imagery, yoga and meditation, breathing exercises, tai chi, qigong, pilates, mindfulness-based stress reduction programs, progressive muscle relaxation, and related programs) on menopausal symptoms. We excluded

Results

Of over 3500 potentially relevant abstracts and citation indices scanned, 54 possibly eligible papers were identified for detailed review; of these, 33 were excluded for the following reasons: 11 did not involve an eligible mind-body therapy as a central component, 2 did not present original data or reported data included in another paper, 4 used an ineligible study design, 1 was an unpublished trial, 3 were not available in English, and 12 did not target symptoms of menopause. A total of 21

Discussion

The financial, health, and social costs of vasomotor disturbances and other menopausal symptoms are substantial and are projected to continue increasing in coming years with the progressive aging of populations in the U.S. and other western industrialized countries [13], [14]. In response to publication of findings regarding serious adverse health effects of HRT, once widely prescribed for menopausal complaints, use of HRT has fallen dramatically [16]. In addition, use of HRT is generally

Conclusions

In short, findings from studies to date suggest that yoga-based programs, breathing practices, and certain other mind-body therapies may be beneficial for reducing vasomotor and other menopausal symptoms. However, most existing studies suffer methodological limitations that hinder interpretation of findings and preclude firm conclusions. Additional rigorous, high-quality controlled trials are needed to determine both the short- and long-term effects of specific mind-body therapies on menopausal

Contributors

Paper conception and design was done by KEI and TKS. Literature search, review, and data extraction was done by KEI, TKS and AV. Manuscript preparation was done by KEI. Table preparation was done by TKS, KEI and AV. Critical review/revision was done by KEI and TKS. Manuscript/table formatting was done by TKS and KEI.

Competing interest

None of the contributing authors have a conflict of interest.

Provenance and peer review

Commissioned and externally peer reviewed.

Acknowledgements

This work was made possible by the National Center for Complementary and Alternative Medicine (Grant Numbers R21AT002982 and 1 K01 AT004108). The contents are solely the responsibility of the authors and do not represent the official views of West Virginia University, the University of Virginia, or the National Institutes of Health.

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