Sofia M. Chernoff, PsyD, CBT Program Director

For decades, menopause has been seen as a relatively straightforward progression of women’s health and was given minimal attention by the medical community, as well as the public at large. However, this period in women’s lives can be incredibly complex as it may incorporate not only significant biological changes, but also psychological and social transitions as well. In addition to changes in hormonal levels, women may experience shifts in how they perceive themselves, their bodies, and what is ultimately important to them in life.

Social transitions can include shifts in roles within family units, communities, and careers. Women may experience their children leaving home or they may step into the role of caregiver for aging parents, both of which can further contribute to the complexity of the transition. With the current lifespan, women may spend one third of their lives in menopause. Therefore, it’s wonderful to see that we are finally paying attention to this important and complex transition.

What Are the Treatment Options for Menopause? 

As demonstrated in a number of studies (Green et al., 2019; Norton et al., 2014; Reddy & Omkarappa, 2019), Cognitive Behavior Therapy (CBT) can be an incredibly helpful nonpharmacological intervention to support individuals through menopause and beyond. It allows individuals to explore their beliefs and attitudes towards menopause in a way that empowers and frequently contradicts societal taboos around the topic.

Menopause encompasses a medical transition, and for many women, treatments such as hormone replacement therapy (HRT) can be safe and effective. At the same time, no single approach addresses every aspect of menopause. CBT is a practical evidence-based approach that can help women manage the emotional, cognitive, and behavioral challenges that often accompany hormonal changes. Many women benefit from combining HRT with CBT to address both physical symptoms and quality-of-life concerns.

How Does CBT for Menopause Work?

CBT targets some of the most common challenges during this transition and introduces concrete, helpful ways to cope. Treatment targets may include vasomotor symptoms, irritability and difficulty regulating emotions due to hormonal changes, stress, depression, and anxiety, as well as urogenital and sexual concerns. Another crucial component of CBT treatment focuses on improving sleep quality, which can be especially poor and impactful during this transition. A powerful feature of CBT is that it is always tailored to the unique symptoms, needs, goals, and culture of every individual. The most bothersome and interfering symptoms are addressed in an efficient, evidence-based manner.

An older woman embraces her husband.

For instance, if a woman experiences significant problem with hot flashes and other vasomotor symptoms and tends to ruminate about these problems throughout the day, their CBT therapist may introduce interventions to normalize, decrease hypervigilance of, and improve coping with the symptoms through cognitive techniques and practical strategies. If a client struggles with body image concerns, the therapist may help her identify her unhelpful thoughts and beliefs and develop alternative, more useful cognitions that incorporate emphasis on function and client values.

Similarly, sexual concerns, if present, may be addressed by exploring and addressing thoughts that negatively impact intimacy and increase related anxiety and stress. Women may have thoughts like, “My partner must notice how much I’ve changed,” or “What if I can’t get aroused?” which can contribute to lower levels of relationship satisfaction. Communication strategies to increase closeness between partners can be incorporated with great positive impact. CBT therapists may teach clients assertiveness strategies or interpersonal effectiveness skills from Dialectical Behavior Therapy to ensure needs and concerns are communicated clearly. Clients can develop “I” statements to share their feelings about physical changes, i.e. “I’ve been feeling self-conscious lately, and I’d love to feel closer to you.” Teaching clients active listening can improve communication and help both clients and partners feel heard.  

How Does CBT Address Identity and Role Transitions?

Identification and discussion of personal values and aspirations is another powerful component of CBT treatment. These interventions are especially helpful in assisting with role transitions, focusing on what is most important to the client during this often-difficult stage of life. Therapists can help women find new opportunities to enrich their lives in meaningful ways. A client who is transitioning from the role of longtime caregiver might identify that connection and mentorship remain deeply important to her and explore volunteering or professional mentoring as a meaningful new outlet. Menopause is a complex, deeply individual experience that requires a range of thoughtful, evidence-based treatment options. CBT offers useful tools to improve sleep, reduce distress, and navigate emotional and identity shifts, helping women move through menopause with confidence.

References: 

Green, S. M., Donegan, E., Frey, B. N., Fedorkow, D. M., Key, B. L., Streiner, D. L., & McCabe, R. E. (2019). Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial. Menopause, 26(9), 972-980.

Norton, S., Chilcot, J., & Hunter, M. S. (2014). Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats): moderators and mediators of treatment effects. Menopause, 21(6), 574-578.

Reddy, N. V., & Omkarappa, D. B. (2019). Cognitive-behavioral therapy for depression among menopausal woman: A randomized controlled trial. Journal of family medicine and primary care, 8(3), 1002-1006.

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