Key takeaways
- Cognitive Behavioural Therapy (CBT) has been shown to help with specific symptoms of menopause, including hot flushes and disturbed sleep
- CBT sessions can help someone understand why a hot flush happens, and to manage the anxiety that may arise around it
- Working with a CBT professional can help you set aside time to explore your feelings around the menopause, as well as learning the technique
- There are many effective ways to learn CBT skills, including in one-to-one and group settings, both in-person and online
Some cancer treatments can cause menopausal symptoms. Whether temporary or permanent, these symptoms can be extremely challenging, especially on top of other physical and psychological side-effects of cancer treatment. There are a range of options for managing the symptoms of treatment-induced menopause, including prescription medication and lifestyle changes. Cognitive Behavioural Therapy (CBT) has been shown to help with anxiety and stress, hot flushes, night sweats and sleep problems in particular. We asked Beverly Longhurst, a Menopause Practitioner at Perci, and Lisa Punt, Centre Head of Maggie’s Cambridge and a consultant radiographer in gynaecological oncology, how and why they recommend CBT.
It’s important to remember that menopause, no matter whether natural or experienced as a result of cancer treatment, is a transition and a change process.
Beverly Longhurst, Menopause Practitioner
What is cognitive behavioural therapy?
CBT is a type of psychological therapy that looks at your thoughts, feelings and behaviours. It encourages you to develop coping skills to deal with various problems (such as anxiety), by looking at your thoughts and beliefs, and how these affect your feelings and actions. It can help you to break cycles of thinking in a particular, often default way.
How can CBT be helpful during treatment-induced menopause?
Beverly: CBT involves looking at the significant link between thoughts, physical reactions (such as hot flushes) behaviours and feelings, and how these work in a cycle, sometimes called a vicious cycle. By becoming aware and modifying thoughts, we can set off a new cycle, one that is healthier and where you are more in control – a virtuous cycle.
Anxiety and stress are common around the menopause, and everyday life can feel overwhelming, which can add to the stress. Being able to reduce anxiety and stress is a helpful strategy to improve wellbeing and to reduce the impact of menopausal symptoms on your daily life.
The CBT approach I use, which is informed by the British Menopause Society, looks at how physical and emotional health interact. I provide evidence-based information and help to dispel myths that you might have been holding on to, as well as teaching coping strategies to improve physical and emotional health. This will help you to make the shift from not being an active participant in your care to learning strategies to self-manage the experience of menopausal symptoms.
Can CBT support treatment-induced menopause in men?
Lisa: Yes, absolutely. Men with prostate cancer have hormone manipulation, known as androgen therapy, which results in a male menopause, including hot flushes. CBT is highly effective for this group.
How can CBT alter the experience of hot flushes?
Lisa: Firstly, CBT can help someone to understand the mechanism of a hot flush. During menopause, changes to oestrogen levels cause what is known as the ‘thermo-neutral zone’ to narrow. Before menopause, a small change in core body temperature will remain inside the thermo-neutral zone, causing no symptoms. During menopause, because that zone has narrowed, the same change can result in excessive sweating.
Often, a hot flush can cause a huge amount of anxiety. The person might experience palpitations or feel like they are having a panic attack. What is actually happening is the brain is interpreting the change in body temperature. But these symptoms are made worse by worrying that people are looking at you, and you feeling like you want to escape into the fresh air. This causes that thermo-neutral zone to narrow even further, and those feelings intensify.
Understanding the experience, as well as the breathing and relaxation techniques taught as part of CBT, help you to switch off that automatic response to the experience of a hot flush. You may then feel differently because you know what’s happening, and behave differently using CBT tools and techniques. This can be especially helpful at night, when you might wake up because of a hot flush.
Often, a hot flush can cause a huge amount of anxiety. The person might experience palpitations or feel like they are having a panic attack. What is actually happening is the brain is interpreting the change in body temperature.
Lisa Punt, Centre Head of Maggie’s Cambridge
What is the value of working with a CBT professional?
Beverly: It’s important to remember that menopause, no matter whether natural or experienced as a result of cancer treatment, is a transition and a change process. As with any change, it needs time, motivation, knowledge and reflection, and, most of all, support. CBT sessions offer regular, protected time to explore your thoughts and feelings around the menopause, and the physical changes experienced. Working together, I guide members to feel more empowered and calm so that they’re able to:
- Be more aware of when hot flushes or brain fog happen
- Feel more prepared and in control in those moments
- Understand the science behind sleep and manage insomnia
- Manage low libido and low energy
- Manage the feeling of overwhelm at work or hom
What’s the best way to learn CBT?
Lisa: The evidence points to a six-week course, however this can be a huge commitment for someone recovering from cancer treatment. A shorter course can also be effective. Virtual sessions can work just as well as face to face.
Some people like to learn one-to-one, where they have the practitioner’s full focus; others prefer a group. The value in a group setting isn’t about learning specifics, but understanding that you’re not alone. There’s a huge amount of relief in that, especially if you’ve been through the private healthcare system and not met anyone else during treatment.
Managing treatment-induced menopause can feel challenging, especially after treatment, but techniques like CBT can offer relief. Our Cancer Nurse Specialists can answer your questions and refer you to CBT practitioners who specialise in the menopause.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
‘Cognitive Behaviour Therapy (CBT) for Menopausal Symptoms’, Women’s Health Concern, Feb 2023, https://www.womens-health-concern.org/wp-content/uploads/2023/02/02-WHC-FACTSHEET-CBT-WOMEN-FEB-2023-A.pdf
‘Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms?’, ncbi.nlm.nih.gov, September 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453849/
‘Non‐hormonal interventions for hot flushes in women with a history of breast cancer’, cochranelibrary.com, September 2010, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004923.pub2/full
‘Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial’, ncbi.nlm.nih.gov, March 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314999/?tool=pubmed
‘Treatment of Hot Flashes in Patients With Breast Cancer’, dynamed.com, https://www.dynamed.com/management/treatment-of-hot-flashes-in-patients-with-breast-cancer#COGNITIVE_BEHAIVORAL_THERAPY
‘Impact of the CBT-Meno protocol on menopause-specific beliefs, dysfunctional attitudes, and coping behaviors’, ncbi.nlm.nih.gov, August 2022, https://pubmed.ncbi.nlm.nih.gov/35881942/