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Introduction
The menopause transition can cause psychological and somatic disturbances in a woman's life, with more than 75% of women experiencing menopause-related symptoms (Gartoulla, Bell, Worsley, & Davis, 2015). Menopausal symptoms may continue for 4–10 years, with around 25% reporting problematic symptoms that affect the quality of life (QoL) (Avis et al., 2015; Ayers & Hunter, 2013). Menopausal symptoms affect 65–85% of women treated for breast/ovarian cancer, and often occur while women are still adjusting to the effects of cancer treatment (Gupta et al., 2006). In cancer survivors, menopausal symptoms can reduce adherence to endocrine therapy if left untreated.
Hormone replacement therapy (HRT) is an effective treatment for menopausal symptoms (Maki, Girard, & Manson, 2019). However, HRT also has side effects, and its influence on breast cancer remains unclear (Beral, Peto, Pirie, & Reeves, 2019; Chlebowski et al., 2020). Other medications for menopausal symptoms, including gabapentin, clonidine, and selective serotonin reuptake inhibitors, show mild to moderate effects (Rada et al., 2010), but have bothersome adverse effects such as gastrointestinal problems, addiction, and relapse when medication is discontinued (Hervik & Stub, 2016; Nelson et al., 2006). For some non-pharmacological therapies (e.g. magnetic devices or acupuncture), a Cochrane review concluded that outcomes were either inconsistent or not statistically significant (Hickey, Szabo, & Hunter, 2017).
Non-hormonal options to decrease menopausal symptoms include cognitive therapy and behavior therapy (CTBT) such as cognitive behavioral therapy (CBT), relaxation therapy (RT) and mindfulness-based therapy (MBT). CTBT is an effective psychological treatment, and the approach has been refined recent (Furukawa et al., 2021). Dozens of randomized controlled trials (RCTs) have shown that CTBT was effective in treating women with menopausal symptoms, but there was heterogeneity between the studies. One study reported that there was a significant improvement in overall levels of menopausal symptoms at both post-treatment and long-term follow-up (Atema et al., 2019). However, another study recorded no significant difference between the intervention group and control group with regard to the hot flush frequency at follow-up (Mann et al., 2012).
One meta-analysis has evaluated the effect of CTBT on menopausal symptoms; this search was conducted in June 2017 (Van Driel, Stuursma, Schroevers, Mourits, & de Bock, 2019). However, this meta-analysis excluded internet-based therapeutic trials, and potentially important between-study differences remained unexplored, including participants,...