When it comes to menopause symptom management, for years it’s been either fight to get HRT, go it alone or “do it naturally”.
Whilst the recent menopause revolution has increased demand and confidence with HRT, there are still some women who can’t or don’t want to use it. So what are your other options? This blog post aims to take you through what cognitive behavioural therapy is and how it can help with menopause symptoms.
Pharmacological v non-pharmacological
There are a number of “medical” options when it comes to managing menopause symptoms. This ranges from HRT to antidepressants, antihypertensives and anticonvulsants. Those last few are usually prescribed for other conditions such as depression, high blood pressure and epilepsy. They are also known to have other uses though.
HRT has been around for many years and has had a bad reputation which meant it’s use declined for years. However, recent research has changed thinking and it is now being more widely prescribed.
There are also a number of non-medical options for treatment that involve complementary therapies, supplements and herbal remedies.
There is some good evidence to support use of the medical treatments. This shows that in most cases it has mild to moderate benefit in terms of reducing the frequency of symptoms (around 15 – 58%). Side effects are also common though and mean a lot of women discontinue treatment.
With the non-medical treatments there is a lot less evidence about their effectiveness. A lot of women try these and rely on anecdotal evidence or recommendations from other women regarding different types.
Non-medical treatments include complementary therapies, herbal remedies and supplements.
Another non-medical approach that does actually have a lot of evidence to back up its effectiveness is cognitive behavioural therapy which you will often see shortened to CBT.
What is CBT?
CBT is a type of therapy that looks at your thoughts, feelings and behaviours and helps to change some of these to manage your problems or symptoms.
The main aim of CBT is identifying the negative thinking patterns that you might feel trapped in. Or even recognising patterns of negative thinking that you might not have picked up on. It then helps you develop ways of helping you to break the cycle and to feel better or manage your symptoms better.
CBT focuses on equipping you with the tools to address current problems in your life and relieve the symptoms you’re living with.
Why use CBT for management of menopause symptoms?
CBT takes what is called a biopsychosocial (BPS) approach. This means it looks at the physical as well as the psychological effects and also takes into account what is happening in your life that impacts on your symptoms.
This moves away from a purely medical approach and this can be helpful when you’re dealing with the real world such as having to go to work everyday or looking after others.
CBT has a long proven history in successful treatment and management of chronic pain, chronic fatigue, cardiovascular issues, diabetes management and weight loss.
The technique does require you to be committed as it involves a lot of active engagement. The benefits and rewards can be reaped though and it is a very practical and pragmatic way of managing symptoms.
What is the BPS model?
The BPS model emphasises the connections between biological, psychological and socio-environmental factors in your life. When this model is applied to your health, it demonstrates the importance of maintaining wellness in all aspects of your life.
As a woman in peri/menopause, this is vital as there are many physical things beyond your control such as the rate at which your hormones change and deplete. This can then also be impacted negatively or positively depending on other factors such as your mood, how you view menopause and what is going on in your life. For example, if you are under a lot of stress at work, this can often make symptoms seem amplified.
How does this fit with hot flushes and night sweats?
There is a biological (physical) impact in what is termed the thermoneutral zone. This zone demonstrates where our body maintains an optimal temperature with slight fluctuations based on things like external temperature or illness. During peri/menopause the decrease in oestrogen narrows the thermoneutral zone which makes us more sensitive to temperature changes.
Our psychological health also affects hot flushes and night sweats. This is due to both the narrowed thermoneutral zone but also when we feel worried and anxious about hot flushes happening, it makes them feel worse and we don’t feel able to cope as well.
You might also have certain beliefs about menopause such as the expectation that it will be a very negative experience or you see yourself in a negative light due to changes that occur. Research shows that this directly correlates with increased inability to cope with hot flushes and night sweats.
There are also external factors that affect your experience of hot flushes and night sweats that are part of your day to day life. This might be your diet (consumption of caffeine/spicy food/alcohol), the temperature of your environment (e.g. at work) and your social commitments which might include environments where it is warm and stuffy, drinking sociably, feeling anxious etc.
What are the advantages of CBT for menopause symptom management?
There are a number of advantages to using CBT to manage menopause symptoms.
- Firstly it is very effective for some of the most common symptoms which are hot flushes, night sweats, anxiety and low mood.
- There are absolutely no side effects! There are no medications or physical impacts on your body.
- Using CBT is skill based. You’re not relying on external factors such as medication or pieces of equipment. You can use it whenever and wherever you are.
- It has the added benefit of reducing your overall stress levels.
- It can be used by anyone, no matter what. Often there are lots of “clinical” factors that could exclude you from other treatments such as your age, your BMI, where you are in the menopause transition or your medical history. With CBT none of this matters. It’s suitable for anyone.
How can you access CBT?
In the UK you can access CBT for free via the NHS. In other countries, you will also have access to CBT from certain therapists but you would likely need to seek a therapist who specifically offers CBT as there are a number of different therapeutic techniques and not all therapists will practise CBT.
In the UK, accessing it via the NHS means it will be generic CBT and not specifically aimed at managing menopause symptoms. In other countries you will have to find a therapist who specialises in menopause and it’s possible there may be limited numbers who do.
There are a small number of people delivering specialist menopause CBT and a google search will help you to research this.
I will be running some specific CBT for menopause group programmes in the next few weeks. if you would like more information on the groups such as content, duration, cost etc or to have a chat to see if it is right for you, please feel free to email me at firstname.lastname@example.org or check out my website here.