Talking therapies can help women with menopause-related anxiety

Talking therapies and mindfulness techniques can reduce depression and anxiety in women experiencing menopause, according to a new study.

The University College of London (UCL) research, a meta-analysis of 30 studies involving 3,500 women in 14 countries, found that talking therapies such as cognitive behavioural therapy (CBT) could also improve memory and concentration problems.

Of the 30 studies, 10 looked at CBT, nine looked at mindfulness-based interventions (MBI), and the remaining 11 examined acceptance and commitment therapy (ACT), group counselling, marital support, health promotion coaching, and emotional freedom techniques.

The studies examining the effectiveness of CBT interventions also included education for women about the psychological symptoms of menopause, relaxation techniques and symptom monitoring.

Those that used MBI-based therapies promoted a non-judgemental understanding of symptoms and focused on the present experiences of the women involved.

All psychosocial interventions proved effective

Symptoms were measured before and after treatment using standardised reporting measures, such as the patient health questionnaire PHQ-9 and the GAD7 questionnaire.

The study, which was published in the Journal of Affective Disorders, found that all the psychosocial interventions were effective in improving quality of life, regardless of their type.

Dr Roopal Desai, clinical fellow at UCL and a study co-author, said that GPs and health care providers often struggle to know what to offer beyond medical treatment, adding that the research will “help give GPs and patients more options.”

Women going through the menopause showed statistically significant improvements in anxiety and depression following CBT and MBI when compared to those receiving no treatment.

Participants undertaking CBT and group-based psychosocial interventions also saw improvements in their memory and concentration levels.

Compared to other interventions, CBT was found to be the most cost-effective option for menopause management, as it requires a shorter course of treatment compared to other therapies.

Link between physical and psychological symptoms

Aimee Spector, professor of old age clinical psychology at UCL, said: “There’s a clear link between these physical and psychological symptoms. So a clear example is the link between hot flushes and anxiety. When people have hot flushes, they tend to get very anxious about having them. And that anxiety can often cause people to have more hot flushes.”

She added: “Poor sleep can lead to depression because it reduces mood. But then, when people have depression, one of the symptoms is poor sleep – so again, another cycle that we see. What we then sometimes see is people leave, avoid situations, leave work, feel they are unable to cope, because they get into this vicious cycle. So what CBT aims to do is to counter these negative cycles, by getting people to use strategies to think about different ways of looking at things. They might do experiments that involve reducing avoidance, testing things out.”

The study authors reported some limitations, noting that the study was unable to consider the best stage of the menopause to deliver interventions, and it could not account for long-term symptom changes that occur with different types of therapy.

Zishi Li, a UCL Master’s graduate and co-author on the study, said: “This study provides encouraging evidence to support the use of psychosocial interventions for managing non-physiological menopausal symptoms. This is in line with the NICE Menopause guidelines, updated in 2023 and currently in the consultation phase, which promote CBT as a treatment option.”

Dr Paula Briggs, chair of the British Menopause Society, said that HRT does not always completely resolve symptoms associated with the menopause, while women can also face other difficulties during the menopause, including those relating to lifestyle. “Anything that helps women in this period of their lives is useful,” she said.