New guidance for talking therapy and the menopause

Talking therapy and choice

New draft guidance from the health watchdog NICE (National Institute for Health and Care Excellence) suggests women should be offered talking therapy through the NHS to help manage symptoms related to menopause. Talking therapy might be used alongside or instead of hormone replacement therapy (HRT) to offer women more choice. NICE said women should talk to their doctor and then be able to choose which treatment will work best for them. In particular, the guidance points out that coping strategies learned through cognitive behavioural therapy (CBT) can be effective when managing menopause related sleeping problems, night sweats and hot flushes, and symptoms of depression.

Manage menopause related symptoms

Speaking on BBC Breakfast on 17 November 2023, GP Dr Nighat Arif explained how her practice already offered cognitive behavioural therapy to patients. This type of talking therapy was mainly to help manage menopause related symptoms like brain fog, irritability, anger, and low mood. ‘Some women find their symptoms are really impacting them and their sleep is also affected’, she stated, explaining that the previous NICE guidance suggested HRT should be prescribed for psychological symptoms, rather than anti-depressants.

Talking therapy waiting times

Dr Arif went on to highlight some of the controversy surrounding this new guidance, recognising it might increase the disparity of health inequality by pushing more women to seek counselling in the private sector. It seems the issue is not around the effectiveness of talking therapy, but a lack of available therapists within the NHS. She said, ‘currently, offering CBT for menopausal symptoms on the NHS is just not there’ and that ‘clinical care boards have not been offering it because of funding.’ According to Dr Arif, waiting times for NHS counselling is also an issue, with a three to six month wait even for online CBT, and that’s likely as part of a group session. ‘For face-to-face CBT we are looking possibly a year’. The low availability of some services on the NHS has long been discussed, and she suggested, ‘this guidance I feel has come around to maybe take the pressure off the demand for HRT. That’s the cynic in me!’

Mental health wellbeing

Dr Arif also shared some observations about the nature of issues presented to her as a GP in recent times, ‘Since COVID, nearly 100% of my consultations have some sort of mental health wellbeing aspect that needs to be tackled’, adding that ‘CBT is brilliant’ for patients with some of those issues. She felt it important not to oversimplify CBT as an approach however, and that we ‘need to think of CBT as not just this umbrella term because there are different layers to [it] that a woman needs, so acceptance-commitment therapy … really helps with hot flushes and night sweats. This is important she added, because up until now much of the focus has been on HRT for managing symptoms related to menopause. In addition, some women are advised not to take HRT because of pre-existing medical conditions, while others are put off because of its associated risks. ‘HRT is not a silver bullet and it’s not one size fits all.’

'The Knowledge: Your guide to female health - from menstruation to the menopause' Published August 2023
‘The Knowledge: Your guide to female health – from menstruation to the menopause’ Published August 2023

NICE guidance

Dr Paula Briggs from the British Menopause Society was also interviewed by the BBC. She believed that the guidance would be beneficial for women that can’t have HRT, as it would ‘go a long way to helping them feel recognised.’ You can find out more about the guidance at the NICE website, here.