Self-help cognitive behavior therapy for working women with problematic hot flushes and night sweats (MENOS@Work): a multicenter randomized controlled trial.

Claire Hardy,Amanda Griffiths,Myra S Hunter,Sam Norton

doi:10.1097/gme.0000000000001048

Abstract

The aim of the study was to examine the efficacy of an unguided, self-help cognitive behavior therapy (SH-CBT) booklet on hot flush and night sweat (HFNS) problem rating, delivered in a work setting. Women aged 45 to 60 years, having 10 or more problematic HFNS a week, were recruited to a multicenter randomized controlled trial, via the occupational health/human resources departments of eight organizations. Participants were 1:1 randomized to SH-CBT or no treatment waitlist control (NTWC). The primary outcome was HFNS problem rating; secondary outcomes included HFNS frequency, work and social adjustment, sleep, mood, beliefs and behaviors, and work-related variables (absence, performance, turnover intention, and work impairment due to presenteeism). Intention-to-treat analysis was used, and between-group differences estimated using linear mixed models. A total of 124 women were randomly allocated to SH-CBT (n = 60) and NTWC (n = 64). 104 (84%) were assessed for primary outcome at 6 weeks and 102 (82%) at 20 weeks. SH-CBT significantly reduced HFNS problem rating at 6 weeks (SH-CBT vs NTWC adjusted mean difference, -1.49; 95% CI, -2.11 to -0.86; P < 0.001) and at 20 weeks (-1.09; 95% CI, -1.87 to -0.31; P < 0.01). SH-CBT also significantly reduced HFNS frequency, improved work and social adjustment; sleep, menopause beliefs, HFNS beliefs/behaviors at 6 and 20 weeks; improved wellbeing and somatic symptoms and reduced work impairment due to menopause-related presenteeism at 20 weeks, compared with the NTWC. There was no difference between groups in other work-related outcomes. A brief, unguided SH-CBT booklet is a potentially effective management option for working women experiencing problematic HFNS.

Highlights

With rising employment rates for women and an ageing profile of the workforce in the UK and most European countries, increasing numbers of women will be working during their menopause transition and postmenopause.[1,2] As a result there is growing interest in improving the health and wellbeing of working women, and retaining and increasing the numbers of experienced older women in the workplace
Menopausal symptoms - hot flushes and night sweats (HFNS) - are difficult for women to deal with at work, due to embarrassment, discomfort and some aspects of the work environment
This study demonstrates that an unguided self-help Cognitive behaviour therapy (CBT) approach can be effective in reducing the impact and frequency of Hot flushes and night sweats (HFNS) experienced by working women

Summary

Introduction

With rising employment rates for women and an ageing profile of the workforce in the UK and most European countries, increasing numbers of women will be working during their menopause transition and postmenopause.[1,2] As a result there is growing interest in improving the health and wellbeing of working women, and retaining and increasing the numbers of experienced older women in the workplace. Women suggested several areas requiring organisational change in order to improve women’s experience of menopause at work; these included: (i) greater awareness among managers about menopause as a possible occupational health issue, (ii) flexible working hours, (iii) access to information and sources of support at work, and (iv) attention to work place temperature and ventilation. CBT for HFNS has been found to be effective in reducing the impact of HFNS, i.e. how problematic they are, in several clinical trials,[27,28,29] frequency of night sweats[27] and physiologically monitored HFNS.[35] CBT was recommended as an effective treatment for vasomotor symptoms in a recent position statement on non-hormonal interventions, by the North American Menopause Society.[36] Group CBT and self-help CBT (a self-help booklet containing the same information with a breathing/relaxation CD) formats for HFNS have been shown to be effective in reducing the impact of HFNS;[27] group CBT had more impact on mood and quality of life. CBT interventions for HFNS are available in self-help and group formats,[37,38] there have not been any previous work based trials and CBT interventions for HFNS are not yet widely accessible to women at work

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