CBT for menopause

CBT, cognitive behavioural therapy, is a short talking therapy. Women's Health Concern describes it as working on the links between four things: physical symptoms, thoughts, feelings and behaviour. How you think about a symptom shapes how you feel and what you do, and those reactions can make the symptom itself feel stronger.

Menopause-specific CBT was built for hot flushes, night sweats and sleep disruption. The British Menopause Society describes it as covering stress and wellbeing, flushes, sweats and sleep over a few weeks, in a self-help book or a small group. In the UK, it says, GPs, counsellors, psychological wellbeing practitioners and trained nurses can deliver it.

It is not a medicine. Women's Health Concern says it can be used on its own or alongside HRT.

The Women's Health Concern fact sheet walks through skills like these.

Paced breathing comes first: slow, even breathing from the stomach, practised daily so it is there when you need it. At the start of a flush you drop your shoulders, breathe slowly and let it pass over you.

Then catching the thought. A flush starts and the mind says everyone is looking, I cannot cope. You learn to notice that thought and answer it with a calmer one, such as: this will pass, and people notice it far less than I do.

Then staying put. Leaving the room teaches you that you could not have managed. Staying, where you can, teaches you that you did.

For nights, simple sleep habits and a calm routine for a night sweat: get up, cool down, breathe, back to bed, and leave the worrying for the morning.

NICE NG23 names three situations where CBT can be considered: hot flushes and night sweats (1.5.2), low mood that does not meet the criteria for depression and comes with flushes (1.5.22), and sleep problems that come with flushes (1.5.24). It asks doctors to explain what CBT is and the options: face to face or remote, alone or in a group, or self-help (1.4.4). The BMS tool covers anxiety as well.

The Menopause Society, in the US, recommends CBT for bothersome hot flushes and rates the evidence as strong, both for women at menopause and for women who have had breast cancer.

The Pakistan Menopause Society's recommendations say CBT, stress management, support groups and education all play an important role in mood symptoms around the menopause (section 7.2).

CBT is an option, not a substitute you have to accept. NICE NG23 lists it alongside HRT, or for women who cannot take HRT or would rather not. It is one of the non-hormonal treatments.

It is not magic either. NICE's appraisal of fezolinetant recorded patient and clinical experts saying CBT does not reduce physical symptoms for many people, and that it can be hard to get, with long waiting lists (TA1143, section 3.2). Worth knowing before you start.

On antidepressants, NICE NG23 says SSRIs and SNRIs, and clonidine, should not routinely be offered first for hot flushes on their own (1.5.4). See SSRIs for menopause.

If your mood has been low for weeks, you have lost interest in things you used to enjoy, or worry is running your days, see a doctor. The PMS recommendations ask doctors to screen for depression and anxiety at menopause appointments with short questionnaires (section 4.2.4.6), and say women with past depression or anxiety are at higher risk of it getting worse during this time (section 7.2).

The BMS notes that mental health is not really talked about in South Asian communities, so saying yes to therapy can feel like a big step. It helps to know what it is: skills, not a verdict.

The PMS recommendations describe daily Islamic practices, salah, dhikr and dua, as built-in ways of steadying emotions (section 4.2.4.7). For many women, faith is already part of how they cope. They also ask doctors to involve family in counselling, because in Pakistan's family-centred culture support from a husband and family strongly shapes how a woman looks after her health (section 4.2.4.4).