CBT and menopause: can it help?

Could Cognitive Behavioural Therapy help manage your symptoms?

It’s quite a mouthful, but don’t be put off by the term ‘Cognitive Behavioural Therapy’. Often known simply as CBT, the NHS defines it as a talking therapy. Essentially, it means analysing what you think (cognitive) and do (behavioural). And in turn, changing the way you think and behave can help you better manage certain aspects of your life.

CBT is based on the concept that our thoughts, feelings, and actions are linked. Consequently, how we feel and think affects how we behave. It makes sense, therefore, that our negative thoughts and feelings can trap us in a vicious cycle of thinking and acting in a certain way.

But how can this help me during menopause?

For some, dealing with menopausal symptoms can be very stressful. We are also often coping with other life challenges, such as elderly parents, adolescent children, children leaving home, or work demands. These stress-induced thoughts and feelings can influence our actions, and lead to us feeling out of control.

Here’s where CBT can help to make a difference. For example, many women find they have disturbed sleep during the menopause transition. In fact, 50-70% experience hot flushes and night sweats. CBT has been shown to have a positive impact on these women’s ability to deal with these episodes.

Clinical trials of group CBT have been undertaken with women following breast cancer treatment, who reported that their hot flushes and night sweats had a significant detrimental effect on their lives. Following their attendance at group CBT sessions, 78% of the women registered a clinically significant reduction in their hot flushes and night sweats. This was compared with the group who received the usual care given, who reported only a 33% reduction in their symptoms. Also, at the completion of the trial, the CBT group continued to report significant improvements in mood, sleep, and quality of life.

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How does it work?

This is essentially CBT in action, helping people develop practical ways of managing problems. As you can apply these skills to all aspects of life, many people often find it improves their overall wellbeing, as well as the problem at hand.

In terms of hot flushes, CBT won’t instantly stop a hot flush from happening. But by changing your thoughts and behaviours during a hot flush, it can help you remain calm. And as one of the contributing factors to the exacerbation of hot flushes and night sweats is stress, it stands to reason keeping calm while you’re dealing with them can help.

CBT can help you to find ways to reduce these negative thoughts and develop calmer responses so you feel more in control and more able to cope. Paced breathing is a good example of this. Here, you focus on your breathing and accept that you will cope and the hot flush will pass by allowing the hot flush to pass over you.

The rhetoric you use in your thoughts is also important. For example:

Instead of “Oh no I can’t cope” an alternative thought could be “Let’s see how well I can deal with this one. I’ll just take one flush at a time, and use my paced breathing.”

“Everyone is looking at me” could change to “I will notice my flushes more than other people, they may not even notice.”

Turn “I am out of control” into “There are things I can do to take control.”

Change “I’ll never get back to sleep” to “This night sweat will pass, and I will get back to sleep.”

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By reframing your thoughts, you can alter your response to the situation, which is a powerful tool to have at your disposal. Ask: “Is my initial thought really accurate? What would a close friend/family member say to me? What would I say to them if they were having a hot flush?”

You can also review your reaction to an event. Is avoiding all social situations an appropriate reaction to having a hot flush?

CBT and other symptoms

While the hot flush is often the poster symptom for menopause, many women are often surprised by the psychological symptoms they can experience, such as anxiety, low mood, loss of confidence and problems with memory recall.

CBT has also proven to be very effective in dealing with psychological symptoms. In fact, The National Institute for Care and Health Excellence (NICE) recommends considering it to alleviate low mood and anxiety.

Anxious thinking tends to overestimate the likelihood of the worst-case scenario happening, and underestimate our ability to cope. In turn, this leads to an increase in feelings of anxiety.

The use of cognitive and behavioural strategies can help you develop a calmer view of a situation and to respond in a more helpful way. It can also be beneficial when examining your thoughts, feelings and reactions to write down how you are feeling during a time of stress and anxiety.

From here, you can identify a typical anxious thought and consider whether this is overly negative, overestimating the threat or underestimating your ability to cope. You could also try reviewing your behavioural responses to anxiety and stress. Are you working longer hours, eating or drinking too much, or avoiding certain people or activities? Are these healthy responses? Could you find a more appropriate response?

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Think about what behaviours make you feel calmer or more relaxed. This could be yoga, going for a walk, exercise, calling a friend, reading a book, or gardening, for example. Try to do more of these activities, even for a short time every day. Pace them throughout the day to get a happy balance between rest and activity.

CBT in practice

Cognitive Behavioural Therapy is delivered by a therapist and it is important that you only use a qualified and competent practitioner. The British Association for Counselling and Psychotherapy holds a register of qualified professionals who meet and exceed recommended minimum quality standards.

You can learn CBT either one to one or in a group setting,  face to face, over the phone and, more recently, via text messages. The NHS suggest you will usually have a session with a therapist once a week or once every two weeks. A course of treatment usually lasts between five and 20 sessions, with each session up to an hour.

Resources

References

Mann E, Smith MJ, Hellier J, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol. 2012;13(3):309‐318. doi:10.1016/S1470-2045(11)70364-3

Ayers B, Smith M, Hellier J, Mann E and Hunter MS. Effectiveness of group and self-help cognitive behaviour therapy to reduce problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause 19,7:749-759 (2012). Funded by NIHR BRC

Other sources