When I read the new NICE guidance for menopause treatment I thought they’d made a misprint; that they’d written CBT rather than HRT by mistake. It seemed the only logical explanation. After all, HRT which is currently the go-to treatment for menopausal symptoms on the old NICE guidelines, is Hormone Replacement Therapy. For those of you who don’t know, that means pills or gels containing oestrogen and progesterone, the chemicals which decline in the body as women age, causing them to stop having periods, ie become menopausal. By contrast CBT – Cognitive Behaviour Therapy – although it shares the word ‘therapy’ is otherwise entirely different. CBT is a mind-control technique used to change ruminative or obsessive behaviour patterns and is useful for those suffering from anxiety, or depression or eating disorders. It works a bit like pinging an elastic band on your wrist to pull you out of a particular loop of thoughts. It’s about exerting control over entrenched mental habits to try and change them – or free the patient from their intrusive nature.
The worst kind of medical misogyny
But menopause is a physical condition, created by fluctuating hormone levels with a list of 40 or more possible symptoms. So why on earth is NICE recommending CBT for menopause? To be honest it seems down-right insulting and depressing given the recent focus on better treatment. Suggesting women do CBT rather than take HRT is the medical equivalent of saying to us Queenagers: ‘Calm down dears! Have a bit of CBT and all those hot flushes, and night sweats and vaginal atrophy, and heart palpitations will vanish. They aren’t real, they are just in your mind.’ To me that smacks of the worst kind of medical misogyny, dismissing women’s pain and real suffering as hysteria, all made up in our pretty little dumb heads, rather than being physical symptoms of a huge hormonal change in the body. It would be like saying to a Type One diabetic – don’t worry about the life-threatening swings in your blood sugar levels which can send you into a coma – just have a bit of CBT. It’s all in your mind, after all. Telling women they need a talking cure rather than hormone treatment for menopause is a return to the worst kind of Victorian view of women as hysterical (the word hysteria comes from the Greek for uterus hystera) imaging our pain and discomfort. It is dismissing the all to real symptoms and distress of millions of women – we are 51% of the population and all of us with female biology go through it.
Of course HRT doesn’t work for everyone
As the founder of a community of queenagers and a platform for women in midlife (noon.org.uk) I spend more time than most listening to menopausal and peri-menopausal women. I have spent hundreds of hours talking to them and hearing from experts in this field of medicine. I’ve heard about how HRT might well prevent women getting Alzheimer’s and dementia, how it is good for minimising our risks of osteoporosis, as well as how it might protect from heart disease. Yes there are well-documented breast cancer risks for some women from taking extra hormones, but a doctor friend described the elevated risk to me as being “no more than drinking a few glasses of wine a week or having a higher than advised BMI”. Of course, HRT doesn’t work for everyone, if you’ve had breast cancer for instance, it isn’t advisable. And some women don’t need it. I find for instance that swimming in cold water and not drinking minimises my menopausal symptoms. But for millions HRT is a lifesaver – just ask Davina Mcall!
The experts are gobsmacked too
This CBT advice sounds barmy – and it is certainly leftfield. In all the hours I’ve spent talking to women about and researching menopause I have NEVER heard any doctor recommend CBT or even mention it as a ‘cure’ for menopause sleep habits or anything else. Nor has anyone else. Before writing this I checked in with a few experts who were all as gobsmacked by these new guidelines as I was.. “Are they mad?” said one doctor friend. “Do they not know that the current waiting times for CBT or any kind of talking therapy on the NHS are months, if not years, long? This sounds to me like a way of saving the NHS money on HRT by sending women who need help to the back of the CBT queue. It’s just another way of kicking the menopause issue into touch.” Another expert described the advice as “Insulting and positively medieval, the worst kind of Victorian thinking. I’ve never heard anyone mention CBT in this context, where are NICE getting this from?” Quite.
By Eleanor Mills
As both a woman going through perimenopause, and a women’s self-development coach I can see your perspective but am concerned about how we often fail to see that bigger joined up picture for health and well-being. The body and mind work together and when one’s down – the other follows. Going through the menopause is a psychological battle as well as a physical one. Quite often the symptoms of menopause are all muddled in with that time in life that we realise we have lost vision and identity. So whilst CBT is not a suitable replacement for HRT (and I don’t believe it is being suggested as that) it is a brilliant complimentary therapy for women going through menopause – as is any form of therapy or coaching that helps them with their mindset, inner goals, personal development and vision for themselves. These therapies can help reduce or eliminate symptoms of anxiety and overwhelm through not only tools and techniques but by encouraging and supporting the person’s commitment to nurturing their mind, body heart and soul in equal measures.
As a 57 year old women coming out the other side of menopause and also in full disclosure a CBT therapist perhaps the latter does create a bias but surely it’s great to have more options to explore. I’m of the view that if HRT helps you take it if safe to do so. If CBT helps try it and it really is so much more than a mind control technique. CBT looks at both our thoughts and behaviours and whether there are more helpful ways to think or to do. Many women have found this therapy effective in managing hot flushes, sleep, menopausal anxiety and depression. After all the menopause is so much more than just reduced hormones. Surely we need to have options not one or the other.