Vasomotor symptoms: Psychological and physical interventions

Cognitive behavioural therapy

One RCT (with a moderate risk of bias) in women after breast cancer found that purpose-designed cognitive behavioural therapy (CBT, 90min per week for 6 weeks) versus usual care had no effect on the frequency of hot flushes, but reduced the problem rating of hot flushes and night sweats.45 In addition, another RCT (with a moderate risk of bias) found that purpose-designed group CBT in combination with physical exercise (2.5 to 3 hours per week) versus no intervention reduced the problem rating of hot flushes and night sweats.46 [ES8]

One RCT (with an unknown risk of bias) identified in a Systematic Review (with a moderate risk of bias) in peri- and postmenopausal women found that CBT significantly reduced hot flushes and night sweats compared with no intervention.47 [ES41]

Hypnotherapy

One RCT (with a moderate risk of bias) in women after breast cancer reported that a purpose-designed hypnotherapy protocol delivered once/week for 5 weeks reduced hot flush frequency and severity compared with no treatment.48 [ES9]

Acupuncture

One RCT (with a low risk of bias) in women after breast cancer comparing acupuncture (needle inserted 0.5-3cm deep for 30min)  to sham acupuncture (needle inserted 2-3mm deep for 30min) reported a reduction in frequency and severity of hot flushes.49 However, two RCTs (with a moderate risk of bias) found no difference between acupuncture (needle inserted 5–20 mm deep for 20min or 0.25 to 0.5 inches deep) and sham acupuncture, in terms of frequency and severity of hot flushes.50, 51 One RCT (with a low risk of bias) reported acupuncture (for 15-20min once a week) reduced the nuisance of hot flushes, but did not report between-group differences compared to sham acupuncture or no treatment.52 [ES10]

Three RCTs (with a moderate to high risk of bias) comparing acupuncture with relaxation,53, 54 menopause hormone therapy (sequential or continuous combined oestrogen/progestogen)36, 37 or venlafaxine25 did not report between-group differences. [ES10]

One RCT (with a moderate risk of bias) compared the effect of electro-acupuncture or Gabapentin with Sham acupuncture or placebo, for 8 weeks. Acupuncture produced a significantly greater placebo effect than gabapentin; but reported no statistically significant difference in hot flush frequency and severity compared to sham acupuncture.55 [ES10]

Eight RCTs (with a high risk of bias) identified in a Systematic Review (with a low risk of bias) in peri- and postmenopausal women (including women with breast cancer) found that acupuncture significantly reduced hot flush severity, but not frequency, compared with sham acupuncture.  Three RCTs (with a high risk of bias) identified in the same Systematic Review found that hormone therapy significantly reduced hot flush frequency, but not severity, compared with acupuncture.56  [ES45]

One additional RCT (with a low risk of bias) was published after the end of the literature search period. This trial enrolled peri- and postmenopausal women with no history of breast cancer and found no statistically significant difference in improvement in hot flush frequency and severity between acupuncture and sham acupuncture.57 [ES45]

Relaxation therapy

One RCT (with a low risk of bias) in women after breast cancer reported reduced hot flush frequency and severity during relaxation therapy at one month (one hour session and a 20min tape to use once a day) versus no relaxation therapy.58 Another RCT (with a high risk of bias) compared relaxation therapy with electro-acupuncture therapy but did not report between group differences.53 [ES11]

Four RCTs (with a high risk of bias) identified in a Systematic Review (with a low risk of bias) in peri- and postmenopausal women (including women with breast cancer) found that 12 weeks of relaxation techniques did not significantly reduce hot flush frequency or severity compared with placebo/no treatment or acupuncture/superficial needling.59 [ES44]

Yoga

One RCT (with a moderate risk of bias) in women after breast cancer found that an 8 week course of a “Yoga of awareness” program reduced the frequency and severity of hot flushes compared with no intervention.60 [ES12]

In a population of peri- and postmenopausal women after breast cancer, one RCT (with moderate risk of bias) found that yoga with meditation (Hatha yoga, 90min/week for 12 weeks) significantly improved total menopausal symptoms compared to usual care.61  [ES12]

One RCT (with a low risk of bias) in menopause transition and postmenopausal women found that yoga (90min weekly class for 12 weeks) did not significantly reduce vasomotor symptom frequency and bother compared with usual activity.19, 62 One RCT (with an unknown risk of bias) identified in a Systematic Review (with a moderate risk of bias) in menopausal women (excluding trials exclusively conducted in women with breast cancer) found that 8 weeks of integrated yoga therapy (1 h/day, 5 days/week) significantly reduced vasomotor symptoms compared with exercise.63 One additional RCT (with a high risk of bias) identified in a Systematic Review (with a low risk of bias;) in peri- and postmenopausal women (excluding women with breast cancer) found that there was no significant difference between yoga (up to 12 sessions) and exercise in reducing vasomotor symptoms.64 [ES43]

Exercise

One RCT (with a low risk of bias) in menopause transition and postmenopausal women found that exercise (3 times per week of either treadmill, elliptical trainer, or stationary bicycle for 12 weeks) had no significant reduction in vasomotor symptoms frequency and bother compared to the usual activity control group.65 A meta-analysis of three RCTs (one low risk of bias, two with a high risk of bias), including Sternfeld et al (2014), identified in a Systematic Review (with a low risk of bias) in peri- and postmenopausal women (excluding women with breast cancer) found that exercise (of any type) did not significantly reduce the frequency of hot flushes/night sweats compared with no active treatment.64 One RCT (with an unknown risk of bias) identified in a Systematic Review (with a moderate risk of bias) in menopausal women (excluding trials exclusively conducted in women with breast cancer) found that exercise did not significantly reduced vasomotor symptoms compared with no exercise or oestradiol.63 [ES42]