Emma Persand on CBT to support menopause symptoms

Menopause transition in western society and the UK is complex, and is influenced by many factors. So, it can be difficult for women, trans/non-binary people and healthcare professionals to understand the causes of any physical and mental health symptoms.

In an ideal world, menopause transition should be a welcomed stage, free from menstruation or contraception, and with the confidence of life experiences. However, we need to understand the term ‘symptoms’ is used to recognise that even though menopause is not a medical condition, some people who go through menopause will have negative experiences that impact their quality of life and ability to cope.

We are beginning to understand that the perimenopausal phase (when biological changes brought on by fluctuating hormones manifest in a variety of symptoms) can be experienced before periods begin to alter.

There is also a psychological response, as perceptions of menopause are influenced by our experiences, beliefs and attitudes. If we believe that a hot flush or difficulty concentrating is the result of something bad happening, then we may feel negative emotions like being scared for our health, or feeling anxious, embarrassed, out of control or even believing ourselves to be incompetent at work. We may start to think overly negative thoughts, like ‘this is absolutely the worst’, ‘I cannot cope’, ‘everyone is looking at me’, or ‘I am getting old’. This can affect self-esteem and cause low mood.

We are recognising that for the majority of women and trans/non-binary people, midlife responsibilities can be acute and so it is not surprising that research shows that stress and symptoms of the menopause transition are inextricably linked. Striving in a job with fertility issues, childcare and elder care concerns; worrying about children leaving home or not being financially able to leave home are just some stressors. Continuing statistics from the British Labour Force surveys highlight that women between the ages of 45 – 54 years report the highest incidences of work-related stress.

Then there is a cultural influence in how the menopause transition is interpreted and represented. Narratives that focus on the severe physical, emotional and psychological symptoms will inform general attitudes and beliefs that it is a solely negative phase. Portrayals of an age-related condition is also not helpful to younger women experiencing menopause prematurely, after certain treatments (for example, breast cancer or due to a surgically-induced menopause). It can also mean that we neglect the diverse needs and experiences of our wider communities, due to ethnicity and sexual and gender identity.

Cognitive Behaviour Therapy (CBT)

CBT for menopausal symptoms is an evidenced-based and non-medical intervention to introduce coping skills and useful strategies to help manage and reduce the impact of symptoms on daily life. CBT, in this context, examines the body’s physical response to fluctuating hormones as triggers that can have a negative influence on our thoughts, emotions and behaviours, which can in turn impact the severity of the physical symptoms and vice versa.

Feeling stressed and anxious due to life’s multiple demands may also precipitate a hot flush or worsen the ability to concentrate on a task, which can then affect other aspects of life like difficulty sleeping or waking up early and feeling too fatigued to exercise. This relationship is sometimes called the vicious cycle with one area influencing the other.

Helping to break the vicious cycle

How we think about something or a situation can make us feel a range of emotions. Negative thoughts can activate the fight or flight response as we feel stressed and threatened, causing us to behave in a stressed-out way – like avoiding situations, acting out emotionally, withdrawing from socialising or isolating ourselves at work.

Changing the way we think when we feel threatened is hard as the body is programmed to respond to fear by pushing any positive thoughts away, to focus solely on the negative – this is to increase stress hormones in order to survive the imminent perceived danger.

Paced breathing to lower your heart rate

Refocusing our attention onto our breathing and away from the situation can be the first step to interrupting the cycle. Sometimes we ‘forget’ how to breathe and especially at times of stress, our breathing quickens as part of the fight or flight response, which can make hot flushes or concentration worse.

You can control your breathing to allow the body to stand down from the threat to introduce a calmer and more helpful response, by using paced or diaphragmatic breathing.

  • You might find it easier to do this in bed lying down or sat upright in a chair with feet placed on the floor and eyes closed
  • Take a deep breath and notice what happens to your stomach. Our stomach and chest should expand and move out on a deep breath
  • Put both hands across your stomach with middle fingertips just touching each other. Take a deep breath in counting to 3 and your fingertips should part slightly as your stomach expands
  • Breath out slowly and count to 5 and your fingertips should touch again
  • Repeat: breathing in for a count of 3 and out for a count of 5
  • Practise this every day and when you feel the onset of a flush start paced breathing through it

Think about your thinking!

  • Once you can feel calmer through the breathing technique, it will be easier to take notice at what is happening to your thoughts
  • For the hot flushes or night-time cold sweats where there is no obvious trigger, take a moment to think about what you are thinking at the time they start. Is it overly negative? How true are the thoughts? Are you being over critical about yourself?
  • Try telling yourself ‘this will pass’ or ‘I will get this finished a little slower today, it’s not the end of the world’
  • What would you say to a friend experiencing a hot flush? Would you agree with her negative thoughts of incompetence and failure? You would more likely be caring and want to reassure her through this time? Practise self-care and talk to yourself as you would a close friend or relative

Managing Hot Flushes and Night Sweats: A Cognitive Behavioural Self-help Guide to the Menopause by Myra Hunter & Melanie Smith

Managing Hot Flushes and Night Sweats: A Cognitive Behavioural Self-help Guide to the Menopause

This revised edition of Managing Hot Flushes and Night Sweats offers up-to-date and evidence-based information about the menopause and about hot flushes and night sweats, which are the main reason that women seek medical help. The four-week self-help guide uses cognitive behavioral therapy, providing information and strategies for managing hot flushes and night sweats, as well as stress and sleep.

CBT fact sheet:

Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms

Download PDF factsheet Cognitive behaviour therapy is a brief, non-medical approach that can be helpful for a range of health problems, including anxiety and stress, depressed mood, hot flushes and night sweats, sleep problems and fatigue. CBT helps people to develop practical ways of managing problems

The content of the QVC website is for information only. It is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the QVC website.

We understand there’s a lot of information out there on the menopause. You can read through the NICE guidance on menopause management, as well as the NHS overview on the menopause.