CBT adapted for menopause shows benefits for vasomotor symptoms, mood, and sleep, according to Danette Conklin, PhD, at The Menopause Society.
Cognitive behavioral therapy (CBT) continues to be adapted for women experiencing menopause-related symptoms, according to Danette Conklin, PhD, director of Behavioral Health Services for Bariatric Surgery and Weight Management at University Hospitals, and assistant professor of Psychiatry and of Obstetrics and Gynecology at Case Western Reserve University School of Medicine. Conklin discussed the evidence and clinical application of CBT for menopause during a session presented at The Menopause Society annual meeting.1
“Education is a big piece of this, and even with traditional CBT, there’s a lot of education,” Conklin said. “The education about menopause and the possible length of menopause, the variations between women, I think that’s a big deal, and it helps women to know they’re not alone.” She emphasized that this knowledge can help normalize symptoms and reduce anxiety for patients who may compare their experiences to others.
Following the educational component, therapy is tailored to each woman’s primary concerns. “We adapted it to help with hot flashes and night sweats, most definitely, since that’s the number one reason why people seek treatment,” she said. Current adaptations also address mood swings and sleep disturbances, with additional work underway to extend CBT protocols to weight-related concerns in peri- and postmenopausal women.
Conklin credited much of the foundation for CBT in menopause to the work of Myra Hunter, PhD, of King’s College London. “I actually followed her work for quite some time, and I ran a non-randomized clinical trial based on her several randomized clinical trials,” Conklin explained. Hunter’s studies initially focused on breast cancer survivors with severe vasomotor symptoms and later expanded to working women and group formats.2
Conklin’s own research, conducted with women who had mood disorders using Hunter’s protocol, demonstrated reductions in both the severity and frequency of hot flashes and night sweats. She also cited additional evidence from researchers Green and Soares, whose CBT-Meno protocol “found a reduction in the severity [and] frequency of hot flashes” as well as “some positive impact on mood and anxiety.”
“To me, that’s not a surprise, because traditional cognitive behavioral therapy helps with anxiety and depression,” she noted. “So I would say there’s a lot of evidence for vasomotor symptoms for sure.”
Conklin highlighted how anxiety can exacerbate insomnia and rumination among perimenopausal and postmenopausal women. “The problems have increased. The rumination is harder to stop and harder to manage, and it affects sleep onset for sure,” she said. When sleep disruption occurs, “the rumination starts again,” making CBT techniques for coping skills and sleep maintenance particularly valuable.
She added that urinary frequency is another issue that may require inclusion in CBT-based management plans for menopausal women.
Although the intervention shows clinical promise, Conklin stressed that CBT for menopause should be administered by properly trained professionals. “I would not encourage anyone who doesn’t have training to use an intervention, because, you know, our licenses are like, we have to be ethical,” she said. However, clinicians can provide general information or refer patients to reputable sources.
Conklin recommended the Menopause Society website and the National Register of Health Service Psychologists as starting points for locating qualified providers. “Even if you find psychologists in your area, you would have to ask if they specialize in menopause treatment,” she advised. For patients without access to a psychologist, clinicians can also share “tip sheets” or educational resources to support symptom management.
Conklin reports no relevant disclosures.
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