November 7, 2024

expert reaction to updated NICE guidelines on menopause

Scientists comment on updated NICE guidance on treatment for the symptoms of menopause. 

Prof Aimee Spector, Professor of Clinical Psychology of Ageing, University College London (UCL), said:

“Cognitive Behavioural Therapy (CBT) has been recommended in the updated NICE guideline for menopause as a possible addition to HRT or for those for whom HRT is contra-indicated or choose not to take it. Whilst CBT was recommended in the previous guidelines for psychological symptoms (anxiety and depression), the key change is that it is now a suggested treatment for vasomotor symptoms (hot flushes and night sweats) and sleep. I am aware that many felt, when the new draft guidelines were written; that this change might risk undermining the impact of hormonal changes and imply that symptoms were purely ‘in the head’. I am pleased that the guidelines clarify that CBT might be a useful addition to HRT, or an alternative for the many people unable to take it – myself included as someone who has recovered from breast cancer and has struggled with menopausal symptoms.

“A meta-analysis published this year from our Menopause Mind lab, including data from 3501 women across multiple studies; demonstrated the potential value of non-pharmacological therapies in menopause transition, particularly CBT in significantly improving anxiety and depression. Our second meta-analysis, this time combining data from 9141 women; highlighted how menopause transition is a period of vulnerability for depression, hence the importance of providing a range of treatment options.

“Whilst the symptoms of menopause are undoubtedly caused by hormonal changes, the way that we perceive them, the way they make us feel and how we might alter our behaviour are something that CBT can help us with. An example is sleep. Whilst HRT might eliminate the hormonal impact on sleep and for many the problems will resolve, others may develop long-term insomnia – triggered by menopause but then maintained by the thoughts and feelings experienced whilst lying awake all night (‘I won’t ever get to sleep, how will I do my job tomorrow’, etc.). The knock-on effect might be severe ‘brain fog’ the next day, an increased lack of confidence over time, and ultimately result in leaving work. We know that around one in ten women leave work permanently during menopause transition, not just because of the symptoms, but the consequences including shame and loss of cognitive skills. In this scenario, CBT and HRT could complement each other beautifully, by developing techniques that may manage and overcome the insomnia.

“However, it’s important to note that CBT doesn’t work for everyone, and we need a toolkit of similar psychological therapies available – like we have when working with people in all other areas of clinical need.

“A significant challenge, highlighted by NICE; will be implementation. NHS waiting times for CBT in people with anxiety and depression tend to be huge and this will create significant new demand. But we need to see the bigger picture; investments in wellbeing will ultimately save costs in terms of working hours and quality of life for millions.”

The updated NICE guidelines on menopause were published at 00:01 UK time on Thursday 7 November 2024.

Declared interests

Prof Aimee Spector: No COI.

This Roundup was accompanied by an SMC Briefing.