Cognitive Behavioural Therapy (CBT) is a psychological therapy that many people have benefitted from. It is an evidence based treatment that can be used to treat multiple symptoms related to menopause.
Perimenopause and menopause can be a challenging time for women both in terms of symptoms that arise from fluctuating hormones alongside life events and responsibilities. All of these things can result in feeling low or overwhelmed.
Aside from medication such as hormone replacement therapy (HRT) and lifestyle changes, treatment that focuses on your mental well-being can help improve your overall outlook and allow you to better manage your menopause symptoms. CBT for menopause is one such treatment which is highly effective.
What is CBT?
Cognitive Behavioural Therapy (CBT) has been used for many years to help people who are experiencing issues such as low mood, anxiety, stress and insomnia.
It's a form of talking therapy that can help you manage physical and emotional problems by challenging and changing your thought patterns and behaviours.
CBT is based around the concept that how you think, and feel is connected to physical sensations and reactions. This link can create a negative cycle where negative thoughts and feelings can cause or exacerbate physical symptoms or undesirable actions.
CBT seeks to change this pattern by breaking down problems, allowing you to focus on making positive differences to small aspects at a time. It can improve your overall well-being and quality of life.
How does CBT help during menopause?
During menopause, fluctuations in hormones including oestrogen and progesterone can lead to mood changes, sleep disruptions, and hot flushes, amongst other things.
Cognitive behavioural therapy for menopause helps women manage these various menopause symptoms by teaching them how to modify maladaptive behaviours and reframe negative thoughts that may create or worsen particular problems. In time, this approach arms them with the tools and emotional resilience to navigate menopausal changes more effectively.
CBT and symptoms of menopause
Hot flushes and night sweats
Hot flushes and night sweats in menopause are incredibly common, affecting up to 80% of women. There is often a sudden sensation of heat spreading across the face and body, reddening skin and sweating. Night sweats often cause women to wake up from sleep to find themselves, their pyjamas and bedding drenched.
CBT was shown to be effective in managing hot flushes and night sweats in three clinical trials for women experiencing treatment induced menopausal symptoms after a diagnosis of breast cancer. These improvements continued for at least six months after the CBT sessions ended.
Depressive symptoms
CBT is a well-established treatment for anxiety and depression. During menopause, about 10% of women are more likely to experience a depressed mood.
Several meta-analyses have found that CBT significantly improves mood symptoms of menopause and it is recommended as a treatment by the National Institute of Care Excellence (NICE).
Sleep problems
Menopause and sleep problems are closely linked, as changing hormones can lead to night sweats and insomnia. Up to 64% of women who experience hot flushes also report significant sleep disturbances and higher rates of insomnia during menopause.
CBT for insomnia (CBT-I) is widely recognised as a first-line treatment for sleep issues, being as effective as medication in the short term and more effective in the long term. One study that focused specifically on telephone-based CBT for insomnia in peri and postmenopausal women found it improved sleep both immediately after treatment and at follow-up after 24 weeks.
The results of other research revealed that menopause CBT reduced the frequency of night sweats by 39% on average.
Migraines and headaches
CBT may help manage migraines during perimenopause and menopause by reducing stress, which is a known trigger. Mindfulness techniques, which are often incorporated into CBT, can help to reduce the severity of headaches.
The findings of a systematic review and meta-analysis also indicate that CBT reduced the frequency of headaches and the Migraine Disability Assessment (MIDAS) scores of participants.
Anger and mood swings
CBT can help women learn to regulate their emotions and identify triggers for mood swings as well as helping to manage low mood. While there is limited research on CBT and its effect on anger in menopause, CBT-based anger management has been shown to be effective overall.
Intrusive or overwhelming thoughts
CBT is particularly effective for addressing intrusive thoughts. It helps women challenge irrational thinking patterns, and fixation on certain thoughts. This helps to break the negative spiral of thoughts, feelings and behaviours that can occur in menopause.
Low self-esteem
There are a lot of changes to deal with during menopause and these can take a toll on how you feel about yourself. 26% of menopausal women say they feel less outgoing in social situations, 23% feel more isolated and 32% feel like they aren’t good company to others.
CBT can help people to challenge the negative thoughts they are having about themselves, leading to increased self-esteem and confidence.
Problem drinking and binge eating
It isn't uncommon for people to adopt unhealthy coping mechanisms during challenging periods of their lives.
Although there isn’t a wealth of research on the topic, there is data that suggests a small yet significant increase in binge eating symptoms and eating disorders during perimenopause.
Other research indicates that women in the early peri and postmenopausal stages were more likely to transition to become excessive drinkers, as compared to the perimenopausal stage.
CBT can help by enabling you to work out what is triggering you to overeat or drink alcohol. It can also encourage you to plan meals and activities that support a healthier lifestyle, challenge negative thoughts you have about your body and better manage difficult emotions.
Who is CBT for?
Anybody experiencing low mood, anxiety or stress could benefit from CBT, but it is especially helpful during menopause for people experiencing hot flushes, night sweats and insomnia.
Whether you're on HRT or not, if you're experiencing common menopause symptoms, CBT can help you manage them.
If you’re feeling particularly low or are experiencing suicidal thoughts, we recommend you speak to your GP as soon as you can as you may benefit from discussing medication and other treatments.
At Menopause Care, Dr Rebecca Smithson specialises in CBT for menopause and CBT for Insomnia. Her person-centred approach empowers women to support themselves during menopause and beyond through hour-long online sessions that can be booked individually or in a series. To begin, book a CBT consultation.
¹Overview - Cognitive behavioural therapy (CBT) - NHS NHS (March 2022)
²³Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms The British Menopause Society (November 2022)
⁴⁵⁶How Can Menopause Affect Sleep? Sleep Foundation (January 2024)
⁷We know CBT-I works, now what? - PMC Muench et al. (February 2022)
⁸⁹¹⁰Cognitive Behavioral Therapy for Migraine Headache: A Systematic Review and Meta-Analysis - PMC Bae et al. (December 2021)
¹¹BMS & WHC’s 2020 recommendations on hormone replacement therapy in menopausal women The British Menopause Society and World Health Organisation, Consensus Statement (2020)
¹²A systematic review and meta-analysis on the effectiveness of CBT informed anger management - ScienceDirect Henwood et al. (December 2015)
¹³What is CBT and how can it help with symptoms of Menopause? The Menopause Charity
¹⁴More than half of women feel negative about their experience of the menopause The British Menopause Society (October 2017)
¹⁵A systematic review and meta-analysis of CBT interventions based on the Fennell model of low self-esteem - ScienceDirect Kolubinski et al. (September 2018)
¹⁶¹⁷¹⁸Treatment - Binge eating disorder - NHS NHS (July 2023)
