An integrative cognitive-behavioural model of menopausal hot flushes and night sweats

© 2017 Dr. Valerie Michelle BrownThe menopause, which marks the end of a woman’s reproductive period, is universal, but the experience of its hallmark symptom, hot flushes and night sweats, also referred to as vasomotor symptoms (VMS), varies significantly across cultures and between women of the same culture. Despite evidence that thoughts and emotions play an important role in the perception of VMS, little research has focused on the filtering role of menopausal schema and how women’s cognitive style may contribute to those schemas. The main objective of this thesis, which focused on women from a Western culture, was therefore to better understand women’s cognitions about the menopause and VMS, in the context of a negative historical narrative of the menopause, ageism and widespread stereotypes about menopausal women. Another main objective was to develop an integrative cognitive-behavioural model, that would help us better understand the VMS experience. This thesis postulated that certain cognitions would confer women a vulnerability to experience VMS more negatively. Leventhal’s Self-Regulated Model of illness (SRM), was partly used as a theoretical framework to test how women’s cognitive style may influence their menopause representations, and, in turn, how these representations may affect the coping strategies women use and VMS appraisals. The study involved a cross-sectional prospective survey of an Australian community sample of 517 pre-, peri- and postmenopausal women, aged between 40 and 60 years old. A subset sample of women who had entered the menopause and were experiencing VMS at the time of data collection (n = 171) was used for the model testing. The survey included seven measures of cognitive factors, identified as potential vulnerabilities (anxiety sensitivity, catastrophic thinking, depressive symptoms, negative affect, control beliefs, body consciousness, and perceived stress), measures of menopausal symptoms and beliefs, three measures of behavioural coping (positive strategies, cooling and avoidance) was also included, as well as three subjective measures of VMS appraisal (perceived frequency, bothersomeness and daily interference). The main results of the study revealed that women’s cognitive and emotional representations of the menopause (MR) were generally neutral to positive. Overall, the menopause representations were significantly more positive for postmenopausal women than for pre- or perimenopausal women. Avoidance coping was used more often by women who scored more negatively on cognitive factors and had a more negative MR, and was associated with more negative VMS appraisals. Similar patterns were found for cooling, and opposite patterns for positive strategies. Results also showed partial support for the mediational model as outlined in the SRM. Findings from two competing models (MR-Coping-VMS appraisals and MR-VMS appraisals-Coping), however, revealed that, overwhelmingly, the direct effects were stronger between MR and VMS appraisals than between MR and coping strategies, while the opposite was true for the indirect effects. The tested integrative cognitive-behavioural model of vasomotor symptoms, which had excellent fit indices, showed that control beliefs, catastrophic thinking, depressive symptoms and perceived stress influenced MR (explaining 45% of the variance), which in turn predicted all three measures of VMS appraisals. Catastrophic thinking and control beliefs also had strong direct effects on bothersomeness, while perceived stress directly influenced daily interference. Bothersomeness strongly predicted daily interference, and direct effects were also found from frequency onto bothersomeness, but not daily interference. Together these factors contributed to 14% of the variance in frequency, 59% in bothersomeness, and 65% in interference. Avoidance coping was predicted by catastrophic thinking and daily interference (44% of variance explained), positive behaviour by both MR and body consciousness (22% of variance explained), and cooling only by bothersomeness (11% of variance explained). The results of this study highlight women’s resilience in displaying neutral to positive MR, and suggest that MR may improve as women transit through the menopausal stages. The findings also extend previous studies by highlighting the impact of distinct cognitive factors in influencing MR and its mediation role, the relationships between VMS appraisals, and the relationships between cognitive factors, coping strategies and VMS appraisals. These results improve our understanding of psychological factors that influence the menopause experience, and will assist researchers in developing cognitive-behavioural therapy that will enable women to manage VMS more effectively