Relaxation for perimenopausal and postmenopausal symptoms

Review question: We wanted to discover whether relaxation techniques were better or worse than other interventions, such as acupuncture, in the management of menopausal symptoms. We reviewed the evidence on the effects of these techniques on hot flushes, night sweats and sleep disturbances in menopausal women.

Background: Management of menopausal symptoms, such as hot flushes, depressed mood or sleep disturbances, has become more complicated because of increased awareness of the risks associated with hormone replacement therapy (HRT). Options include prescription drugs and self care strategies such as relaxation techniques. Relaxation techniques are thought to be relatively harmless, but their effectiveness in treating hot flushes and sleep disturbances remains unclear.

Study characteristics: We found four randomised controlled studies, with 281 participants. Relaxation was compared with electroacupuncture, superficial needling, paced respiration, placebo and no treatment. The age range of participants was 30 to 77 years. These trials were conducted in Sweden, the UK and the USA. No study was funded by an agency with commercial interest in the results of the study. The evidence is current to February 2014.

Key results: Evidence is insufficient to show the effectiveness of relaxation techniques as treatment for menopausal vasomotor symptoms, or to determine whether this treatment is more effective than no treatment, placebo, acupuncture, superficial needle insertion or paced respiration. No evidence indicates that relaxation reduces the number of hot flushes per 24 hours or their severity. None of the studies reported night sweats, sleep disturbances associated with night sweats or adverse effects as an outcome.

Quality of the evidence: The quality of the evidence was very low. The main limitations of identified evidence included lack of data, imprecision and failure to report study methods in adequate detail.

Authors' conclusions: 

Evidence is insufficient to show the effectiveness of relaxation techniques as treatment for menopausal vasomotor symptoms, or to determine whether this treatment is more effective than no treatment, placebo, acupuncture, superficial needle insertion or paced respiration.

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Background: 

Since the time of publication of the Women’s Health Initiative (WHI) study, menopausal symptom management has become more complex because of increased awareness of the risks associated with hormone replacement therapy (HRT). Currently, a wide range of management options is available. Some women take prescription drugs, and others use self care strategies, including lifestyle modifications, over-the-counter preparations and complementary and alternative therapies, such as herbal preparations, exercise programmes and relaxation techniques. Relaxation techniques consist of a group of behavioural interventions. They are considered relatively harmless, but their effectiveness in treating vasomotor symptoms and sleep disturbances remains debatable. 

Objectives: 

To determine the effectiveness of relaxation techniques as treatment for vasomotor symptoms and associated sleep disturbances in perimenopausal and postmenopausal women.

Search strategy: 

Searches of the following electronic bibliographic databases were performed in February 2014 to identify randomised controlled trials (RCTs): the Cochrane Menstrual Disorders and Subfertility Group Specialised Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, PsycINFO, Social Science Citation Index and CINAHL. Handsearches of trial registers, relevant journals and published conference abstracts were also performed.

Selection criteria: 

RCTs were included if they compared any type of relaxation intervention with no treatment or other treatments (except hormones) for vasomotor symptoms in symptomatic perimenopausal/postmenopausal women.

Data collection and analysis: 

Two review authors selected studies, assessed quality and extracted data. Included studies were combined, if appropriate, by using a random-effects model to calculate pooled mean differences and 95% confidence intervals.

Main results: 

Four studies were eligible for inclusion (281 participants): Two studies compared relaxation with electroacupuncture or superficial needling, one study compared relaxation with paced respiration or placebo control (α-wave electroencephalographic biofeedback) and one study compared relaxation with no treatment.

No evidence was found of a difference between relaxation and acupuncture or superficial needle insertion in the number of hot flushes per 24 hours (mean difference (MD) 0.05, 95% confidence interval (CI) -1.33 to 1.43, two studies, 72 participants, I2 = 0%; very low-quality evidence). Nor did any evidence suggest a difference between the two interventions in hot flush severity, measured using the Kupperman Index (MD -1.32, 95% CI -5.06 to 2.43, two studies, 72 participants, I2 = 0%; very low-quality evidence).

The other two studies found no clear evidence of a difference in hot flush frequency between relaxation and paced respiration, placebo or no treatment. The data for these comparisons were unsuitable for analysis.

None of these studies reported night sweats, sleep disturbances associated with night sweats or adverse effects as an outcome.

The main limitations of identified evidence were lack of data, imprecision and failure to report study methods in adequate detail.

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