We may be talking a lot about the menopause, but, asks Deputy Editor Jennifer Gledhill, can psychologists offer more support during this transitional time?
07 October 2025
We've all received the 'menopause memo'. Davina McCall is showing us how she applies her oestrogen gel on YouTube, Michelle Obama is podcasting about hot flushes and weight gain, and Gwyneth Paltrow is on TikTok, talking about how she feels 'sudden fury for no reason'.
Like many of us, I've been on mandatory workplace menopause awareness training, but it left me feeling no better. I was told to go easy on myself. I'm too busy feeling the shame of brain fog and the weight of anxiety – just a couple of the 30+ symptoms of menopause – to figure out how I do this.
My Instagram algorithm is pushing me to spend a month's salary on menopause supplements, which promise to help me sleep and find more energy and clarity. Yet it all feels more about money than science – the global market for menopause products is reportedly worth nearly 17 billion dollars.
So, what will help? Thankfully, we now know that the benefits outweigh the risks for many symptomatic women when taking hormone replacement therapy. That's a turnaround from the early 2000s when the Women's Health Initiative suggested a substantially increased risk of breast cancer. HRT can help to relieve symptoms including hot flushes, sleep problems and low mood. However, many women, including me, are advised not to take it due to medical family history and other risk factors. Can psychology offer us more options? And, more importantly, do they work?
'We need other options'
I speak with Aimee Spector, Professor of Clinical Psychology of Ageing and one of the psychologists at University College London's Menopause Mind Lab – dedicated to understanding more about the impact of menopause transition on cognition, mental health and wellbeing. When I tell her that the only thing I was offered when I reported heightened anxiety and low mood to my GP was antidepressants, she expresses disappointment.
'This shouldn't be the only option,' says Spector, who believes psychology can now play a huge role in making the transition a more positive one. 'I have firsthand experience of navigating this journey for myself. It's hard. There often seems to be a lot of focus on the biological changes our bodies go through, but there are lots of psychological and cognitive symptoms as well. For me, HRT was helpful at first, but then I got breast cancer, and the recommendation was to come off it. We need other options as well.'
Spector and her team have evaluated the effectiveness of psychosocial interventions, including Mindfulness-Based Interventions and Cognitive Behavioural Therapy, on non-physiological symptoms of menopause, including mood, cognition and quality of life, combining data from 3,500 women. 'CBT can help with the psychological thoughts about the physiological feelings,' she says. 'And the combination of CBT and HRT works well together. Take hot flushes that are disrupting sleep, for example. Someone may take HRT to help with the physiological symptoms, but they may well have also got into a negative thought pattern too, something I think we can all identify with – waking up in the night and not being able to drift back off because you are worrying that you are going to be awake all night. Or, we can worry about having a hot flush at work and being judged by our colleagues. CBT can be helpful when we are stuck in a negative pattern of thought, which may be hard to come out of, even when symptoms start to get better. It can help us to find strategies and techniques to help.'
One size doesn't fit all
But like with anything, there is no 'one-size fits all' and menopause support is no exception. 'For example, some neurodiverse people don't like CBT because something telling you to change the way that you think about things can be very challenging,' says Spector. 'One of the projects that we're doing now is looking at the results of Compassionate Mind Training (CMT) on women going through menopause transition; we're getting really promising results from it and hoping to expand it into a trial. CMT is a 'third wave CBT' that aims to reduce feelings of self-criticism and shame. It focuses on helping individuals to take better care of themselves and learn strategies to manage their symptoms.'
King's College London's Emeritus Professor of Clinical Health Psychology, Myra Hunter, who has worked in women's health for over 35 years, has been instrumental in creating a CBT programme that, in 2024, for the first time, was recommended by NICE as an intervention for the main menopausal symptoms – hot flushes and night sweats.
'This was good news,' she tells me. 'In the first menopause NICE Guideline in 2015, the only symptom CBT was recommended for was depression in menopause. We have now carried out six successful clinical trials and have enough evidence that CBT can help reduce the impact of hot flushes and night sweats, and help to reduce depressed mood and sleep problems. This offers a choice for women who prefer not to use HRT or for whom HRT is contraindicated. It can be used either in conjunction with HRT or on its own, and is available in self-help, group and online formats.'
Hunter explains that it is helpful to use a biopsychosocial approach to understand the range of factors that can affect a woman's experience of menopause. 'Although there are typical symptoms, we will all have our own experience, and an important need for people in perimenopause or menopause is to feel understood. As psychologists, how do we explore this? We can start by being informed and aware of what might happen during menopause, but not to judge or make assumptions. On average, about 25% of women have symptoms that impact quality of life. As well as biological factors, such as general health and menstrual changes, it makes sense to explore psychosocial factors, such as mood, beliefs about menopause and ageing, workplace environment, shame and stigma, and social support. There are bi-directional relationships between hot flushes and depressed mood, and this is important because mid-life is a time of higher reports of depressive symptoms for both men and women. There are many interactions between experience of symptoms and psychological stressors – children leaving home perhaps, older relatives needing more care – as well as expectations of how we should age and the social meanings and beliefs around women ageing.'
Hunter tells me that's where CBT and working in groups can really help. 'I think it's important with menopause awareness to remind people we're not treating an illness but offering evidence-based information and useful tools to navigate the menopause journey. We offer CBT in groups and individually, and it's manualised for psychologists and other health professionals. The course is 8 hours in total and involves psychoeducation around how to reduce stress and how lifestyle, thoughts and behaviours can impact our wellbeing. We use diaphragmatic breathing to help calm stress reactions and hot flushes. We then move on to use cognitive therapy to challenge overly negative beliefs about ageing and menopause, and coping strategies for hot flushes, sleep and night sweats. We encourage self-compassion and use CBT to help reduce the stigma and shame that we can often feel around having them. In group settings, we look at how to talk about menopause, grow our confidence and not feel the need to apologise for it.'
Menopause not illness
However, when the NICE guidelines were initially published in a consultation document, there was an immediate backlash, with the media and some advocacy groups expressing outrage that psychological interventions were being recommended for their debilitating symptoms. A quick Google points to some early reactions: 'Rubbish. How is mindfulness going to help you when you wake again at 3am drenched in sweat?' and, 'Try being in a responsible job with long hours and making time for this. HRT got me through without fuss.'
Both Hunter and Spector remember the reactions well. 'Opinions can be very divided,' says Spector, 'but saying that CBT might help doesn't mean that HRT won't. It certainly helped me, but I was told to stop taking it! Many people would benefit from both, and some may want choices in terms of treatment options.'
'The wording of the final guidance, published in 2024, was changed to be clear that CBT is recommended as an option – not instead of HRT ', says Hunter. 'However, given that women's experience varies such a lot, it makes sense to wait to find out if you need to have HRT, rather than viewing it as something you should be doing. There have been people on social media talking about menopause as if it's a disease that you must take medication to treat. What we can do is not say that the menopause is automatically a disaster for everybody.'
After falling down a rabbit hole reading the responses to the NICE guidelines around CBT, I wonder if part of it is fuelled by the ongoing legacy of women not feeling heard by the health system. After all, a 2025 study funded by the Department of Health and analysed by The London School of Hygiene and Tropical Medicine has found that one in four women in England have suffered with serious reproductive health issues, with 'systemic, operational, structural and cultural issues' preventing them from accessing care.' Overall, 74 per cent of women reported experiencing some form of reproductive health problem relating to menstruation, menopause, pregnancy and diseases such as endometriosis and polycystic ovary syndrome.
If we haven't experienced personalised, compassionate care from our health care provider (and how much can we expect in a brief appointment?), and menopause-training has, for the first time, only just become mandatory for medical students, can we really expect our reproductive and menopausal health needs to be met when we ask for support? Do we need to stay on the defensive until we can be assured that professional caregivers have caught up?
Researching psychiatric disorders
'Progress is always too slow and too frustrating,' says Professor Arianna Di Florio, Professor of Psychological Medicine and Clinical Neuroscience at Cardiff University. Di Florio's recent 2024 study has highlighted just how much we need to question research methods that study the experience of perimenopausal people.
Her team looked at incidence rates of psychiatric disorders during the perimenopause (classed as four years around the final menstrual period – FMP) and found that, compared with the pre-menopausal period (6-10 years before FMP) incidence rates of psychiatric disorders significantly increased (0.59% to 0.88%), mainly due to small increases in new onset major depression and mania. However, these prevalence rates returned to premenopausal levels during postmenopause (0.50%).
The study was the first of its kind in the UK to include over 120,000 participants and use 'age at menopause' rather than simply 'age' as a variable. 'In my clinic, I found that some women, previously living lives without any experience of severe mental health issues, developed severe mental illness around the time of the menopause,' says Di Florio.
'Psychiatric disorders associated with the menstrual cycle, childbirth and menopause are very complex, very heterogeneous conditions. The crucial point to me is that, clinically, we cannot make any strong assumption based on averages. By using age at menopause rather than simply age, we found that participants without a previous history of mania were over twice as likely to develop mania for the first time in the perimenopause than in the late reproductive stage (6 – 10 years before FMP).'
'So, in practical terms,' says Di Florio, 'if a perimenopausal woman presents to the doctor for the first time with symptoms of bipolar disorder, the doctor should take her seriously and not, as sometimes happens, confuse a severe mental illness with another condition, such as major depression or, even worse, with an existential crisis or a stereotype such as the "empty nest syndrome" or, even, dismiss this as "only menopause". HRT is not enough to treat mania.'
'Why did nobody ever teach me about this?'
I'm fully aware I'm at the 'lucky' end of the scale in terms of my menopausal symptoms. I wasn't offered any psychological interventions when I asked for help, but I am a privileged, healthy, white woman, a psychotherapist who has access to experts and information at hand. For many women, it's not that simple, something Diane Danzebrink, founder of Menopause Support, a not-for-profit community interest company that campaigns for better menopause information, knows all too well.
As founder of the #MakeMenopauseMatter campaign – which calls for mandatory menopause education for doctors, a public health menopause information project, greater support in the workplace and for menopause to be added to the curriculum in secondary school education – Danzebrink knows that having a 'menopause policy' in the workplace isn't enough.
'The problem with awareness is that if you raise it, and more people recognise there might be options for their symptoms, then they are disappointed when the infrastructure isn't there to support them. It may take three or four weeks to see a GP. That appointment is probably going to be for about eight minutes. Unless they see someone who specialises in menopause, which is unlikely, they may come away no better off.'
Danzebrink says that despite working with lots of menopause specialists over the years, it feels like it's only now that there's more understanding about hormones. 'Often women have been experiencing premenstrual dysphoric disorder, which causes significant distress in some menstruating women, and they have been misdiagnosed as bipolar. There may be neurodiverse people who haven't had a diagnosis but perhaps have been masking throughout their lives, who then enter perimenopause, and all their coping strategies go out the window.'
Danzebrink's own experience of enduring years of painful periods, horrific pain and being fobbed off by doctors eventually resulted in a diagnosis of grade four endometriosis and adenomyosis following a total hysterectomy for suspected ovarian cancer in 2012, at the age of 44. Three months after surgery, her mental health plummeted. 'I came very close to taking my own life', she tells me.
'Not one doctor gave me information about the menopause, nobody mentioned HRT to me, not until I hit rock bottom. After I recovered, I thought, "Why did nobody ever teach me about this? Why didn't I hear about menopause when I learned about periods and pregnancy at school? And why is there no kind of national campaign to bring about public awareness?"'
Despite never campaigning before, with Menopause Support, Danzebrink has managed to bring menopause to the curriculum in schools, and mandatory menopause training for all medical students has just started. 'We are still campaigning for a government public health campaign, and we want to have menopause guidance and support in every workplace, regardless of the number of people you employ. We don't want it to be simply a tickbox exercise. We want to ensure that the entire workforce is educated about what menopause is, when it happens, why it happens, what people can do to support themselves, and what your role is in supporting your colleagues. I think the benefit would be enormous for the health and wellbeing of the whole population, but I think there would be a huge financial benefit too. However, not many women hold the purse strings when it comes to these decisions', says Danzebrink.
She's right. UK grant-making charity, The Rosa Foundation, announced in 2023 that from a total of £4.1 billion worth of grants awarded to charities, the women and girls sector received just 1.8 per cent.
Making a difference
In addition to educating the workplace and the next generation of GPs, should there be plans to educate more psychologists? Professor Spector informs me that plans are afoot as we speak: 'We are about to launch a half-day online course called 'Introduction to Menopause for Psychological Therapists' from the Menopause Mind Lab. This is because most psychological therapists in the UK haven't had any menopause teaching. The course not only provides a background and biopsychosocial perspective but also encourages people to formulate using case vignettes and discuss if, when and how to bring menopause into a discussion with the client. I have just run a session for our second year Clinical Psychology Doctorate trainees at UCL,' says Spector, 'and most were amazed that this was the first time menopause had been introduced to our curriculum. Thankfully, this will now be an annual session at UCL, but I believe that all psychology training courses should be covering it.'
Perhaps the best way psychologists can make a difference to the menopause experience is by creating interventions that can reach the largest number of people. Professor Hunter is working on that right now.
'With the British Menopause Society, Drs Melanie Smith and Janet Balabanovic are training health professionals to use the manualised group CBT program and the therapy is being implemented in NHS trusts and cancer charities. With colleagues – Prof Amanda Griffiths and Dr Claire Hardy – we have developed an online package for organisations to use called Menokit that's got something for everybody – for employers, for menopause champions and with CBT for those who need it. We aim to make it available to organisations as soon as possible. It is important to consider the work environment as well as the individual. And important not to forget that menopause is a process and most symptoms are time-limited. When we have done qualitative studies with women who have come through it, they talk about feeling stronger, with a renewed sense of themselves and their identity. Maybe that's through shaking off some of those negative gender stereotypes and taking the opportunity to reflect on who we are, and what we need to look after ourselves.'
SOURCE:
https://www.bps.org.uk/psychologist/menopause-psychology-doing-enough(accessed 15.10.25)
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