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Applied relaxation as treatment of vasomotor symptoms in postmenopausal women
Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Vasomotor symptoms often disturb the night sleep and may lead to tiredness and mood disturbances. Many women who suffer from vasomotor symptoms ask for medical help and are often prescribed hormonal treatment. During the last years the popularity of HRT among women and doctors has decreased, probably because of the findings of long-term risks of HRT on breast cancer and the fact that the positive effects on cardiovascular health has not been confirmed in prospective randomized studies. The most effective treatment for hot flushes is HR T but for various reasons there is a need for developing alternative treatments. Relaxation therapy and behavioral therapies have been suggested for vasomotor symptoms but there are few randomized, controlled studies in this field, especially in women with breast cancer.

The general aim of this thesis was to evaluate a technique in behavior therapy, applied relaxation, as a possible treatment of vasomotor symptoms in healthy women and women treated for breast cancer.

The specific aims were:

• to assess if stress coping differed between postmenopausal women, who wanted therapy for vasomotor symptoms and postmenopausal women without symptoms and to assess if stress coping changed when women with vasomotor symptoms received estrogen therapy. 18 women were recruited to the target group and 17 women to the comparison group

• to evaluate if training applied relaxation for 12 weeks would decrease the number ofvasomotor symptoms and to evaluate if applied relaxation for 12 weeks would affect wellbeing in postmenopausal women seeking medical advice for vasomotor symptoms. 30 postmenopausal women were recruited and randomized to applied relaxation or estrogen therapy. In this study we also aimed to compare applied relaxation and estradiol as treatment of vasomotor symptoms in healthy postmenopausal women and also to compare the effects of applied relaxation and estradiol on wellbeing in healthy postmenopausal women

• to evaluate if applied relaxation or electro-acupuncture for 12 weeks would decrease the number of vasomotor symptoms in postmenopausal women treated for breast cancer and to evaluate if applied relaxation or electro-acupuncture for 12 weeks would affect wellbeing in postmenopausal women treated for breast cancer. 38 women with breast cancer and with moderate to sever vasomotor symptoms were recruited.

The main results were: Postmenopausal women bothered by vasomotor symptoms had significant lower stress coping ability measured with SCI, than women without symptoms.

Eleven out of 12 healthy postmenopausal women randomised to treatment with applied relaxation had a mean decrease of flushes about 77% six months after end of therapy. The reduction was significant and persisted six months after end of therapy. General psychological wellbeing and mood were significantly ameliorated in healthy postmenopausal women treated with applied relaxation.

Ten out of 14 breast cancer treated women randomised to treatment with applied relaxation had a mean decrease of flushes with 78 %. General psychological wellbeing was significantly ameliorated and this phenomenon appeared after the flushes were significantly reduced. Both the significant reduction of flushes and significantly ameliorated wellbeing persisted 6 months after end of therapy.

In summary: This thesis shows that that behavioral therapy with applied relaxation significantly decreases flushes and ameliorates general psychological wellbeing in postmenopausal women bothered by climacteric symptoms. Therefore we suggest that applied relaxation is a viable alternative treatment of vasomotor symptoms in healthy postmenopausal women and in women treated for breast cancer.

Place, publisher, year, edition, pages
Linköping: Linköping Universitet , 2005. , 88 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 900
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-30120Local ID: 15595ISBN: 91-85299-13-8 (print)OAI: oai:DiVA.org:liu-30120DiVA: diva2:250941
Public defence
2005-09-22, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved
List of papers
1. The relationship between stress-coping and vasomotor symptoms in postmenopausal women
Open this publication in new window or tab >>The relationship between stress-coping and vasomotor symptoms in postmenopausal women
1998 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 31, no 1, 29-34 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The objective was to assess whether menopausal women with vasomotor symptoms had a lower stress-coping than menopausal women without symptoms and if stress-coping changed when vasomotor symptoms had been effectively treated with estrogens. The objective was also to assess whether menopausal women, effectively treated for vasomotor symptoms, had a higher neuroticism score than women without such symptoms.

Methods: Two groups of physically and mentally healthy postmenopausal women were recruited from the outpatient clinic at the Department of Obstetrics and Gynaecology, University Hospital of Linköping, Sweden. Sixteen women with vasomotor symptoms (target group) were treated with oral 17β-estradiol, 2 mg/day during 3 months. A comparison group was formed comprising 17 women without vasomotor symptoms. The Kupperman Index was used to cover menopausal characteristics in all women at baseline as well as at the second visit after 3 months. Stress-coping was measured by means of the Stress Coping Inventory, which is an instrument developed to measure of the individual's appraisal of having adaptive resources for handling stressful situations. At the second visit all women were also asked to complete the Eysenck Personality Inventory.

Results: Women in the target group had a significantly lower stress-coping than women in the comparison group at baseline as well as after 3 months. Stress-coping did not change after estrogen therapy, although the vasomotor symptoms had virtually disappeared. Women in the target group successfully treated for vasomotor symptoms, had a significantly higher neuroticism score compared to the comparison group.

Conclusions: Differences in behaviour patterns and personality are probably two reasons why some women report or seek advice due to vasomotor symptoms and some women do not. Stress-coping in women with moderate to severe vasomotor symptoms is unaffected by estrogens.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-83011 (URN)10.1016/S0378-5122(98)00058-9 (DOI)
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved
2. Treatment of menopausal symptoms with applied relaxation: a pilot study
Open this publication in new window or tab >>Treatment of menopausal symptoms with applied relaxation: a pilot study
1997 (English)In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 28, no 4, 251-261 p.Article in journal (Refereed) Published
Abstract [en]

Applied relaxation (AR) was tested in a series of six women with postmenopausal hot flushes. The AR program consisted of group instructions I hour per week over a 12 week duration. The number of flushes were registered from 1 month before to 6 months after training AR. Menopausal symptoms (Kupperman Index), psychological well-being (Symptom Checklist), and mood (MOOD Scale) were measured at various moments during the study. For the six patients the number of flushes decreased from the baseline period to 6 months follow-up with 59, 61, 62, 67, 89 and 100% respectively, in mean 73%. While the scores on the Kupperman Index and the Symptom Checklist followed the pattern of the flushes, a similar trend was not seen for the scores on the MOOD Scale.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-83012 (URN)10.1016/S0005-7916(97)00030-X (DOI)
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2017-12-07Bibliographically approved
3. Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women
Open this publication in new window or tab >>Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women
2005 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 51, no 2, 154-162 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to evaluate and compare the effects of applied relaxation and oral estradiol treatment on hot flushes, mood and psychological wellbeing in postmenopausal women.

Patients and methods: In a prospective study, 30 postmenopausal women with vasomotor symptoms were randomized to applied relaxation or oral estradiol treatment during 12 weeks with 6 months follow-up. Number and severity of flushes were registered daily and Kupperman’s Index and a general estimate of climacteric symptoms, Mood Scale and Symptom Check List were completed at baseline, 4, 8 and 12 weeks of treatment, and 3 and 6 months after therapy.

Results: After 12 weeks of treatment, the number of flushes/24 h decreased significantly over time in both treatment groups. In the group receiving applied relaxation, the mean number of flushes/24 h decreased from 6.0 (95% CI 4.5–7.6) to 3.0 (95% CI 2.1–3.9) after 12 weeks of treatment. The mean number of flushes/24 h was 1.7 (95% CI 0.7–2.5) at 6 months follow-up; i.e. a 72% decrease. In the estrogen group, the mean number of flushes/24 h decreased from 8.4 to 0.8; i.e a 90% decrease in the number of flushes after 12 weeks of treatment. The significant change in flushes reached after 12 weeks of treatment and remained to 6 months after end of treatment in both groups. Estrogen therapy reduced flushes significantly faster than applied relaxation. General climacteric symptoms according to the Visual Analogue Scale and the Kupperman’s Index decreased significantly over time in both groups. General mood (Mood Scale) increased significantly in the estrogen group, but not in the group receiving applied relaxation. Psychological wellbeing according to Symptom Checklist, increased significantly from baseline to 12 weeks in both groups.

Conclusions: We suggest that applied relaxation may be used as an alternative treatment of vasomotor symptoms for postmenopausal women but should be further evaluated.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29369 (URN)10.1016/j.maturitas.2004.05.017 (DOI)14701 (Local ID)14701 (Archive number)14701 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
4. Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study
Open this publication in new window or tab >>Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study
2005 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 8, no 3, 243-250 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effect of applied  relaxation and electro-acupuncture on vasomotor symptoms in women treated for breast cancer.

Methods: Thirty-eight postmenopausal women with  breast cancer and vasomotor symptoms were randomized to treatment with electro-acupuncture (n = 19) or applied relaxation (n = 19) during 12 weeks. The number of hot flushes was registered daily in a logbook before and during treatment and after 3 and 6 months of follow-up.

Results: Thirty-one women completed 12 weeks of treatment and 6  months of follow-up. After 12 weeks of applied relaxation, the number of flushes/24 h had decreased from 9.2 (95% confidence interval (CI) 6.6-11.9) at baseline to 4.5 (95% CI 3.2-5.8) and to 3.9 (95% CI 1.8-6.0) at 6 months follow-up (n = 14). The flushes/24 h were reduced from 8.4 (95% CI 6.6-10.2) to 4.1 (95% CI 3.0-5.2) after 12 weeks of treatment with electro-acupuncture and to 3.5 (95% CI 1.7-5.3) after 6 months follow-up (n = 17). In both groups, the mean Kupperman Index score was significantly reduced after treatment and remained unchanged 6 months after end of treatment.

Conclusion: We suggest that applied relaxation and  electro-acupuncture should be further evaluated as possible treatments for vasomotor symptoms in postmenopausal women with breast cancer.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2005
Keyword
Vasomotor symptoms; Menopause; Breast cancer; Applied relaxation; Acupuncture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-11901 (URN)10.1080/13697130500118050 (DOI)
Note
Original publication: E. Nedstrand, K. Wijma, Y. Wyon, M. Hammar, Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study, 2005, Climacteric, (8), 3, 243-250. http://dx.doi.org/10.1080/13697130500118050. Copyright © Taylor & Francis Group, an informa businessAvailable from: 2008-05-23 Created: 2008-05-23 Last updated: 2017-12-13
5. Psychological wellbeing ameliorates in women with breast cancer randomized to treatment with applied relaxation or acupuncture for vasomotor symptoms
Open this publication in new window or tab >>Psychological wellbeing ameliorates in women with breast cancer randomized to treatment with applied relaxation or acupuncture for vasomotor symptoms
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The aim of this study was to evaluate effects of applied relaxation and electro-acupuncture on psychological wellbeing in breast cancer treated women with vasomotor symptoms. Thirty-eight postmenopausal women with breast cancer and vasomotor symptoms were included in the study. They were randomized between treatment with elcctro-acupuncture (n=19, three of them with tamoxifen) or applied relaxation (n=19, five of them with tamoxifen) during 12 weeks with six months follow-up. Vasomotor symptoms were registered daily and a visual analogue scale on climacteric symptoms as well as estimates of general wellbeing using the Symptom Checklist and mood by the Mood Scale, were completed during treatment and follow-up.

Totally 31 women completed 12 weeks of treatment and 6 months of follow-up. Hot flushes were reduced by more than 50 percent. Climacteric symptoms significantly decreased after treatment and remained so 6 months after treatment in both groups. Simultaneously with the decrease of flushes, psychological wellbeing was significantly ameliorated throughout the study period in both groups. Mood changed significantly in the acupuncture treated group.

In conclusion psychological wellbeing ameliorates in women with breast cancer randornized to treatment with applied relaxation or acupuncture for vasomotor symptoms.

Keyword
Vasomotor symptoms, menopause, breast cancer, applied relaxation, acupuncture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-83191 (URN)
Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2012-10-02Bibliographically approved

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