The secret weapon for dealing with menopause? Talk therapy
Evidence is mounting that cognitive behavioral therapy—or CBT—can help women cope with menopause symptoms ranging from hot flashes to low libido.
Perimenopause and menopause happen to all woman as they age—but many struggle to find effective treatments to manage symptoms. That may be changing.
Mounting evidence suggests that one natural treatment effectively alleviates multiple menopause symptoms including night sweats, hot flashes, sexual dysfunction and diminished libido.
This treatment is a form of talk therapy known as cognitive behavioral therapy, or CBT.
This widely accepted therapy has helped patients manage mental and physical health conditions for more than six decades by teaching them how to be aware of and improve associated negative thought patterns and behaviors.
(What happens during menopause? Science is finally piecing it together.)
While CBT has long been shown to effectively treat menopause-related symptoms like hot flashes and night sweats, new research from scientists at McMaster University in Canada demonstrates that CBT also improves associated rates of diminished libido and sexual dissatisfaction.
Even better, it can do so with almost no adverse outcomes—unlike the drugs and hormone therapies that are often the first medical intervention recommended for menopause.
Last Chance - Save up to $20!
"Western society is adopting the understanding that health is not just about taking the right pills," says Sheryl Green, a clinical health psychologist and pioneer of menopause and CBT-related research at McMaster University, who presented her team's findings at the annual Menopause Society conference this September in Chicago. "People are understanding that they have to actively participate in their health and wellness and that CBT is one treatment option that's proven to be helpful."
How menopause affects mental and physical health
Menopause is what happens when a woman stops producing eggs and hormones, so she can no longer become pregnant. It officially begins 12 months after her last period.
Yet the years leading up to menopause, known as perimenopause, "can be especially difficult for some women," says Ruta Nonacs, a perinatal and reproductive psychiatrist at Massachusetts General Hospital.
For many women, this transitional period begins between ages 45 and 55 and can last from seven to 14 years. During this time, estrogen, progesterone, and testosterone hormone production begin to diminish "and go a little haywire," Nonacs explains, which causes the brain and body to respond with many telltale associated symptoms.
(Frozen shoulder is a real condition—and it mostly affects women.)
CBT has been shown to be helpful in treating some of these symptoms, including common vasomotor responses such as hot flashes and night sweats.
"CBT draws on the understanding that these symptoms are intensified by stress and reactivity,” explains Sharon Bober, founding director of the sexual health program in the Dana-Farber Cancer Institute at Harvard Medical School. “When individuals are able to shift their relationship to these symptoms, the experience itself inherently changes."
For example, scientists know that patients experiencing night sweats and hot flashes tend to become anxious about them and often dread them. This causes a different set of symptoms associated with anxiety to arise, such as digestive issues, increased heart rate, and muscle tension—physical responses that can make night sweats and hot flashes even worse.
To help, a CBT therapist may assist a patient in normalizing and diminishing unfounded or catastrophic concerns over hot flashes or night sweats. They may also provide coping mechanisms and other tools to improve mental and physical responses, explains Sofia Chernoff, acting director of CBT programs at Beck Institute for Cognitive Behavior Therapy in Philadelphia.
Research shows that such strategies are effective at not only reducing anxiety related to hot flashes and night sweats but also reducing how often these symptoms occur.
In another study (also led by Green) CBT has been shown to be similarly effective in treating menopause-related sleep disturbances and addressing "depressive symptoms that sometimes emerge during perimenopause and menopause," says Nonacs.
How menopause affects sexual satisfaction
Some eight out of 10 menopausal women also report concerns related to sexual satisfaction such as painful intercourse, reduced libido, or trouble reaching orgasm—issues that can contribute to a negative self-image, emotional distress, and declining relationships.
"Menopause-related sexual dysfunction can negatively impact your quality of life and have far-reaching impacts," says Jewel Kling, associate director of women's health for Mayo Clinic in Arizona.
Perimenopause and menopause can affect sexual performance and satisfaction a number of ways, but usually start with changes in hormone production.
(What are perimenopause supplements—and do they work?)
Estrogen, for example, "has an abundant number of receptors in vaginal tissue, making it important for blood flow, lubrication, sensation, and elasticity," explains Tara Iyer, director of the menopause and midlife clinic in the division of women’s health at Harvard Medical School. Because of this, when estrogen levels drop, women can experience vaginal dryness, diminished enjoyment, and even pain during intercourse.
Testosterone production is affected as well, which is often the reason many women experience a loss of libido, says Mary Jane Minkin, a practicing OB-GYN and a clinical professor at Yale School of Medicine.
Of course, "hormones aren’t the only thing that affect sexual functioning," says Nonacs. She cites a reduced level of self-confidence due to age-related changes in skin elasticity and weight distribution that cause some women to feel less desirable and less intimately engaged.
"Many things can contribute to low sexual desire in a menopausal woman," echoes Stephanie Faubion, medical director of the Menopause Society in Cleveland, Ohio—including career stress, relationship issues, and caregiving demands. She notes that many women also develop genitourinary issues during menopause, such as affected urination frequency and UTIs.
How CBT offers hope for improved sexual function
Typically, when perimenopausal and menopausal patients report sexual dissatisfaction and dysfunction, doctors prescribe pharmacological therapies such as hormone injections and drugs like ospemifene, flibanserin, and bremelanotide, says Iyer. They may also prescribe serotonin receptor inhibitors (SSRIs)—a class of antidepressants commonly used for treating hot flashes.
(Why delaying menopause could lead to longer lives for women.)
While such treatments are safe and effective for many women, they can come with side effects such as headache, chest pain, changes in vision, and nausea. And hormone therapy treatments have been found to be unsafe for some postmenopausal women and women with preexisting medical conditions. Other times, pharmacological therapies simply don't work. "This further demonstrates a critical need for non-pharmacological treatment options," Green says.
CBT may be the answer.
Green and her team studied 30 40-to-60-year-old women who were experiencing different levels of perimenopausal and menopausal-related sexual dissatisfaction and dysfunction.
The researchers asked the women first to assess their individual levels of sexual frustration across multiple factors including sexual desire, sexual distress, body image, and couple satisfaction. They then participated in four individual 90-minute CBT sessions over a month, where they learned to better understand how their thoughts influence their feelings and behaviors.
For example, Green says, the women learned that pain during sex can be improved by understanding and accepting that intercourse doesn't have to happen the way it did before menopause. Individually tailored strategies such as taking things slower, trying new techniques, and communicating with their partner were taught so they could experience better outcomes. Ditto for improving self-talk regarding negative body image messaging.
The results at the end of the four sessions? "Statistically significant improvements across all measures," says Green. Indeed, using the baselines established by their initial assessments, the women experienced a 40 percent average improvement in their scores. Moreover, Green says participants reported that "most to all of their needs were met by the therapy and that they would recommend it to a friend if they were experiencing the same difficulties."
"Our mind and body are intimately connected," says Kling, so CBT works by helping women change the way they think about sex and aging by "reducing worries about sexual performance, improving communicating with one’s partner, and reducing distracting thoughts during sex," says Thurston.
This can ultimately help women not only stop dreading aging, but welcome it.
"Midlife and the menopause transition can be an incredible time as many women report feeling more self-confident, self-aware, and worrying less about what people think of them," says Thurston. "All of these things can help women improve their sex lives."
