Mindfulness and Menopause- A Review

Mind-body therapies hold several advantages from the viewpoint of divurity, fulfilment, implementation and possible ancillary social and psychological health benefits. Side effects and risks of mind-body practice are generally nominal, implementation costs are little and most mind-body therapies can be performed by a broad range of populations, including overweight and sedentary menopausal women. The use of mind-body therapies for the alleviation of a menopausal symptoms is becoming increasingly common because of the perceived therapeutic benefits. The practice of mindfulness allows the participants to be aware of the present moment without concern for past or future consequences. Several researchers have discovered that being mindful may be helpful for menopausal women struggling with irritability, anxiety and depression. The purpose of this article aimed at reviewing the literature which studies the impact of the mindfulness-based training on menopausal symptoms among women during their climacteric period. Many midlife women try out practices like relaxation techniques, breathing exercises and yoga to help them get through these difficult times during their transitional period of life. Although these daily practices probably do not relieve symptoms such as hot flashes, they might improve overall wellbeing and help them sleep better. The literature was searched using databases such as CINAHL, Pub Med, Pro-Quest and Google scholar. The search terms used were: menopause, menopausal symptoms, mindfulness, quality of life and midlife transition. In India, the practice of mindfulness is not very well known among the menopausal women, so the aim of this review was to show a pathway to the primary health care workers like physicians, counsellors and the nurses, who can guide them about the practice of mindfulness thereby improving the quality of life.

Menopause is a normal occurrence in the life of every woman and it marks the end of a woman’s reproductive phase [1]. It has been estimated that the average age of onset of menopause of women in India is 47.5 years and they have an average life expectancy of 71 years [2]. The number of post-menopausal women has increased in the world because of the enhanced lifestyle practices [3]. As per the statistics of the United States in 2000, 27% of the population consist of women 45 years and older, whereas now it is estimated to be increased to 38% [3]. According to the Indian National Family Health Survey carried out between 2005-2006, nearly 18% of currently married women are in the age group of 30-49 years and has reached menopause [4]. In 2030, nearly half of female will become post-menopause and by 2060, the proportion of post-menopausal women will be increased up to 59.8% [5]. The Population Projections Survey in India in the year 2006 estimated that the number of women aged 45 years and above is expected to reach 401 million in 2026 [6]. Whereas, the median age at natural menopause among Caucasian women in Western society is 50 years [7]. Hot flashes and night sweats are among the most common and troubling menopausal symptoms associated with physical discomfort, disturbances in sleep, mood changes including increased anxiety, irritability, depressive symptoms, fatigue and musculoskeletal pain are generally reported by the menopausal women [8]. These facts necessitate the need to understand and address the concerns of the post-menopausal women to lead a healthy and happy life. Non-hormonal medications, complementary and alternative therapies are used by many women seeking relief from troublesome hot flashes. Mind-body therapies used for menopausal symptoms are relaxation and stress-reduction therapy, Mindfulness-Based Stress Reduction (MBSR), cognitive behaviour therapy, hypnosis, relaxation training, biofeedback, imagery, yoga, meditation, breathing exercises and progressive muscle relaxation [9]. Since, a large number of women seek relief from menopausal symptoms particularly to improve the physical and psychological symptoms, the goal of this review was to highlight current evidence of a mind-body approach to help the health care professionals to provide evidence-based advice as they discuss therapeutic options with menopausal women.

MBSR is a multi-component program and it was first framed by Jon Kabat-Zinn at the University of Massachusetts, Medical Center in 1979 [10]. Since then it has become a basic component in hospital based ‘integrative’ medical clinics. From the time when the MBSR program was systematised and widely used in hospital settings, it has also been widely studied to find its use and effects [11]. This program has eight techniques during which the facilitator provides instruction related to the meditation. The technique includes various types of meditation in the form of breathing meditation, body scan meditation, hatha yoga postures, raisin and sitting meditation. MBSR combines the ancient practices of yoga and mindfulness meditation to cultivate awareness and reduce stress [12]. The standardised curriculum for MBSR includes an eight weeks program which includes one and half hours of weekly sessions (every Monday) and the rest of the days the participants will practice the guided instructions with the help of audio clippings at home for 45 minutes [13].

The time required: 15 Minutes

Instructions: During the exercise, the participant may get distracted by thoughts that are normal and natural. Once you are noticed you are getting distracted by thoughts you can gently bring the attention to the breathing exercise.

The time required: 30 Minutes

Instructions: Raisin meditation includes 7 stages. The participants should spend a minimum of 4 minutes on each of the following stages.

Holding: Take one of the raisins and hold it in the palm of your hand.

Seeing: Look at the raisin with great care and full attention.

Touching: Turn the raisin over between your fingers and explore its texture,

Smelling: Now hold the raisin beneath your nose.

Placing: Slowly consume the raisin and observe how hand and arm to understand the exact place in the mouth.

Chewing: Consciously, take a bite to the raisin and feel the texture as your teeth bite into it.

Swallowing: Observe, if you can identify the first intention to swallow as it arises in your mind.

The time required: 20 Minutes

Instructions: Sit upright and gently close the eyes. Begin the meditation by bringing a present attention to whatever you feel within you and around you.

The time required: 20 Minutes

Instructions: During the meditation, if mind wanders concentrate on thoughts and identify which thoughts have deviated the mind then slowly bring the attention on breathing pattern.

The time required: 40 minutes

Instructions: Try to stay awake during the process of meditation. Allow yourself to be exactly just the way you are. Remember there is no right way to feel.

The time required: 25 Minutes

Instructions: You are reminded to use your breath as an anchor to bring yourself to the present moment on getting distracted.

The time required: 10 minutes

Instructions: Both the feet will use for the exercise and notice the sensations in the muscle of your legs as they swing forward. On getting distracted you are allowed to permit yourself to stop, take a moment, and pay attention to the thought, sight, or whatever distracted you and then continue to walk again.

The time required: 15 minutes

Time: whenever you are relaxed

Instructions: Keep your body as loose as possible. Do deep breathing. Be calm and peaceful. It begins with three timer rings, paused for 15 minutes in silence and ends with three timer rings. After this, when you feel like slowly open your eyes.

The present review considered two types of studies which included Prospective randomised controlled trials and Trials published in the English language. The literature searched for the studies conducted among menopausal women and also looked for interventions like Mindfulness, MBSR and Cognitive behaviour therapy.

There have been numerous studies on the benefits of mindfulness on the menopause. Revealed that being mindful is useful for menopausal women stressed with irritability, nervousness, difficulty in getting sleep and hopelessness [11,13]. Few research studies clearly showed a significant reduction in the psychological and somatic vegetative symptoms among menopausal women after attending the MBSR session [11,14].

A study conducted by Carmody J et al., concluded that MBSR training demonstrated positive effects on anxiety and irritability, although the study results were unable to replicate any positive effects on vasomotor symptoms like hot flashes and night sweats [11]. The study results were consistent with another study conducted by Sood R et al., which showed that mindfulness practice helped the participants to approach their thoughts and feelings in a non-reactive manner, which facilitated a healthier relationship when they were under stress. Besides, the results correlated with positive behaviours and outcomes, reduction in cognitive decline, and lower depressive symptoms [14]. Regarding the supporting role of mindfulness in emotion regulation, Sood R discovered that being mindful is helpful for menopausal women struggling with irritability, anxiety, and depression. The results showed that, there is an association between the increased mindfulness scores and decreased menopausal symptoms such as irritability, depression, and anxiety among the menopausal women [15].

A study conducted by Van Driel CM et al., on MBSR for menopausal symptoms after hysterectomy and the findings proved that MBSR was effective at improving quality of life in the subscale of vasomotor symptoms like hot flashes, night sweats and sweating and in the subscale of physical symptoms like burden caused by stamina reduction, aches, urination frequency among menopausal women after hysterectomy [16]. Similar findings were shown in a study conducted by Wong C et al., who found that the mindfulness training program had a significant effect on reducing the vasomotor symptoms such as hot flashes and night sweats among menopausal women [17]. Besides, Suhaila L observed that MBSR training teaches the participants to sit with pain or discomfort in a non-reactive way and the study findings reported that the MBSR training program has contributed to lower the intensity of hot flashes [18]. However, the findings were not able to show a statistical significance. MBSR training improved capacity among participants to deal with symptoms arising in the body during a hot flash [18]. Carmody J et al., conducted a pilot study of MBSR for hot flashes and the results showed that women’s scores on quality of life measures increased significantly and the average occurrence of a hot flush severity score per day has come down to 40% over 11 weeks of the appraisal period [19]. A study conducted by Garcia MC et al., concluded that post-menopausal women with difficulty in getting sleep are less mindful than menopausal women with no sleep irregularities [20].

University of Massachusetts Medical Centre reported a 40% reduction in the vasomotor symptoms like hot flashes and night sweats among participants after attending the MBSR session [11]. The menopausal women also reported that after attending the MBSR program, they are less bothered by their symptoms, thus enhancing their sense of well-being [11].

Mindfulness techniques like deep breathing and being focused helps the menopausal women to reduce the intensity of hot flashes, stress anxiety and irritability which come with menopause. Mind-body approaches such as MBSR and cognitive behaviour therapy may improve the frequency and severity of vasomotor and psychological symptoms of menopause, thus enhancing the quality of life and experience during the midlife period.

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