CBT for menopause: how talking therapy helps hot flashes, sleep and mood
Cognitive behavioral therapy (CBT) is a short, structured talking therapy. Trials show it makes hot flashes and night sweats less bothersome and improves sleep, and NICE and The Menopause Society both recommend it.
Get help quickly if low mood is severe, lasts more than two weeks, or comes with thoughts of self-harm. CBT for menopause is not a substitute for urgent mental health care.
What it is
CBT helps you notice how thoughts, feelings and actions affect each other. The menopause version was designed for hot flashes, night sweats, sleep problems and stress.2
It usually runs over 4 to 6 weeks. It can be done in a small group or through a self-help book. Trained nurses, counselors and other health workers can deliver it.2
Sessions cover practical skills. Examples are slow breathing at the start of a flash, calmer ways of thinking about it, and a set routine for night waking.2
A related form, CBT for insomnia (CBT-I), focuses on sleep habits and thinking patterns that keep people awake.3
What the research shows
Hot flashes and night sweats. One UK trial included 140 women, with an average age of 53. Each had at least 10 troublesome hot flashes or night sweats a week. Group CBT was four weekly 2-hour sessions.1
Group CBT and self-help CBT both made hot flashes much less of a problem after 6 weeks, compared with no treatment.1
The benefits were still present at 26 weeks. Women in the CBT groups also reported better mood or general health than the comparison group.1 The British Menopause Society notes similar results in trials that included women after breast cancer.2
CBT seems to work mainly by making flashes less distressing and easier to manage. It is less clear how much it changes the number of flashes.
Sleep. A US trial gave 106 women with hot flashes and insomnia either telephone CBT-I or menopause education. After 8 weeks, insomnia scores fell by about twice as much with CBT-I. The women were aged 40 to 65 and were followed up to 24 weeks.3
Guidelines. In 2023 The Menopause Society recommended CBT for hot flashes.4 NICE updated its CBT advice in November 2024.5 Its final guideline says CBT is an option for hot flashes and night sweats, low mood linked to menopause, and sleep problems. It can be used alongside HRT or instead of it.6
Safety and who should be careful
CBT has no drug side effects or interactions. It can be used alongside hormone therapy or non-hormonal medicines.6
It takes time and practice, and results depend on doing the exercises. It is not a cure for depression or anxiety disorders, which may need other treatment.
CBT may suit women who cannot take hormones, such as some breast cancer survivors, as well as those who simply want a drug-free option.2
Related mind-body approaches
The Menopause Society also recommended clinical hypnosis for hot flashes in 2023.4
It did not recommend paced breathing on its own, mindfulness, relaxation training or yoga for hot flashes.4
These approaches may still help with stress or general wellbeing. They just should not be counted on to reduce hot flashes. Ask your doctor which approach fits your main symptoms.
How it is available
Menopause-focused CBT is available as self-help books, group courses and through some health services.2 Access, waiting times and cost vary a lot between countries.
Ask a doctor, a menopause clinic or a licensed therapist what is offered near you. Some programs are available by phone or online.3
What it is used for: evidence rated
| Option | Evidence | What the research shows |
|---|---|---|
| Hot flashes and night sweats | Randomized trials show they become much less bothersome; recommended by NICE and The Menopause Society.1,4,6 | |
| Sleep problems | CBT for insomnia is the first-line treatment for chronic insomnia in major guidelines, and a 106-woman menopause trial found clear benefit.3,7 | |
| Low mood and anxiety | NICE says CBT can help depressive symptoms linked to menopause; menopause-specific trial data on mood are more limited.1,6 |
Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.
Related
Sources
- Women found relief for menopause transition through cognitive behavioral therapy (MENOS 2 trial), Healio (2012)
- Cognitive behaviour therapy for menopausal symptoms, factsheet for health professionals, British Menopause Society (2017)
- Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: an MsFLASH randomized clinical trial, JAMA Internal Medicine (2016)
- The 2023 nonhormone therapy position statement, press release, The Menopause Society (June 1, 2023)
- Menopause: identification and management (NG23), update information, NICE (November 2024)
- Menopause: identification and management (NG23), rationale and impact, NICE (November 2024)
- ACP recommends cognitive behavioral therapy as initial treatment for chronic insomnia, American College of Physicians (2016)