Since the release of the update in the NICE guidelines for menopause, there’s been much debate around the inclusion of CBT as a recommended treatment choice for women. Surely this can only be a good thing – increasing choice so that women can make their own decisions around what to try, to alleviate the problems of menopause. I agree with many, however that this shouldn’t detract from the option of HRT and access to this. Access to therapy will be problematic too as it is in every area from young to old. It does frustrate me that CBT is the only therapy proposed and this will be down to lack of funding for both mental health research and menopause research. CBT can be useful in all areas of life from addressing sleep problems to coping with anxiety and low mood, and now research shows it is linked to fewer hot sweats during menopause too. This will be great for some women, but I feel a more bespoke approach is required. We’re individuals with different life stories, traumas and personalities and any approach to care needs to be individualised. I am encouraged to read that Professor Jonathan Benger, chief medical officer at NICE said: “The impact of menopause symptoms on quality of life can vary hugely. It is important that healthcare practitioners take a personalised approach when discussing treatments, using evidence-based information tailored to individuals’ circumstances.” The update also includes recommendations for trans men and non binary people registered female at birth, so we’re making progress, although some would say not enough.
Women are worried that they will be steered towards therapy and not offered HRT, and many believe that a recommendation for CBT indicates that, “it’s all in your head”. We need to be careful not to dismiss what women are saying and what they’re asking for. Frontline staff need to be educated around CBT so that they can have useful conversations with women, and to enable them to make informed choices. Information is key.
CBT looks at the multiple factors that heighten both physical and emotional symptoms. It’s not that psychological therapy suggests the hot flashes aren’t really there or that they’re not that bad, instead it’s based on the scientific understanding that what we do in response to our circumstances and how we’re feeling can worsen or improve the overall experience. Another tenet of CBT is that the things we tell ourselves in our minds, can worsen or improve how we’re feeling and this is true for pain and a multitude of health problems. Paying attention to what’s going on inside our minds can help make small changes to our overall experience of the pain or distress and suffering. CBT teaches strategies for noticing and responding to this and coping skills.
Some charities or your workplace may offer access to free online CBT so this is worth investigating if you’re interested,otherwise access through the NHS has much longer waiting times, although it might still be worth getting your name down on the list. The more things we have in our armour the better I say, but if it’s not for you – ask for what you need. We know that nutrition and exercise are massively helpful, as is peer support and employer support. So speak up! And reach out! We’re in this together!
Image by Jupilu Pixabay
Sea change 