A small Dutch study suggests that a specific type of online therapy, called internet-based cognitive behavioral therapy, can help reduce the toll of hot flashes, night sweats, and other menopausal symptoms caused by breast cancer treatments.
The research was published online on Feb. 14, 2019, by the Journal of Clinical Oncology. Read the abstract of “Efficacy of Internet-Based Cognitive Behavioral Therapy for Treatment-Induced Menopausal Symptoms in Breast Cancer Survivors: Results of a Randomized Controlled Trial.”
Breast cancer treatment and menopause
Most women go through menopause as a natural part of the aging process, around age 51 on average — some sooner, some later. But if you’ve been diagnosed with breast cancer before menopause, some of your treatments, including chemotherapy and hormonal therapy medicines, could bring on menopause more quickly and more abruptly than you expected. This is called medical or surgical menopause, or induced menopause.
Breast cancer treatment-induced menopause causes a sudden shift within the body — lowering hormone levels within days or weeks instead of years. Symptoms may come on more abruptly than they would with a more gradual, natural menopause.
For some women, menopausal symptoms such as hot flashes, night sweats, and sleeping problems can be severe and dramatically affect their quality of life.
In search of relief, some women consider hormone replacement therapy (HRT), which can help these symptoms. But because HRT contains estrogen or a combination of estrogen and progesterone, which can make breast cells grow, it is not recommended for women who have been diagnosed with breast cancer.
So researchers are looking for other ways to control menopausal symptoms that don’t use hormones.
About the study
The study included 254 women age 50 or younger at the time they were diagnosed with breast cancer. All the women had had one or more of the following treatments:
- ovary removal
- hormonal therapy
All the women reported problematic hot flashes and/or night sweats.
The women were randomly assigned to one of three groups:
- One group (85 women) went through a self-guided online cognitive behavioral therapy program. The program was 6 weeks long and focused on easing hot flashes and night sweats, as well as stress management and sleeping problems. The program was made up of six modules, each of which included self-reflection, education, and assignments. The assignments were done as part of the module and also as homework. The women also used a diary app to record their hot flashes and night sweats. Education was provided in printed materials and as video clips from medical experts and other women diagnosed with breast cancer with similar symptoms. The average amount of time to complete a module was about an hour per week, plus 30 minutes per day to do the relaxation and homework assignments. Weekly reminders were sent out to encourage the women to continue to use the program.
- The second group (85 women) went through the same program but were guided by a therapist. Each woman in this group was interviewed by telephone before the program started and was given written feedback on the program each week. The feedback was provided by the therapists, who could read the women’s online diary entries about hot flashes and night sweats.
- The third group (84 women) was the control group. These women were told they were assigned to a waiting list for the online cognitive behavioral therapy program. These women received the usual care, which didn’t include any specific programs for easing menopausal symptoms.
The researchers assessed the women’s menopausal symptoms using a questionnaire before the study started, and again 10 weeks and 24 weeks after the study started.
Compared to the women in the control group, women in both the self-guided and therapist-guided internet-based cognitive behavioral therapy groups had a decrease in how much hot flashes and night sweats were affecting them. They also had better sleep quality. These differences were statistically significant, which means that they were likely due to the difference in therapy programs and not just because of chance.
Women in both of the cognitive behavioral therapy groups also had more improvement in overall levels of menopausal symptoms compared to women in the control group.
The researchers concluded that “…the [internet-based cognitive behavioral therapy], with or without therapist support, has a positive effect on the perceived impact of hot flashes and night sweats, overall levels of menopausal symptoms, sleep quality, and frequency of hot flashes and night sweats.”
What this means for you
While this study was small, the results are very encouraging and suggest that online cognitive behavioral therapy may be a good option for younger women who are struggling with hot flashes, night sweats, and other menopausal symptoms after breast cancer treatment.
While an online program doesn’t allow you to establish the same personal relationship with a therapist that you can develop by sitting in the same room together, online therapy may be a more convenient and private choice for some women. Online therapy also may be available to more women, including women who can’t travel to in-person therapy.
If you’re having problems with hot flashes or other menopausal symptoms because of breast cancer treatment, you may want to talk to your doctor about this study. Ask your doctor if she or he can recommend an online cognitive behavioral therapy program that might be right for your unique situation. You also may want to ask others on your medical team if they know of programs that are available.
For more information, visit the Breastcancer.org Managing Menopausal Symptoms pages.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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