CBT for Menopause
A Comprehensive Guide to Managing Symptoms with Cognitive Behavioural Therapy (CBT)
Menopause is a natural biological process that every woman experiences. Yet, it often comes with a range of challenging symptoms that affect physical, emotional and mental wellbeing. Understanding the changes that occur during perimenopause and menopause is essential to navigating this transition with confidence. Cognitive behavioural therapy (CBT) offers an evidence-based approach to managing menopause symptoms improving mental health and enhancing quality of life.
What Happens in the Body During Perimenopause and Menopause?
Perimenopause:
Perimenopause, meaning “around menopause”, typically begins in a woman’s 40s but can start earlier. This phase can last anywhere from a few months to over a decade before menopause officially begins. It is marked by fluctuating oestrogen and progesterone levels, leading to irregular menstrual cycles and various physical and emotional symptoms.
Key hormonal changes during perimenopause include:
- Declining Oestrogen Levels: Affects mood, sleep, and bone health.
- Progesterone Reduction: Can lead to heavier or irregular periods and impact sleep patterns.
- Increased Follicle-Stimulating Hormone (FSH): Signals the ovaries to produce eggs but with inconsistent effectiveness, causing cycle irregularities.
- Changes in Testosterone: Can influence libido and energy levels.
Menopause:
Menopause is officially diagnosed when a woman has not had a period for 12 consecutive months. The average age of menopause is 51, but it can occur earlier due to genetics, medical conditions or surgical interventions, such as: hysterectomy.
During menopause:
- Ovaries stop producing significant amounts of estrogen and progesterone.
- The body adjusts to lower hormone level leading to a variety of symptoms.
- Risks of osteoporosis, cardiovascular disease and cognitive decline may increase.
Symptoms of Perimenopause and Menopause
The symptoms of perimenopause and menopause can be categorised into physiological, psychological, cognitive and behavioural changes. Below is a table outlining these symptoms:
| Category | Common Symptoms |
| Physiological | Hot flashes, night sweats, irregular periods, weight gain, vaginal dryness, headaches, joint pain, fatigue, changes in skin and hair |
| Psychological | Mood swings, increased anxiety, depression, irritability, feelings of sadness, emotional instability, low self-esteem |
| Cognitive | Brain fog, difficulty concentrating, forgetfulness, mental fatigue |
| Behavioural | Sleep disturbances, decreased libido, social withdrawal, increased stress responses, changes in eating and exercise habit |
How can Cognitive-Behavioural Therapy (CBT) improve quality of life?
Cognitive Behavioural Therapy (CBT) is a structured, evidence-based psychological therapy that helps individuals recognise and manage unhelpful thoughts and behaviours. CBT has been shown to be highly effective in reducing many menopause-related symptoms, particularly those related to mood, sleep and stress.
1. Managing Anxiety and Depression
Menopausal women often experience increased anxiety and depressive symptoms due to hormonal fluctuations. CBT helps by:
- Identifying negative thinking patterns and replacing them with balanced perspectives
- Using relaxation techniques, such as: controlled breathing and progressive muscle relaxation
- Developing problem-solving strategies to manage stress effectively
2. Coping with Hot Flashes and Night Sweats
Hot flashes and night sweats are among the most common and disruptive menopause symptoms. CBT can help by:
- Teaching mindfulness and acceptance strategies to reduce distress during hot flashes
- Encouraging lifestyle adjustments, such as: avoiding triggers like caffeine and alcohol
- Using cognitive re-structuring techniques to shift focus away from discomfort
3. Improving Sleep Quality
Insomnia and frequent night time awakenings are common during menopause. CBT for insomnia (CBT-I) is a specialised form of CBT that focuses on improving sleep by:
- Establishing a consistent bedtime routine and sleep schedule
- Reducing anxiety about sleep through cognitive re-framing
- Encouraging relaxation techniques and sleep hygiene improvements
4. Enhancing Cognitive Function
Brain fog and memory lapses can be frustrating symptoms of menopause. CBT can help by:
- Encouraging structured daily routines to improve focus
- Reducing cognitive overload through stress management strategies
5. Boosting Self-Confidence and Social Connection
Menopause can impact self-image and confidence. CBT helps by:
- Challenging negative self-perceptions and reinforcing positive affirmations
- Encouraging social engagement and support-seeking behaviours
- Helping women re-define their sense of purpose and self-worth beyond caring for others
Additional Lifestyle Strategies to Support CBT
While CBT is highly effective, combining it with lifestyle changes can further enhance wellbeing. Consider the following:
- Balanced Nutrition
- Regular Exercise
- Mindfulness and Meditation
- Social Support
Rebalance & Renew: A CBT Approach to Menopause
Rewrite Your Menopause Story. 6 Weeks. 10 Women. Real Strategies That Make a Difference.
Perimenopause and menopause are significant transitions in a woman’s life, often accompanied by physical, emotional and cognitive challenges. However, by understanding the physiological changes and utilising effective interventions, such as Cognitive Behavioural Therapy (CBT), women can regain control over their symptoms and improve their overall wellbeing.
This is the reason my experienced colleague, Ilia Maltezou, and I developed a 6-week online group programme for women going through (peri)menopause.
As we are both interested in women’s health, we wanted to create a safe space for women to share their experiences, receive and offer support and, of course, learn practical strategies that they can put in place to manage their distressing symptoms, navigate this period of change and improve their quality of life.
Our 6-week programme, based on the principles of Cognitive-Behavioural Therapy, covers the following areas:
- Identifying and managing physical symptoms of (peri)menopause
- Self-compassion and acceptance
- Identifying and managing unhelpful thoughts related to (peri)menopause
- Managing change
- Self-perception and identity shifts
- Using menopause as an opportunity for growth
- Developing a helpful routine that prioritises values
- Sleep hygiene and relaxation
Our programme will take place online. In this way, it will be more accessible to women in the UK. Every session will last for 90 minutes and the duration of the programme will be 6 weeks.
Following every session, we will provide participants with written materials that they can re-visit at any point during or after the end of the programme.
In regards to the cost, it is £510 for 6 weeks (£85 per 90-minute session).
Considering that nowadays we might pay around £85 for a massage or a facial that could last for less than 90 minutes, we really hope that women will also invest in their mental health in a similar way by attending our 6-week programme.
Sign up to our programme by sending us an e-mail to: therapyforme@outlook.com
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CBT for Health Anxiety
We have all heard of the term ‘health anxiety’ or ‘hypochondria’ and ‘hypochondriasis’ before. It is a term that we sometimes use lightly to suggest that we struggle with the idea of becoming unwell or we feel disgust and discomfort when we think about germs.
We have all felt concerned about our health at some point in our lives. It is likely that we have experienced urges to avoid medical procedures or medical professionals or to control the future by asking for reassurance and trying to predict the future. However, this is not an indication that we experience health anxiety or hypochondria.
What does ‘health anxiety disorder’ or ‘illness anxiety disorder’ mean in clinical terms? Who would meet the diagnostic criteria and what are the signs we might suffer from health anxiety?
Health anxiety symptoms:
1. Preoccupation with having or acquiring a serious illness
2. The preoccupation is excessive and disproportionate (even if a medical condition exists)
3. Excessive controlling or avoidant behaviours related to health (e.g. frequent visits to the GP, reassurance-seeking behaviours, researching symptoms on the internet but also avoiding talking about certain health conditions, avoid checking or touching parts of one’s body etc). In most cases, there is a mixture of controlling and avoidant behaviours and they can also co-exist and alternate (e.g. frequent visits to GP replaced by avoiding the GP)
4. Preoccupation for more than 6 months (even if the concerns change in content)
5. Preoccupation is not better explained by another mental disorder
I would like to clarify here that health anxiety is not just a preoccupation with our physical health. It can also be a preoccupation with our mental health – for example, the idea that one is losing their minds or developing psychosis or dementia.
Health anxiety can be diagnosed in people who already suffer from a medical condition or who have done in the past (in their childhood or early adulthood). It adds a layer of distress, anxiety and fear in their experience and it can be treated to improve their quality of life.
Health anxiety can be a debilitating condition – its severity ranges from mild to severe but when someone meets the diagnostic criteria for health anxiety, it means that their functioning is affected by the condition.
‘Health anxiety is ruining my life! Can I stop health anxiety?’
Health anxiety disorder is indeed a condition that can have a serious impact on people’s lives, routines, relationships…it can affect all life areas. Cognitive-behavioural therapy is an evidence-based treatment for health anxiety. Unfortunately, it won’t make the health anxiety stop but it will teach you important strategies for you to start managing your health anxiety symptoms better and start taking back the control from your anxiety.
‘’How can CBT help with health anxiety? How can I handle health anxiety?
What can I expect from health anxiety treatment using the CBT model?’’
First of all, let’s think what it is realistic to expect from health anxiety therapy. Many people come to therapy expecting their worry thoughts and anxiety to go away. However, although we would expect that CBT therapy will help with the reduction in anxiety and worry symptoms in the long-term, it is unrealistic to expect that such thoughts and feelings will disappear forever. As human beings it is natural and expected to experience difficult thoughts and emotions at certain points in our lives.
CBT therapy does not aim to reduce the uncertainty that the future brings or rule out the possibility of a medical condition. These would be unrealistic expectations. CBT therapy for health anxiety aims to help the person tolerate uncertainty and find better ways in managing their distress and difficult thoughts through:
– Educating the person about how anxiety and fear affect the body and lead to distressing physical sensations. Some people ask whether health anxiety can cause ‘fake symptoms’. The answer is that anxiety activates the ‘fight-or-flight’ response in our bodies leading to new symptoms that could be perceived as dangerous and an indication of a serious health condition. For example:
– Working with the catastrophic misinterpretations that the person is led to when interpreting new or ambiguous physical symptoms.
– Helping the person identify rigid and unhelpful thinking styles. Working on reinforcing flexibility in the way situations are interpreted.
– Encouraging the person in therapy to test out negative predictions through engaging with distressing thoughts, feelings and scenarios.
– Teaching the person how to focus their attention on what they find meaningful and in line with their values, rather than what their anxiety directs them to.
– Postponing unhelpful behaviours which reinforce the anxiety in the long-term, such as: checking, asking for reassurance and monitoring symptoms excessively.
– Liaising with the GP in order to develop a joint plan that would benefit the person.
– Working with the family of the individual to educate them on health anxiety and make sure they do not unintentionally reinforce health anxiety symptoms.
– Helping the person reduce avoidant behaviours as a way of building self-confidence and self-esteem and reducing fear and anxiety.
Health anxiety by proxy
When individuals are preoccupied with the health of someone else (e.g. their children) and they experience the health anxiety symptoms we referred to in the beginning of this article, they could be diagnosed with health anxiety by proxy. The treatment for this type of health anxiety would involve the same processes and the aim of therapy would be exactly the same as the above description.
Books recommended for health anxiety
Overcoming Health Anxiety: A self-help guide using cognitive behavioural techniques (2009) by David Veale and Rob Willson
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Idyli Kamaterou on BBC radio for Stress Awareness Month
”Stress Awareness Month has been held every April, since 1992. During this annual thirty day period, health care professionals and health promotion experts across the country will join forces to increase public awareness about both the causes and cures for our modern stress epidemic”.
This year, as part of the Stress Awareness Month, Idyli Kamaterou from Therapy For Me attended an interview on BBC radio. During this interview we talked about areas, such as:
• Symptoms of stress that we should all monitor in our lives
• Support available for people who experience stress
• Causes of stress in adults under 35 years old
• What Cognitive -Behavioural Therapy is and how it can help people manage stress
If you work in a charity or organisation that might be interested in discussing adult mental health, please contact us. It would be our pleasure to organise a workshop and continue raising awareness.
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