Is psychotherapy the answer for menopause?

During peri- and postmenopause there is a high prevalence of psychological symptoms such as emotional instability, depressive moods, anxiety, sleep disorders, and sexual dysfunction.

Aetiologically relevant factors for discomfort are decline of sex hormones and psychosocial factors such as lifestyle, attitude towards menopause, pre-menopausal mental health and sociocultural factors. In contrast to the relevance of psychosocial factors, there are few studies on psychological interventions. A study published in the September issue of Psychotherapy and Psychosomatics evaluates an open trial of cognitive-behavioural group intervention consisting of psychoeducation, group discussion and coping skills training for women suffering from climacteric symptoms.

Thirty women were enrolled in this first trial. Standardised (MRS, HADS-D, Partnership Questionnaire, McCoy Female Sexuality Questionnaire) and especially developed ('Attitudes Towards the Menopause') instruments were administered 3 times, twice before (T1 and T2) and once after the group intervention (T3). General linear model repeated measures were used to analyse changes in questionnaire measures.

Taking the average of the two pre-intervention scores, significant improvements were observed in anxiety (p < 0.01), depression (p < 0.02), partnership relations (p < 0.02), overall score of sexuality (p < 0.02), hot flashes (p < 0.01) and cardiac complaints (p < 0.01) from pre- to post-intervention. No changes were found for sexual satisfaction and stressfulness of menopausal symptoms.

This pilot study points at a possible effectiveness of cognitive-behavioural interventions for the treatment of climacteric syndrome. Further studies will have to use randomised trials, comparing different treatments (HRT, phyto-oestrogens, relaxation training, discussion groups) for their effectiveness.