Managing Menopausal Symptoms without Hormones

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Mind Over Hot Flashes: Part 1
By Leslie Schover, Ph.D., and Andrea Bradford, Ph.D.

Hot Flashes FanMenopausal symptoms, including hot flashes, night sweats, and vaginal dryness, affect many women who receive chemotherapy, radiation to the pelvis, or surgical removal of the ovaries. These symptoms also affect women who were already postmenopausal at the time of their diagnosis, since survivors of several types of cancer (e.g., breast cancer, endometrial and ovarian cancers) are often advised to stop taking hormone replacement therapies containing estrogen.

Hot flashes are the most common symptom prompting women to seek treatment. Although estrogen replacement is the most effective solution, many women don't want to take hormone replacement. Also, estrogen is usually not recommended for survivors of hormone-sensitive tumors. Fortunately, several non-hormonal medications may help, including antidepressants like venlafaxine [Effexor], and the blood pressure-lowering drugs like clonidine, and gabapentin, whichare commonly used to treat neuropathic pain. Although they aren't as effective as estrogen, these drugs offer relief too many women.

Mind over menopause
Two new studies suggest that a form of psychological treatment called cognitive behavioral therapy (CBT) also can improve menopausal symptoms and quality of life in breast cancer survivors.

In a study published in the March 2012 edition of the journal Lancet Oncology, researchers followed breast cancer survivors who attended a 90-minute group CBT session once per week for six weeks. Compared to survivors who had usual care during the same period, those who completed CBT reported fewer problems related to hot flashes and night sweats. The CBT group continued to see these benefits 6 months after finishing treatment. A second study, published recently in the journal Menopause, suggested that similar benefits can be obtained from a self-help version of cognitive behavioral therapy.

It's important to note that cognitive behavioral therapy didn't reduce the actual frequency of hot flashes, but it did reduce distress and problems resulting from hot flashes.

In other words, CBT helped women live better despite their hot flashes. Thus, the most effective nonhormonal treatment may be a combination therapy - using one of the medications above combined with CBT to manage residual hot flashes.

Cognitive behavioral therapy helps people change unhelpful ways of thinking about and coping with their symptoms. It's a form of therapy that focuses on resolving problems in the here-and-now. CBT often includes training in relaxation and coping skills, but it's more than just a set of tools. Being more aware of one's own thoughts, feelings and behaviors, and approaching life's difficulties with this new awareness, is key. This requires time and practice. Even so, most people begin to see improvement after the first few weeks or treatment.

For more information about CBT, visit the website of the Beck Institute for Cognitive Behavior Therapy

My next post will discuss non-hormonal management of vaginal symptoms after cancer treatments that cause menopause and estrogen deprivation.

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