*Nicola Ryan
Menopause expert and awareness advocate Nicola Ryan discusses the effects and strategies of CBT in which “this therapy is used and often first line in the treatment and management of anxiety and depression”.
In this article I wanted to mention cognitive behavioural therapy. I’m currently undergoing a course with the British Menopause Society that will enable me to run workshops with ladies who are still symptomatic while tackling hormone therapy or cannot have hormone therapy.
There is a cohort of women that cannot have hormone therapy, for example some breast cancer survivors. This form of treatment could be very effective for these women as they have unfortunately been hit with a double whammy. I see a lot of cancer survivors in my clinic and their courage and bravery drives me to learn more so I can help alleviate their troublesome symptoms.
CBT is a talking therapy that aims to help change thoughts and behaviours by breaking down overwhelming problems into smaller, more manageable parts. This therapy is used and often first line in the treatment and management of anxiety and depression. CBT can provide skills to manage mood changes. CBT helps people to develop practical ways of coping with problems and provides coping skills and useful strategies and can improve wellbeing in general.
So, you’re probably wondering what has this got to do with menopause? Well actually in fact, new evidence shows that cognitive behavioural therapy (CBT) can help reduce menopause symptoms including hot flushes and night sweats, depressive symptoms and problems sleeping NICE (National Institute for Health and Care Excellence) has said in its draft updated guideline on menopause published today (17 November 2023). CBT has been shown to help with troublesome menopausal symptoms, for example, low mood, night sweats, hot flushes and sleep disturbances.
Hot flushes can be triggered by stimulants, such as coffee, hot drinks, spicy foods, alcohol, stress, changes in temperature and outdoor activities. It is recommended to keep a diary and write down what’s happening before a hot flush so you may be able to identify the triggers and then make little changes to help gain some control. Cognitive and behavioural strategies, for example, paced breathing is an important part of the CBT approach for hot flushes. This skill requires regular practice, breathing from your stomach. At the onset of a hot flush, relax your shoulders, breathe slowly from your stomach, concentrate on your breathing. Paced breathing involves focusing on the breathing and accepting that the hot flush will pass. Breathwork is very effective for keeping your mind on the breathwork and this sends signals to your brain and calms everything down.
CBT is also effective for night sweats and sleep. Try to start a wind down routine, practicing relaxation and paced breathing can reduce stress of our everyday busy lives. If practiced regularly then it’s often easier to apply at night before bed when relaxation is required.
The likelihood that it will reduce the night sweets is low but it’s how you react to them, try to remain calm and with practice this should get easier. Mind over matter in some of these cases. To help with the night sweat, calmly get up and do what you need to do to cool down. Try not to engage with your thoughts at this time and focus on your breathing and relaxation.
It is often easier to worry and ‘catastrophise’ the impact of disturbed sleep so it’s important to try not to engage with those thoughts. If you master and manage anxious thinking, it will be easier to go back to sleep.
Rather than thinking ‘I won’t be able to function tomorrow’, ‘I’ve managed these symptoms before, it’s tough now but it will pass.
