CBT for menopause: what it is, what it can help with, and how to get it

Maybe your GP mentioned it. Maybe you read that it's now in the UK menopause guidelines. Either way, you might be wondering how a talking therapy could possibly help with a hot flush. It's a fair question.

CBT for menopause doesn't pretend your symptoms are "all in your head". They're real, and they're caused by real changes in your body. What CBT does is give you practical skills for how those symptoms affect you: the panic when a flush starts, the 3am worry about tomorrow, the low days that follow bad nights.

This guide explains what CBT is, what the evidence says, how to get it, and a few techniques you can start with tonight.

What is CBT?

CBT stands for cognitive behavioural therapy. The NHS describes it as a talking therapy where a therapist helps you change how you think and act. Its main aim is to help you make changes to deal with the problems you have now.

It looks at how four things link together:

• what's happening in your body
• what you think
• how you feel
• what you do

A change in one can set off the others. That's why changing how you think about a symptom, or what you do when it starts, can change how it feels to live with.

What is CBT for menopause?

Menopause-specific CBT is CBT shaped around menopause symptoms, especially hot flushes and night sweats. Women's Health Concern, the patient arm of the British Menopause Society, calls CBT a brief, non-medical approach. It says it can help with anxiety and stress, low mood, hot flushes, night sweats, sleep problems and tiredness. It can be used on its own or alongside HRT.

Here's how it works for a flush. Say you feel one starting in a meeting. You think "Everyone's staring at me" or "I can't cope with this". You feel embarrassed and out of control. That makes you tense and your heart races, and the flush feels even worse. Women's Health Concern explains that CBT helps you find calmer, more neutral responses, so you feel more in control.

What does NICE say about CBT for menopause?

NICE writes the guidelines that UK doctors follow. In 2024, it added menopause-specific CBT to its menopause guideline, NG23. It says doctors should consider CBT as an option for:

• hot flushes and night sweats, alongside HRT, or for women who can't take HRT or would prefer not to
• sleep problems, such as waking in the night, linked to flushes and sweats
• low mood linked to flushes, when it isn't full depression

NICE also says your doctor should explain what CBT is and talk through the options that suit you. That could be face to face or remote, one to one or in a group, or a self-help option.

Notice the word "consider". NICE treats CBT as an option to discuss, not something everyone must have.

What the evidence shows

NICE has published why it made these recommendations. It's refreshingly honest.

• Hot flushes and night sweats. Overall, the evidence showed CBT helped. The benefits covered how often flushes came, how bad they were, and how much they bothered women. The biggest effect was on how much they bothered women. Many felt their symptoms affected them less.
• Sleep. CBT improved sleep quality, though results varied depending on how sleep was measured.
• Low mood. Most studies showed no difference between CBT and the comparison groups. Some showed better mood. None showed CBT made low mood worse. NICE still included it, because CBT is already an established treatment for low mood more generally.

NICE also noted real limits. Some studies had design problems, results varied between measures, and it wasn't clear how big the effect was. Several types of CBT, including online and group sessions, were found to help, and none stood out as better than another.

The UK trials

Much of the research on CBT for menopause comes from a team at King's College London.

In one trial, published in 2012, 140 women with at least ten problem flushes or night sweats a week were split into three groups: group CBT, guided self-help CBT, or no treatment. After 6 weeks, both CBT groups rated their flushes and sweats as less of a problem than the no-treatment group. The difference was still there at 26 weeks. Night sweats became less frequent, and mood and quality of life improved too.

An earlier trial looked at 96 women with problem flushes and night sweats after breast cancer treatment, when HRT often isn't an option. Half had group CBT: one 90-minute session a week for 6 weeks, including paced breathing. Their flushes and sweats felt less of a problem at 9 weeks, and this lasted to 26 weeks. They also reported better mood, sleep and quality of life, and no harms from the CBT were recorded.

What happens in CBT sessions?

The NHS says you'll usually have between 5 and 15 sessions, depending on the problem. In a session, you talk through difficult situations and how they make you think, feel and act. Your therapist helps you:

• question unhelpful thoughts and look at other ways of seeing things
• notice your emotions and physical feelings without reacting to them
• change what you do, such as slowly going back to things you've been avoiding

You'll be asked to practise between sessions, often with a worksheet or diary. That practice is a big part of how it works.

CBT can be guided self-help (a workbook or online course, with support from a therapist), one-to-one sessions, or a group. It can happen in person, online or by phone.

How to get CBT for menopause

NHS Talking Therapies. If you live in England, you can refer yourself to NHS Talking Therapies for anxiety, low mood, worry or depression without seeing a GP first. You need to be registered with a GP and aged 18 or over (16 in some areas). Elsewhere in the UK, services are run differently, so ask your GP.

It's worth saying that your symptoms are linked to menopause. NICE has noted that waiting times for CBT can be long, and that some therapists may not yet be trained in the menopause-specific approach. NICE suggests online and group CBT may be easier to adapt for menopause.

Your GP. You can ask your GP or practice nurse about CBT for flushes, night sweats or sleep. For sleep problems, the NHS says a GP may offer CBT face to face with a therapist or through an online self-help programme.

Self-help. Women's Health Concern's factsheet points to a four-week CBT self-help guide for hot flushes and night sweats, which has been tested in clinical trials. Its factsheet also lists self-help books on anxiety, low mood and sleep.

Privately or through work. The NHS notes that talking therapies are sometimes free through your employer or local charities. If you pay privately, it suggests choosing a therapist on a register accredited by the Professional Standards Authority.

CBT techniques you can try at home

These ideas come from Women's Health Concern's CBT factsheet. They take practice, so be patient with yourself.

Paced breathing

Slow, even breathing from your stomach. Put one hand on your chest and one on your stomach. The hand on your chest should stay fairly still while the one on your stomach rises and falls. It may be easier to practise lying down at first.

When you feel a flush starting, drop your shoulders, breathe slowly from your stomach and focus on your breath. Let the flush wash over you, knowing it will pass.

Notice your thoughts, then answer them kindly

When a flush or a wave of worry comes, notice what goes through your mind. Write it down. Then ask yourself:

• Is this thought really true?
• What would I say to a friend in the same spot?
• What's a kinder, more helpful way to see it?

For example, "Everyone's looking at me" might become "I notice my flushes far more than anyone else does." And "I can't cope" might become "I've handled this before. One at a time."

Spot your triggers

Keep a short diary of your flushes and what happened just before. Women's Health Concern lists coffee, hot drinks, some spicy foods, alcohol, stress and rushing about as common triggers. Once you know yours, small changes can give you back some control.

Stay put where you can

It's tempting to leave the room or turn down plans. But avoiding things means you never learn that you can manage. Where it feels safe, try staying in the situation.

For night sweats and broken sleep

The factsheet suggests a two-part approach. First, good sleep habits:

• dim the lights and put screens away in the evening
• cut back on caffeine and alcohol
• keep your bedroom cool
• have a wind-down routine you follow every night
• keep regular hours, and avoid naps after 3pm
• after a bad night, carry on with your plans the next day

Second, a calm routine for when a night sweat wakes you. Get up quietly and cool down. Notice your worries, but don't get into them. Then go back to bed and use your paced breathing. A useful phrase to try is "I'll deal with this tomorrow when I can think clearly."

For more on sleep, see our guides to menopause insomnia and waking at 3am.

For low days

Do a little more of what you used to enjoy, even for a few minutes. At the end of each day, write down three things that went well, however small. Our page on menopause mood swings has more ideas.

CBT alongside other treatments

CBT isn't an "instead of everything else" choice. Women's Health Concern and NICE both say it can be used on its own or alongside HRT. If you can't take HRT, our guide to menopause without HRT sets out the other options to discuss.

NHS Talking Therapies also offers help for anxiety, including panic. Our page on perimenopause panic attacks explains more. See heart palpitations in perimenopause for when a racing heart needs checking first. If tiredness is wearing you down, our page on perimenopause fatigue may help. And you can see the full picture on our perimenopause symptoms page.

Where relaxation fits in

If you're working on your sleep, with CBT, your GP or on your own, you might like something gentle to listen to at bedtime. Our menopause sleep hypnosis, Deep Sleep Through the Change, is a bedtime recording to help you unwind and drift off. It's something to use alongside proper care like CBT, never instead of it. It's a relaxation recording, not a treatment, and it doesn't replace advice from your GP.

Related: hot flushes, menopause anxiety and cortisol and menopause.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.