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Lori Cray, PhD, RN Nancy Fugate Woods, PhD, RN, FAAN Ellen Sullivan Mitchell , PhD

Mind-body therapies for symptom clusters during the menopausal transition and early postmenopause : A systematic review. Lori Cray, PhD, RN Nancy Fugate Woods, PhD, RN, FAAN Ellen Sullivan Mitchell , PhD Janet Schnall MS, AHIIP. Funding Support.

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Lori Cray, PhD, RN Nancy Fugate Woods, PhD, RN, FAAN Ellen Sullivan Mitchell , PhD

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  1. Mind-body therapies for symptom clusters during the menopausal transition and early postmenopause: A systematic review Lori Cray, PhD, RN Nancy Fugate Woods, PhD, RN, FAAN Ellen Sullivan Mitchell, PhD Janet Schnall MS, AHIIP

  2. Funding Support • NINR 1R21NR012218-01 Menopause Symptom Clusters: Refocusing Therapeutics • NINR R01-NR 04141 Menopausal Transition: Biobehavioral Dimensions • NINR P30 NR 04001, P50-NR02323 – Center for Women’s Health and Gender Research

  3. Background • Most women experience symptom clusters • Clinical trial reports of hot flash effects often omit co-occurring symptoms • Systematic reviews of therapeutics for symptoms have focused almost exclusively on a single symptom: hot flashes. • Most investigators have focused reviews on hormonal therapy • Increasing numbers are studying non-hormonal pharmacotherapy since the publication of the Women’s Health Initiative hormonal therapies trial results (2002)

  4. Aim • Review controlled clinical trials of mind-body therapies for hot flashes and at least one other symptom from these clusters: • Sleep • Cognitive function • Mood • pain

  5. Methods • Extensive search of: PubMed/Medline, CINAHL Plus, PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, AMED, and Alt HealthWatchconducted by experienced reference librarian (Schnall) • Randomized controlled trials, English language, January 2004 to July 6, 2011 with follow-up alerts

  6. Results • 1193 abstracts identified • 59 trials examining effectiveness of therapies on hot flashes and at least one additional symptom of interest were identified • 9 reports of 8 trials of mind-body therapies • 6 Physical activity/exercise • 2 relaxation therapies • 2 yoga (included as a comparison group in a walking study)

  7. Results – co-occurring symptoms Physical activity/exercise

  8. Results – co-occurring symptoms Relaxation Therapies Yoga

  9. Results – intervention effectiveness Physical activity/exercise Intervention Control Estradiol (b) between groups; (w) within groups

  10. Results – intervention effectiveness Relaxation Therapies Estradiol Yoga *Results reported are for intervention group unless otherwise indicated; (b) between groups; (w) within groups

  11. Conclusion • Studies of mind-body therapies for hot flashes increasingly indicate multiple symptom outcomes • Few report treatment effects in ways that allow clinicians to consider symptom clusters when prescribing therapies • Of all the therapies studied, Yoga was the single therapy that demonstrated treatment effects across all symptom groups (one study) • Mindfulness-based stress response demonstrated promise for managing multiple symptoms (one study) • Recommend further attention paid to the symptom clusters that women experience in future intervention trials

  12. Thank you

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