Meditation could help relieve menopausal anxiety and depression – study

Doctors could offer meditation and talking therapies to help menopausal women with symptoms of anxiety and depression, researchers have suggested.

Analysis of 30 studies involving 3,501 women found mindfulness and cognitive behavioural therapy (CBT) may offer some relief, ranging from a small to medium effect on symptoms.

Experts behind the study said they were not suggesting such therapies should replace hormone replacement therapy (HRT), but could be considered alongside pills and patches.

The research, published in the Journal of Affective Disorders and carried out by University College London (UCL), involved data from 14 countries including the UK and US.

The message we want to be really clear about is that with that we are not in any sense suggesting this as an alternative or recommending this instead of HRT. My personal experience of HRT has been extremely positive

Ten of the studies explored the impact of CBT on menopausal symptoms, while nine looked at mindfulness, a type of meditation in which people focus on being intensely aware of what they are sensing and feeling in that moment.

Other studies looked at a range of interventions, including those based on “acceptance”, group counselling and marital support.

Women’s symptoms were measured using internationally recognised questionnaires, and included a lack of interest in doing things, issues with sleep, low mood and anxiety.

The findings found that women’s low mood “significantly benefited” from CBT and mindfulness.

Data from 11 studies showed a small to medium effect when it came to improvement in anxiety, the researchers said, which equates to some alleviation of symptoms, though they would not be gone completely.

I think what we know is that HRT doesn't get to everyone and not everyone wants it, and not everyone's eligible for it, so we do need to consider other things

Individually, CBT had a small effect on anxiety, while mindfulness had a medium effect.

When it came to depression, CBT had a small to medium effect, while mindfulness had a small effect.

Overall, both interventions offered a medium to large effect on improvement in quality of life.

The authors found a small improvement in memory and concentration, but acknowledged the data in this area was weak.

They also said it was unclear from the studies how long the effects might last for women.

First-line treatment of perimenopause and menopause for most women is replacing the missing hormones by prescribing the right dose and type of HRT

Lead author, Professor Aimee Spector, said there was some evidence that mindfulness could be offered alongside HRT to women.

She said some NHS trusts already offer it for depression.

She added: “The message we want to be really clear about is that with that we are not in any sense suggesting this as an alternative or recommending this instead of HRT. My personal experience of HRT has been extremely positive.

“I think what we know is that HRT doesn’t get to everyone and not everyone wants it, and not everyone’s eligible for it, so we do need to consider other things.”

She said interventions such as CBT could offer additional support to helping women get back to work, for example, “but I don’t think we at any point want to say that addressing the hormone imbalance isn’t probably the most important thing that can be done for many people”.

Senior author Dr Roopal Desai added: “We’re not advocating for this instead of HRT. I think it’s just an additional tool that women can have as an option.”

The most cost-effective and easily accessible treatment should be HRT yet globally only the minority of menopausal women, around 5%, are prescribed it

Prof Spector said around 30% of women going through menopause have a first depressive episode, while “anxiety is highly prevalent” and half of women report tension, nervousness or irritability.

“In terms of HRT, we know it’s not clinically indicated for everyone such as breast cancer survivors, and that its usage is variable depending on certain factors,” she added.

“We know in certain ethnic groups such as south-east Asian and Afro-Caribbean populations, there seems to be a much lower uptake, and those who are socially disadvantaged often don’t get access to HRT.

“So I think our message is that having holistic interventions can provide options for people who maybe aren’t eligible, don’t want HRT, possibly as an addition to HRT, and and they can support the psychosocial aspects as well as the biological.”

Last year, draft guidance for the NHS said women should be offered talking therapy to combat the symptoms of the menopause.

The National Institute for Health and Care Excellence (Nice) said women should be given a better understanding of the risks and benefits of HRT.

HRT replaces the hormones oestrogen, progestogen, or both, and can be administered using gels, creams, pessaries, tablets or sprays.

The risk of developing serious side effects on HRT are “very low” according to the NHS website, although it can lead to a small increase in the risk of breast cancer.

Dr Louise Newson, a GP and menopause specialist, said it was not surprising the new study had found some improvements after mindfulness and CBT “but it is important to remember that menopause is due to a hormone deficiency affecting the entire body”.

She said this deficiency leads many women to experience “numerous physical as well as psychological symptoms” while long-term health risks associated with low hormones include “an increased risk of heart disease, dementia, diabetes, clinical depression, schizophrenia, osteoporosis and early death”.

Dr Newson added: “First-line treatment of perimenopause and menopause for most women is replacing the missing hormones by prescribing the right dose and type of HRT.”

She said she was “unclear why women must accept symptoms when there is a clear treatment (HRT) that is safe and effective available to them”.

And the specialist added: “The most cost-effective and easily accessible treatment should be HRT, yet globally only the minority of menopausal women, around 5%, are prescribed it.”