{"id":28980,"date":"2024-01-03T09:00:08","date_gmt":"2024-01-03T09:00:08","guid":{"rendered":"https:\/\/research.reading.ac.uk\/research-blog\/?p=28980"},"modified":"2024-01-02T16:16:47","modified_gmt":"2024-01-02T16:16:47","slug":"menopause-why-psychological-therapy-is-now-being-recommended-for-hot-flushes","status":"publish","type":"post","link":"https:\/\/research.reading.ac.uk\/research-blog\/2024\/01\/03\/menopause-why-psychological-therapy-is-now-being-recommended-for-hot-flushes\/","title":{"rendered":"Menopause: why psychological therapy is now being recommended for hot flushes"},"content":{"rendered":"<p>There are <a href=\"https:\/\/www.nhs.uk\/conditions\/menopause\">at least 40 symptoms<\/a>\u00a0of the menopause and perimenopause. These symptoms can have a serious affect on a woman\u2019s\u00a0<a href=\"https:\/\/www.theguardian.com\/society\/2023\/jan\/12\/not-just-hot-flushes-how-menopause-can-destroy-mental-health\">day-to-day life and wellbeing<\/a>, which is why having access to timely and effective treatment is so important.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-28041 size-large\" src=\"https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280-1024x683.jpg\" alt=\"A woman sat alone in a dark room.\" width=\"640\" height=\"427\" srcset=\"https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280-1024x683.jpg 1024w, https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280-300x200.jpg 300w, https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280-768x512.jpg 768w, https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280-272x182.jpg 272w, https:\/\/research.reading.ac.uk\/research-blog\/wp-content\/uploads\/sites\/72\/2023\/08\/portrait-5907490_1280.jpg 1280w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><\/p>\n<p>Menopause symptoms can be described in categories such as\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18074100\/#:%7E:text=Vasomotor%20symptoms%20(VMS)%2C%20commonly,treatment%20during%20menopause%20most%20often.\">vasomotor<\/a>, physical and psychological. All happen as a result of declining hormone levels \u2013 primarily oestrogen and progesterone.<\/p>\n<p>Vasomotor describes hot flushes and night sweats. Physical includes brain fog (issues with memory and concentration), vaginal dryness, difficulty sleeping, dizziness, headaches, joint pains, numbness, itchy skin, bladder symptoms and urinary tract infections. And psychological refers to low mood and anxiety. Menopause can also increase the risk of developing\u00a0<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1521693422000414\">weak bones (osteoporosis) and cardiac disease<\/a>.<\/p>\n<p>Given the serious impact these symptoms can have on a woman\u2019s everyday life, many turn to hormone replacement therapy (HRT). HRT is considered the most effective way to\u00a0<a href=\"https:\/\/academic.oup.com\/jcem\/article\/106\/1\/1\/5937009\">manage symptoms<\/a>\u00a0and is recommended by the\u00a0<a href=\"https:\/\/www.nice.org.uk\/guidance\/NG23\">National Institute for Health and Care Excellence<\/a>\u00a0(Nice) as the first-line treatment for menopause. HRT replaces decreasing hormones.<\/p>\n<p>But since 2015, Nice has also recognised the role that cognitive behavioural therapy (CBT) can play alongside HRT in managing the psychological symptoms of menopause \u2013 such as low mood and anxiety. This is because CBT is known to be effective for\u00a0<a href=\"https:\/\/www.nhs.uk\/mental-health\/conditions\/depression-in-adults\/overview\/\">mild depression<\/a>\u00a0and\u00a0<a href=\"https:\/\/www.nhs.uk\/mental-health\/conditions\/generalised-anxiety-disorder\/overview\/\">anxiety disorders<\/a>.<\/p>\n<p>But\u00a0<a href=\"https:\/\/www.nice.org.uk\/guidance\/GID-NG10241\/documents\/draft-guideline\">recent Nice draft guidelines<\/a>\u00a0suggest women should be offered CBT instead of, or alongside, HRT to manage hot flushes, night sweats and sleep difficulties associated with the menopause.<\/p>\n<p>One of the main reasons Nice has recommended this change is to offer women more choice in how to manage their symptoms. Not all women want to take HRT or are able to. This is because HRT has been linked to a small increased\u00a0<a href=\"https:\/\/evidence.nihr.ac.uk\/alert\/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration\/\">risk of breast cancer<\/a>\u00a0\u2013 although this depends on many factors, including age, the type of HRT and how long a person has been taking it.<\/p>\n<p>The decision to include CBT as an option is based on evidence that it can help some people\u00a0<a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/13697137.2020.1777965\">cope better<\/a>\u00a0with the debilitating vasomotor and sleep issues they experience\u00a0<a href=\"https:\/\/www.nice.org.uk\/guidance\/gid-ng10241\/documents\/evidence-review\">during the menopause<\/a>. So while CBT can\u2019t cure such physical symptoms (since it\u00a0<a href=\"https:\/\/www.thelancet.com\/journals\/landia\/article\/PIIS2213-8587(22)00142-5\/fulltext\">cannot replace decreasing hormones<\/a>), it may still be helpful for some when it comes to their wellbeing.<\/p>\n<h2>Considerable backlash<\/h2>\n<p>These new recommendations have received considerable backlash, especially from those campaigning for better treatments for women\u2019s health conditions. For example, the\u00a0<a href=\"https:\/\/www.mumsnet.com\/articles\/mumsnets-response-to-the-nice-draft-guidance-menopause-diagnosis-and-management?callback=in&amp;code=NWI1MZI4MWQTYMQWYY0ZYZK3LWJLNTYTMMIWN2Y5MJE5OTGZ&amp;state=f5f9acdc2f7d44ffb11ab644dec9d0e9\">editors of Mumsnet<\/a>\u00a0\u2013 a UK-based forum and news website for parents \u2013 wrote a scathing review of the updates, claiming the guidance will be detrimental to the health of women.<\/p>\n<p>They wrote that the new guidelines may make doctors more reluctant to prescribe HRT to patients in the UK. They also pointed out that it\u2019s already near-impossible for people to access psychological treatments in the UK for mental health problems \u2013 let alone being able to access it for physical symptoms of the menopause.<\/p>\n<p>Louise Newson, a leading UK menopause specialist, wrote in a\u00a0<a href=\"https:\/\/www.thetimes.co.uk\/article\/this-approach-to-the-menopause-is-gaslighting-women-czh2j9nkj\">recent article<\/a>\u00a0that the draft Nice guidelines neglect to highlight the many benefits of HRT for osteoporosis, cardiovascular disease and diabetes, and instead are hyper-focused on the risks associated with older types of HRT.\u00a0<a href=\"https:\/\/www.theguardian.com\/society\/2023\/dec\/11\/new-menopause-therapy-hrt-guidance-will-harm-womens-health-say-campaigners?CMP=Share_iOSApp_Other\">Other critics say<\/a>\u00a0the new guidance will skew the science and potentially scare women away from using increasingly safe forms of HRT.<\/p>\n<p>These guidelines come at a time when women in the UK already feel they have\u00a0<a href=\"https:\/\/www.theguardian.com\/society\/2023\/dec\/11\/new-menopause-therapy-hrt-guidance-will-harm-womens-health-say-campaigners\">limited access<\/a>\u00a0to\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10657761\/\">proper menopause support<\/a>\u00a0\u2013 especially around HRT options. They also come at a time when unjustified fears around HRT risk caused by the\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6780820\/\">Women\u2019s Health Initiative<\/a>\u00a0in 2002 (which reported that HRT use had more negative than positive effects) are just starting to subside.<\/p>\n<p>Proponents of the decision say CBT would\u00a0<a href=\"https:\/\/www.theguardian.com\/society\/2023\/dec\/14\/offering-cbt-for-menopause-symptoms-is-about-giving-women-choice\">give women more choice<\/a>\u00a0over how they manage their menopause symptoms \u2013 and choice is clearly welcome. However, we must be vigilant that such changes to treatment options don\u2019t reduce or delay access to hormonal treatments that, for the majority of women, are very safe and very effective.<\/p>\n<p><span class=\"fn author-name\"><a href=\"https:\/\/www.reading.ac.uk\/pcls\/staff\/ciara-mccabe\">Ciara McCabe<\/a> is <\/span>Professor of Neuroscience, Psychopharmacology and Mental Health at the University of Reading.<\/p>\n<p>This article is republished from <a href=\"https:\/\/theconversation.com\/menopause-why-psychological-therapy-is-now-being-recommended-for-hot-flushes-220059\">The Conversation<\/a> under a Creative Commons Licence.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>There are at least 40 symptoms\u00a0of the menopause and perimenopause. These symptoms can have a serious affect on a woman\u2019s\u00a0day-to-day life and wellbeing, which is why having access to timely&#8230;<a class=\"read-more\" href=\"&#104;&#116;&#116;&#112;&#115;&#58;&#47;&#47;&#114;&#101;&#115;&#101;&#97;&#114;&#99;&#104;&#46;&#114;&#101;&#97;&#100;&#105;&#110;&#103;&#46;&#97;&#99;&#46;&#117;&#107;&#47;&#114;&#101;&#115;&#101;&#97;&#114;&#99;&#104;&#45;&#98;&#108;&#111;&#103;&#47;&#50;&#48;&#50;&#52;&#47;&#48;&#49;&#47;&#48;&#51;&#47;&#109;&#101;&#110;&#111;&#112;&#97;&#117;&#115;&#101;&#45;&#119;&#104;&#121;&#45;&#112;&#115;&#121;&#99;&#104;&#111;&#108;&#111;&#103;&#105;&#99;&#97;&#108;&#45;&#116;&#104;&#101;&#114;&#97;&#112;&#121;&#45;&#105;&#115;&#45;&#110;&#111;&#119;&#45;&#98;&#101;&#105;&#110;&#103;&#45;&#114;&#101;&#99;&#111;&#109;&#109;&#101;&#110;&#100;&#101;&#100;&#45;&#102;&#111;&#114;&#45;&#104;&#111;&#116;&#45;&#102;&#108;&#117;&#115;&#104;&#101;&#115;&#47;\">Read More ><\/a><\/p>\n","protected":false},"author":693,"featured_media":28041,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"__cvm_playback_settings":[],"__cvm_video_id":"","footnotes":""},"categories":[1785],"tags":[1579,2277,2213,2159,2161,571,1819,2572],"class_list":["post-28980","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-agriculture-food-and-health","tag-cbt","tag-feature","tag-hrt","tag-menopause","tag-menopause-support","tag-mental-health","tag-wellbeing","tag-womens-health"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.8.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Menopause: why psychological therapy is now being recommended for hot flushes - Connecting Research<\/title>\n<meta name=\"description\" content=\"There are at least 40 symptoms\u00a0of the menopause and perimenopause. 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