A cognitive model of menopausal hot flushes and night sweats.
ABSTRACT Hot flushes and night sweats (HF/NS) are commonly experienced by mid-aged women during the menopause transition. They affect approximately 70% of women but are regarded as problematic for 15-20% largely due to physical discomfort, distress, social embarrassment, and sleep disturbance. There is a need for effective and acceptable nonmedical treatments for menopausal symptoms due to the declining use of hormone therapy (HT) following publication of the Women's Health Initiative and other prospective studies which associated HT use with increased risk of stroke and breast cancer. HF/NS are an example of a physiological process embedded within, and moderated by, psychological processes, as evidenced by discrepancies between subjective experiences and physiologically measured symptoms. We describe a cognitive model of menopausal hot flushes that can explain symptom perception, cognitive appraisal, and behavioral reactions to symptoms. Theoretically, the model draws on symptom perception theory, self-regulation theory, and cognitive behavioral theories. The model can be used to identify the variables to target in psychological interventions for HF/NS and to aid understanding of possible mediating factors. As part of Phase II intervention development, we describe a cognitive behavioral treatment which links the bio-psycho-social processes specified in the model to components of the intervention.
Article: A randomised controlled trial of a cognitive behavioural intervention for women who have menopausal symptoms following breast cancer treatment (MENOS 1): trial protocol.[show abstract] [hide abstract]
ABSTRACT: This trial aims to evaluate the effectiveness of a group cognitive behavioural intervention to alleviate menopausal symptoms (hot flushes and night sweats) in women who have had breast cancer treatment. Hot flushes and night sweats are highly prevalent but challenging to treat in this population. Cognitive behaviour therapy has been found to reduce these symptoms in well women and results of an exploratory trial suggest that it might be effective for breast cancer patients. Two hypotheses are tested:Compared to usual care, group cognitive behavioural therapy will:1. Significantly reduce the problem rating and frequency of hot flushes and nights sweats after six weeks of treatment and at six months post-randomisation.2. Improve mood and quality of life after six weeks of treatment and at six months post-randomisation. Ninety-six women who have completed their main treatment for breast cancer and who have been experiencing problematic hot flushes and night sweats for over two months are recruited into the trial from oncology and breast clinics in South East London. They are randomised to either six weekly group cognitive behavioural therapy (Group CBT) sessions or to usual care. Group CBT includes information and discussion about hot flushes and night sweats in the context of breast cancer, monitoring and modifying precipitants, relaxation and paced respiration, stress management, cognitive therapy for unhelpful thoughts and beliefs, managing sleep and night sweats and maintaining changes.Prior to randomisation women attend a clinical interview, undergo 24-hour sternal skin conductance monitoring, and complete questionnaire measures of hot flushes and night sweats, mood, quality of life, hot flush beliefs and behaviours, optimism and somatic amplification. Post-treatment measures (sternal skin conductance and questionnaires) are collected six to eight weeks later and follow-up measures (questionnaires and a use of medical services measure) at six months post-randomisation. MENOS 1 is the first randomised controlled trial of cognitive behavioural therapy for hot flushes and night sweats that measures both self-reported and physiologically indexed symptoms. The results will inform future clinical practice by developing an evidence-based, non-medical treatment, which can be delivered by trained health professionals. Current Controlled Trials ISRCTN13771934.BMC Cancer 01/2011; 11:44. · 3.01 Impact Factor
Article: Concordance between self-reported and sternal skin conductance measures of hot flushes in symptomatic perimenopausal and postmenopausal women: a systematic review.[show abstract] [hide abstract]
ABSTRACT: Sternal skin conductance is considered the gold standard in hot flush and night sweat measurement, but results sometimes differ from women's own self-reports. To date, there has been no systematic review of concordance between sternal skin conductance and self-report measures. An exploratory meta-analysis was conducted to quantify concordance between these measures and to explore the reasons for discordance between them. A search of Medline, EMBASE, Web of Science, and PsychInfo from inception to December 2009 was conducted. Studies that measured self-reported hot flushes and/or night sweats and sternal skin conductance concurrently in symptomatic perimenopausal and postmenopausal women were retained for data extraction. Studies were included if data on concordance between the two measures were available. Concordance rates overall were 29%, but variability between studies was too broad to identify a single typical concordance rate. However, concordance rates for ambulatory monitoring were more homogeneous and also had a 29% concordance rate. Nonambulatory studies tended to result in more concordant hot flushes (54%) than ambulatory studies did, and night sweats tended to be under-reported more often than over-reported (46% and 22%, respectively). Concordance rates were typically lower than early reports of sternal skin conductance measures but were highly variable between studies. Possible measurement error and study conditions might partly explain the discordance and variation in study findings, but further exploration of the effects of symptom perception is warranted. Use of both measures concurrently is likely to achieve more reliable and valid measurement of hot flushes and night sweats than either measure alone.Menopause (New York, N.Y.) 02/2011; 18(6):709-22. · 3.08 Impact Factor
Article: Perceived control, lifestyle, health, socio-demographic factors and menopause: impact on hot flashes and night sweats.[show abstract] [hide abstract]
ABSTRACT: To develop a model to predict the perceived severity of hot flashes (HF) and night sweats (NS) in symptomatic middle-aged women. This was a cross-sectional study of a community-based sample of 243 women with vasomotor symptoms. Menopausal status was ascertained using the 'Stages of Reproductive Aging Workshop' criteria. Women's 'perceived control' over their symptoms was measured by a validated Portuguese version of the Perceived Control over Hot Flushes Index. Structural equation modelling was employed to construct a causal model of self-reported severity of both HF and NS, using a set of 20 variables: age, marital status, parity, professional status, educational level, family annual income, recent diseases and psychological problems, medical help-seeking behaviour to manage menopausal symptoms, use of hormone therapy and herbal/soy products, menopause status, intake of alcohol, coffee and hot beverages, smoking, physical exercise, body mass index and perceived control. Significant predictors of perceived severity were the use of hormone therapy for both HF (β=-.245; p=.022) and NS (β=-.298; p=.008), coffee intake for both HF (β=-.234; p=.039) and NS (β=-.258; p=.029) and perceived control for both HF (β=-1.0; p<.001) and NS (β=-1.0; p<.001). The variables explained respectively 67% and 72% of the variability in the perceived severity of HF and NS. Women with high perceived control had a significantly lower frequency (t(235)=2.022; p=.044) and intensity of HF (t(217)=3.582; p<.001); similarly, participants with high perceived control presented a lower frequency (t(235)=3.267; p<.001) and intensity (t(210)=3.376; p<.001) of NS. Perceived control was the strongest predictor of the self-reported severity of both HF and NS. Other causal predictors were hormone therapy and caffeine intake. All three were associated with less severe vasomotor symptoms.Maturitas 06/2011; 69(4):338-42. · 2.77 Impact Factor