Changing hormones in the menopause, perimenopause and in monthly cycles can have a big impact on anxiety, mood and sleep. Accredited CBT therapist, and sleep specialist, Joanna Hogan MBABCP talks about a new publication* by Dr Louise Newson with Mental Health specialist, Jayashri Kulkarni, that highlights the impact of hormonal changes on mental health and how CBT can help.
For more information on CBT for hormonal issues visit: joannahogancbt.co.uk
The perimenopause and menopause can lead to changes to our mental health and our emotions as well as our bodies. Physical symptoms like hot flushes and night sweats are widely known, but the emotional changes are less well recognised. According to Newson & Kulkarni (2022) around 60% of people are likely to experience perimenopausal or menopausal symptoms and 20% are likely to find that these are severe and have a detrimental impact on their life. Signs of an emotional impact due to menopausal changes can include feeling low, losing confidence, feeling angrier than usual sometimes with bursts of rage, feeling more anxious than usual or feeling more socially anxious than usual. Dwelling, ruminating or procrastinating can also increase. For some people, there can be a sense of impending doom. With extreme emotions the urge to self-harm can be present or suicidal thoughts. For others, difficulty staying asleep, having bad dreams or waking very early can become problematic.
For people with existing conditions mid-life hormonal changes can heighten and worsen these. Recent research has shown that for people with depression, insomnia, anxiety or P.M.T. mid-life hormonal changes can worsen the symptoms. For others, the perimenopause can be the first time that they have experienced high anxiety, low mood, pronounced anger or sleep issues.
So how can these issues be treated? The things that help any person with these issues can help people with hormonal changes. Having the right information and support is key to managing levels of stress, and periods of low mood, irritability and anxiety. Compassion, validation and empathy from others is also crucial to help people manage their often overwhelming feelings.
Louise Newson, founder of the Menopause Society and advocate for Menopausal services is campaigning for greater research into the impact of hormonal changes on our mental and physical health and highlights how a lack of information about this - as well as a lack of understanding by employers and health providers - is creating many challenges to people getting the right support. She highlights that G.Ps will often offer anti-depressants, sleeping tablets or anti-anxiety medications to women in their 40s and 50s presenting with low mood, rage and anxiety rather than looking at hormonal balance.
Doctor Newson suggests that the best approach to manage your mental health and emotional wellbeing in the perimenopause and menopause is one that addresses all the relevant factors combined: "top up your hormones to keep things balanced, make some achievable changes towards eating healthily and being active outdoors, maintain your social and personal connections and talk to others about how you feel, use psychological therapy if needed, and last but not least be kind to yourself!"
Cognitive Behavioural Therapy (CBT) has a strong evidence base for helping with menopausal low mood, anxiety and sleep and is endorsed by the National Institute of Health and Care Excellence (NICE) in their guidelines on menopause management. CBT is an NHS supported therapy that helps increase your awareness of the link between your thoughts, feelings and subsequent behaviours. CBT therapists help you to develop the strategies to cope with unwanted thoughts, feelings, and associated physical reactions. It helps you adapt to changes, and if needed, helps you to make improvements to the way you respond to your thoughts and feelings.
How to get Help
For CBT for anxiety, depression and sleep issues related to PMDD, PMT, perimenopause, menopause or other women's health issues you can talk to Joanna Hogan MBABCP & associated through www.joannahogancbt.co.uk or find an accredited CBT therapist through the BABCP website. Joanna Hogan is based at Springbank Clinic in Sevenoaks, Kent.
For more information on hormonal treatments you can talk to your G.P or ask for a referral to a gynaecologist for my specialised support.
Or you can to to the Menopause Society's website. www.balance-menopause.com
Private providers of Menopause Support are also available - Newson Health provides an online service at Newson Health - Home.
Sources of Information
*Mental health and emotional wellbeing in the perimenopause and menopause by Dr Louise Newson, menopause specialist.
Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial
Sheryl M Green 1 2, Eleanor Donegan 2, Benicio N Frey 1 2 3, Donna M Fedorkow 4, Brenda L Key 1 3 5, David L Streiner 1, Randi E McCabe 1 5
2019 Sep;26(9):972-980.
Development and validation of a new rating scale for perimenopausal depression-the Meno-D
Jayashri Kulkarni 1, Emorfia Gavrilidis 2, Abdul-Rahman Hudaib 2, Caitlin Bleeker 2, Roisin Worsley 2, Caroline Gurvich 2
Transl Psychiatry 2018 Jun 28;8(1):123. doi: 10.1038/s41398-018-0172-0.
Premenstrual Mood Symptoms in the Perimenopause
Bethany Sander 1, Jennifer L Gordon 2, Curr Psychiatry Re . 2021 Oct 6;23(11):73.
Kuehner C, Nayman S.Curr Psychiatry Rep. 2021 Oct 9;23(11):78. doi: 10.1007/s11920-021-01286-0.