Cognitive behavioural therapy for managing menopause symptoms

The stages of menopause can be a rollercoaster of symptoms and changes, many of which you may not have expected. Symptoms range from physical, such as hot flushes and night sweats, to psychological, like low mood and anxiety, and even cognitive, including brain fog and forgetfulness. While lifestyle changes such as diet and exercise are recommended, one approach to managing menopause symptoms is cognitive behavioural therapy (CBT).

What’s CBT?

CBT is a method of psychotherapy, or talking therapy, used by many mental health professionals to treat a range of issues, like anxiety, depression and phobias. It involves recognising and challenging unhelpful thoughts, and understanding how your thoughts affect your feelings and behaviours.

Why CBT for menopause?

There are many reasons why CBT can be an effective treatment method. During the stages of menopause, the body experiences a drop in hormones, particularly oestrogen and progesterone.  As oestrogen levels drop, so too does serotonin, one of the body’s feel-good chemicals responsible for regulating mood, emotions and sleep. In fact, during menopause, serotonin levels decrease by a huge 50%. This can cause symptoms like low mood, irritability, anxiety, brain fog and general apathy. A lack of sleep, also common during menopause, can exacerbate these symptoms.

You may also feel self-conscious due to changes in your body and some of the more visible symptoms of menopause, such as hot flushes. This can lead to low self-esteem and feeling anxious. Not only can CBT provide you with strategies to reframe these thoughts, but studies show CBT may also help alleviate physical symptoms like hot flushes and night sweats.

The CBT framework

The technique involves using the thoughts, feelings and behaviours framework and understanding how each is connected. It should initially be practised under the guidance of a mental health professional.

We spoke with CBHS Counsellor Megan to understand how this framework could be applied during the stages of menopause: 

• Identify your thoughts: During menopause, you might experience negative thoughts related to your symptoms or changes in your body. For example, you might think, “I can’t handle these hot flushes” or “I’m losing control of my body”. These thoughts can lead to feelings of anxiety, stress or low mood.
• Recognise your feelings: Your thoughts influence your feelings. If you’re thinking negatively about your menopausal symptoms, you might start feeling anxious, stressed or depressed. It’s important to acknowledge these feelings without judgement and to recognise that they arise from your thoughts.
• Understand your behaviours: Your feelings then influence your behaviours. For example, if you’re feeling anxious about experiencing a hot flush in public, you might start avoiding social situations. This will then have a negative impact on how you feel, and the cycle continues.

Putting it into practise

According to Megan, there are several tools you can use to put the thoughts, feeling and behaviours framework into practise. These include:

Creating a self-awareness journal

Keep a dedicated journal to document symptoms and thoughts. For example, you might experience a hot flush (symptom) accompanied by thoughts of self-consciousness:

Initial thought: I suffered from a hot flush and I’m worried that people might think there’s something wrong with me. This exacerbated my hot flush and I started to feel panicked. Later that night, I couldn’t sleep, worrying what people think of me.

The aim is to then reframe this situation: If I suffer another hot flush, I will be kind to myself and recognise this is normal. I will take deep breaths to help me relax and take action to alleviate the symptom where I can. I will not get caught up thinking negatively about myself. I will now sleep better not worrying about what other people think about me knowing that my thoughts are not facts. People understand that menopause is a normal part of life.

Recognising patterns and triggers

Recognising patterns in your thinking can help you understand the feelings and behaviours that arise from certain thoughts. For example, you might think, “I’m not good enough”, which can then provoke feelings of low self-worth and lead you to isolate yourself. Note these patterns down in your journal and shift the associated behaviour. For example, you may decide to go for a walk instead when thoughts of low self-worth arise or indulge in some self-care.

By changing the associated behaviour and finding ways to self-soothe, you may notice your mood lifts and your thoughts shift.

Where to get help

CBT takes practise and patience. By working with a psychologist or counsellor, either face-to-face or online, one-on-one or in a group therapy session, you’ll notice that over time you’ll naturally start catching negative thoughts and reframing them.

Your GP may help you access a Mental Health Plan, which means Medicare may subsidise up to 10 sessions with a mental health professional. Alternatively, you may also be able to use your CBHS Extras cover to pay benefits on sessions with a registered psychologist.

To find a doctor with a special interest in menopause, visit the Australasian Menopause Society website.

Need help now?

There are also helplines available if you feel you need talk to someone immediately.

For crisis support:

• Lifeline on 13 11 14
• Suicide Call Back Service on 1300 659 467

For general mental health support:

• Beyond Blue on 1300 22 46 36
• SANE Australia on 1800 18 7263

All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified healthcare professional.

Sources:

https://www.menopause.org.au/hp/information-sheets/what-is-menopause

https://thebms.org.uk/wp-content/uploads/2022/12/01-BMS-TfC-CBT-NOV2022-A.pdf

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-therapy