Cognitive behavioural therapy for menopausal symptoms
Cognitive behavioural therapy (CBT) is a talking therapy in which a therapist helps a woman change how she thinks and acts, so hot flushes and night sweats bother her less.
Remember
CBT eases menopausal hot flushes and night sweats (vasomotor symptoms, which are linked to the body's temperature control) by changing how a woman thinks about and responds to them. It does not change hormone levels.
Memory aid
CBT changes the reaction to the flush, not the body's thermostat.
Use it to recall that CBT works on how a woman responds to a flush, not on the body's temperature control.
Hot flushes and night sweats are called vasomotor symptoms (symptoms linked to the body's temperature control, which is regulated by the hypothalamus, a small area at the base of the brain). They are common in the perimenopause (the transition phase before periods stop).
CBT works on the woman's unhelpful thoughts and behaviours, not on her hormones. The therapist helps her to challenge unhelpful beliefs, for example expecting the worst from the next flush or dreading a bad night. She also learns to notice her feelings and physical sensations without reacting to them, and to change what she does, such as no longer avoiding situations.
The physiology stays the same, but the way she interprets and reacts to it can change. Trials show that this lowers how distressing flushes and night sweats are rated and improves coping, and sleep may also improve.
CBT is non-pharmacological: a treatment that does not use drugs. It suits a woman who prefers to avoid medicines, cannot take hormone replacement therapy (HRT) or does not want it. HRT replaces oestrogen, whereas CBT is a talking therapy with no drug action.
NHS advice is that CBT can help with low mood, anxiety, sleep problems and hot flushes. It is also the first non-hormonal treatment the NHS mentions for hot flushes and night sweats.
Key facts
- What it targets
- the unhelpful thoughts and behaviours around the symptoms, not hormone levels or the hypothalamus.
- What improves
- symptoms are rated as less distressing, and coping and sense of control improve.
- Who it suits
- women who prefer to avoid medication, or who cannot take hormone replacement therapy.
- Breast cancer
- women who have had breast cancer will usually be advised not to take HRT, and CBT does not depend on any hormonal effect.
- What it helps
- NHS advice is that CBT can help with low mood, anxiety, sleep problems and hot flushes.
Exam traps
- CBT does not suppress thoughts about flushes or avoid associated situations: it challenges unhelpful beliefs and helps women re-engage with situations they have avoided.
- CBT does not stop hot flushes by acting on the hypothalamus (the part of the brain that regulates body temperature), because it is a talking therapy and does not act on that centre as a drug would; it changes how the woman thinks about and responds to her symptoms.
- CBT is not just an add-on to hormone replacement therapy: it is a recognised non-hormonal option offered when HRT does not work, cannot be taken or is not wanted, and it does not need HRT in order to work.
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