Menopause Matters Forum

Menopause Discussion => All things menopause => Topic started by: Hurdity on November 18, 2023, 09:03:59 AM

Title: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Hurdity on November 18, 2023, 09:03:59 AM
This was all over the news yesterday.....

https://www.nice.org.uk/news/article/nice-draft-updated-guideline-recommends-more-treatment-choices-for-menopause-symptoms

I haven't yet looked at draft guidelines so the headlines may well obscure the important details, and may well give a misleading impression - but talking therapies instead of oestrogen replacement?

This is just a quick "knee-jerk" response - I'm all for anything that can help women cope with menopausal symptoms and especially for those who are unable to take HRT for medical reasons but I hope, if these guidelines are approved, it does not lead doctors to prescribe CBT preferentially over HRT when  even today, 8 years after the first NICE Guidelines, some women are still having difficulty getting their doctors to recognise that their symptoms are due to menopause, and to prescribe HRT when this is indicated by the Guidelines - instead prescribing anti-depressants.

If CBT is offered on NHS as well as HRT - then this has to be a good thing - since symptoms of anxiety etc seem for some women to be a regular part of the menopausal transition....(are there enough practitioners though) but not instead of, without good reason, surely?

Thoughts?

Hurdity x


Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 18, 2023, 09:26:05 AM
I put a thread up in 'other health discussions'  yesterday : talking therapy for menopause : ............. do keep up  ;D

What do I feel - it's not polite what I really feel.  The public have time to respond.  Apparently.  Well if the NHS listened to the women in the 1st place?  :(

How much has this cost the tax payer?
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Hurdity on November 18, 2023, 09:30:28 AM
I put a thread up here yesterday ............. do keep up  ;D

Lol! I was busy yesterday....

I couldn't see anything on it at all and I was quite surprised - I though it would there would be a very long thread by now - unless there is another forum that lots of women on here also post on....!

Hurdity x
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Diamonds and pearls 53 on November 18, 2023, 09:58:37 AM
Hurdity, l saw a snippet of this on Channel 5 yesterday, and my heart sunk! CBT has its place as you say,  but to me it looks like just another way to push women into  having therapy instead of going  by the obvious vasometer symptoms and prescribing hrt. I get so fed up with women being unable to access what they need, and from speaking to others l understand its still an issue. I also fear CBT will now be suggested in the same way that antidepressants used to be prescribed as a solution  to menopausal symptoms, instead of offering hrt! I just hope l'm wrong.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Donna-paul on November 18, 2023, 10:35:11 AM
I totally agree hrt should be the first line of treatment for peri/menopause. But I do think it’s good for those of us who can no longer take hrt need some support/treatment. The worry is MH in this country is not good and waiting lists are so long so how that will work who knows.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 18, 2023, 10:41:53 AM
Have copied from my thread ;-) so that we stick to the same.

I started by : :bang: :beat: :poke2: :kick:    :angryfire:

some1 needs their head putting down a loo and the flush pulling .......... which bit of hormonal upheaval don't these 'experts' get  >:(

Headlines in the Daily Telegraph.  Victoria Atkins - new to the post of Health secretary by 3 days? 'the guidance would help women strolling with symptoms to "go back to living their lives to the full" '   She'd know then.   :neutral:

I know that the NHS is short of funds: but NICE should know better than support/suggest something that has no clnical background or Research.  Dr Newson is 'disappointed'.  Personally I am APPALLED  >:(
 



Dotty: There’s no way that talking therapies would have helped my symptoms! I find the suggestion quite patronising.



That's a good way of looking at it.  Hurdity has started another thread elsewhere  ::)

from Hurdity:
CLKD - sorry - I did not see your post here because it's in "Other Health Discussion" rather than the main menopause section, and it's about menopause! I rarely look at this section, and possibly others don't look so much here either. Hopefully some sort of discussion will occur somewhere!

Hurdity x


Diamonds and Pearls. Hi CLKD, sorry l missed this, l've replied on Hurditys thread, but 100% agree with you. l am also appalled as we are going backwards here! I fear this will mean more delaying tactics in actually  prescribing women the treatment they need and deserve. I despair!
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Kathleen on November 18, 2023, 12:36:06 PM
Hello ladies.

A friend of mine was recently offered CBT and was told that the wait for a face to face consultation ( meaning via Zoom) would be eight months and a phone consultation would be five months. I can understand counselling being offered in addition to HRT but obviously it should not be instead of it.
I wonder if this is a cost saving/ budget moving exercise? It certainly doesn't make much sense at the moment.

Take care ladies.


K.

Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Taz2 on November 18, 2023, 04:08:16 PM
It was the Five Live phone-in topic yesterday morning. It was interesting to hear different reactions. Louise Newson was one of the contributors. I don't think you can Listen Again on 5 which is a shame.

Taz x
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Kathleen on November 18, 2023, 06:05:08 PM
Hello again ladies.

I didn't hear the phone in but I am a patient of Louise Newson's clinic.  I have decided to ask my GP to take over my HRT etc because I no longer want to pay the large sums of money to the clinic but also because I don't think the care available was worth the cost.

I have seen three different GPs at the clinic and their advice was always that the more Oestrogen I used the better, don't worry about any bleeding or breast pain, use as little Progesterone as possible and add in Testosterone as soon as I can. I applied all of the above but unfortunately I still had problems  I am hoping that my GP will have a more nuanced approach!

I mention all this because although talking therapy will not supply missing hormones, other treatments can help when replacing those hormones doesn't  help very much or causes other problems.

I think various strategies should be explored when treating the menopause because, as we know, one size doesn't fit all.

Take care ladies.

K.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: SarahT on November 18, 2023, 06:52:11 PM
I was initially horrified about this, as like many of a I was worried it may be a bit patronising, in that after my early days being hit by peri, I felt I was at fault for not being able to cope with ( what one nhs site states as ) a ' normal part ' of women's health. Nothing bloody normal about how some of a genuinely go through. So I am concerned CBT would be seen as a cop out in some respects.

But, after struggling with exceptionally scary cyclical mood swings this year, as well as hrt, and AD, I went on the nhs waiting list for talking therapy as I was so scared and anxious as to how bad my moods were. It was a five month wait, but the talking therapy ( differs a bit from CBT) has helped me feel stronger. So a mix of medications and MH therapy has helped me.

But I am still fearful that CBT will be seen as a single support as opposed to being used in conjunction with using hrt or whatever methods help any individual, so that women are ensured   a fuller choice of any of all options as opposed to only a single choice.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 18, 2023, 08:06:26 PM
Talking therapy is totally different to CBT - I've done both, the former enabled me.  CBT was wasted.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: SarahT on November 18, 2023, 08:48:55 PM
I agree, CBT for me was not helpful on a previous occasion. Talking therapy has made a difference for me regarding the anxiety brought on by peri, and feeling overwhelmed with what has in effect been a truly horrendous year for me.

As I say, I am worried some of the helpful parts of supporting hormonal symptoms may be disregarded in favour of CBT. I believe this may help some women..... But all available help should be discussed and offered.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 18, 2023, 08:51:34 PM
Medication should be offered first!  How can CBT ease what is basically a hormonal issue?  An issue that can happen suddenly ........ is embarrassing. 
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: SarahT on November 18, 2023, 09:23:16 PM
I agree. As I say, I am on medication for hormonal symptoms. CBT alone would have been useless if  offered without medication as well,  and in the case of women like me whose mental health has been affected.so seriously by peri or meno, CBT on its own would have been extremely dangerous.
My own cyclical moods made me suicidal, and I know I am not the only one. a full range of medical treatment as well as any form of mental health support should be offered as a package, tailored to individuals. CBT can help some with techniques  to cope with the affect of symptoms, but I can't see how that can alleviate actual physical symptoms.

I find the thought of offering CBT on its own belittleng. Hrt can be successful for many.... But maybe CBT may be an additional help because of course, some women chose not to go down the medical route at all.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: VioletAquarius on November 18, 2023, 09:46:48 PM
I cannot understand how cbt can help, it can't, not on it's own anyway, as it's hormonal.
Used alongside with hrt yes, but not instead of.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 19, 2023, 09:25:29 AM
The updated draft guideline also includes new recommendations on the management of genitourinary symptoms such as dryness, painful sex and vaginal discomfort or irritation. A choice of vaginal oestrogen such as cream, gel, tablet, pessary or ring should be offered to women, trans men and non-binary people registered female at birth, including those on systemic HRT, and treatment should be continued for as long as it’s needed to relieve symptoms.

The draft updated menopause guideline is live for public consultation from 17 November 2023 to 5 January 2024.


Do we write a joint letter explaining ...............
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Dierdre on November 19, 2023, 01:42:05 PM
Good news regarding update for genitourinary symtoms.
I've had CBT for anxiety and although it helped with general anxiety the techniques couldn't control my health anxiety.  It's something I'm either going to have to come to terms with and accept I'll always worry about my health, real or hypothetical. The alternative is citalopram.
I doubt CBT and talking to my vagina would help my GSM  ;D
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Kathleen on November 19, 2023, 06:56:53 PM
Hello again ladies.

I just wanted to add that I have had CBT therapy as well and unfortunately it didn't really work for me. 

I think therapy can help during the menopause because some of the symptoms are psychological and not just physical. Anything that helps us to manage this time in our lives is worth trying!

Wishing you all well ladies and take care.

K.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: suzysunday on November 19, 2023, 08:40:36 PM
It was the Five Live phone-in topic yesterday morning. It was interesting to hear different reactions. Louise Newson was one of the contributors. I don't think you can Listen Again on 5 which is a shame.

Taz x

The phone -in is available on Nicky Campbell's podcast for 5 live.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: suzysunday on November 19, 2023, 08:42:57 PM
Didn't quite get that right with the quote!  It is available on Nicky Campbell's 5 Live podcast
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Taz2 on November 20, 2023, 08:02:55 AM
Thanks suzysunday. I forgot about the podcast. It's worth a listen.

Taz x
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Julia Dizzy on November 20, 2023, 12:32:35 PM
And was the draft of the new guidelines written by a man??? Tell me how CBT can help when you wake in the night drenched in sweat??? Oh just a minute, I will do my CBT practice and it will go away?? What rubbish. Only Oestrogen can stop them.

I have had CBT for anxiety a few times and it has never worked for me.

And don't get me started on how long you would have to wait to see someone on the NHS for it :o
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on November 20, 2023, 01:04:02 PM
Absolutely correct Julia Dizzy ..........
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Katymac on November 20, 2023, 07:05:11 PM
I've had cbt for dealing with longterm health issues and it does play some part in not feeling desperation at times. Coming to terms with "this is the future" & "it might well not get better than this"

But it isn't a magic pill, it takes a fair amount of mental discipline (while you have brain fog & sweats, not to mention anxiety??)

But for menopause? Mine was surgical and came on suddenly; I was ILL; unable to function, eat, sleep, stand at some points
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Dierdre on November 20, 2023, 07:29:59 PM
Menopause is caused by the decrease in estrogen, we become deficient in estrogen. The treatment is HRT for those who need it, not everyone does.
Diabetes is insulin deficiency, will this also be treated with CBT?? No.
Anemia is iron deficiency, will this be also treated with CBT?? No.
Underactive thyroid? No.
The problem is Menopause is still not classed as an illness and a lot of women don't suffer at all. I didn't. I do now with GSM.
CBT will help with the mental health problems but not the physical ones so as long as it's used alongside HRT then great but it can't ever replace HRT.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: dangermouse on January 07, 2024, 04:53:24 PM
With the pendulum swung in the direction of Louise Newson’s high dose strategies, there will naturally be a backlash and new guidelines. The recent media reporting of CBT for menopause was predictably taken out of context. The benefits of HRT as a cure all are often exaggerated by celebs and it, often, does not help with anxiety. In fact, oestrogen, being a stimulant, can make it much worse.

The BMS were just trying to point out that other strategies, like CBT, could also be considered by GPs for some patients, to rationalise the management of their symptoms. As awful as some symptoms are, and I’ve had some intense ones, accepting them rather than concentrating all your focus on them can reduce their overall impact and, in some cases, calm the autonomic nervous system enough for the physical symptoms to reduce. In reverse, it’s very easy to bring on a panic attack whilst in the throws of scary neurological symptoms from the brain reacting to plummeting hormones.

NHS CBT is very restrictive though, due to  needing a rigid, systematic approach. REBT is much more helpful and life changing.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Penguin on January 07, 2024, 04:59:46 PM
With the pendulum swung in the direction of Louise Newson’s high dose strategies, there will naturally be a backlash and new guidelines. The recent media reporting of CBT for menopause was predictably taken out of context. The benefits of HRT as a cure all are often exaggerated by celebs and it, often, does not help with anxiety. In fact, oestrogen, being a stimulant, can make it much worse.

The BMS were just trying to point out that other strategies, like CBT, could also be considered by GPs for some patients, to rationalise the management of their symptoms. As awful as some symptoms are, and I’ve had some intense ones, accepting them rather than concentrating all your focus on them can reduce their overall impact and, in some cases, calm the autonomic nervous system enough for the physical symptoms to reduce. In reverse, it’s very easy to bring on a panic attack whilst in the throws of scary neurological symptoms from the brain reacting to plummeting hormones.

NHS CBT is very restrictive though, due to  needing a rigid, systematic approach. REBT is much more helpful and life changing.

What's REBT? I'm open to trying anything for the anxiety as hrt only goes so far and I've already done two rounds of CBT.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: dangermouse on January 07, 2024, 05:36:38 PM
Hi,

It’s Rational Emotive Behavioural Therapy which focuses on the beliefs behind our self talk, which we tend to exaggerate as no-one else can hear us! It’s about being realistic, rather than expecting to feel happy all the time, by changing our habits, for example, to feel calm concern when in difficult situations rather than out of control anxiety. It’s truly life changing and puts you back in charge of your emotions and how you interact with the world.

You can get some great workbooks on it to do yourself (from Windy Dryden) or you can see a therapist. It’s my main choice of therapy for my clients.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on January 07, 2024, 05:39:12 PM
I understood that the idea was to offer CBT in the first instance for what is basically a hormonal upheaval.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Penguin on January 07, 2024, 05:41:07 PM
Hi,

It’s Rational Emotive Behavioural Therapy which focuses on the beliefs behind our self talk, which we tend to exaggerate as no-one else can hear us! It’s about being realistic, rather than expecting to feel happy all the time, by changing our habits, for example, to feel calm concern when in difficult situations rather than out of control anxiety. It’s truly life changing and puts you back in charge of your emotions and how you interact with the world.

You can get some great workbooks on it to do yourself (from Windy Dryden) or you can see a therapist. It’s my main choice of therapy for my clients.

Thanks, I'll look into it, starting with a workbook I think! I found cbt only goes so far as a lot of my fears (health anxiety) seem too deep rooted to be rationalised with. Anxiety you're right, a lot of it is around my beliefs / self talk which are very extreme in some areas. I've never heard of it before, so thank you.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: dangermouse on January 07, 2024, 05:48:55 PM
It can be used lightly, eg replacing “I can’t take it anymore!” with “It will be ok”, to going into all of your exaggerated unhelpful beliefs (often there is a main underpinning one) that have been holding you back, by proving to you that they are simply not true. Until you believe it, it’s just words, so it’s all about scientifically showing you the truth and then you can’t ever go back and believe the exaggerated lies you had been telling yourself.

Enjoy!
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: dangermouse on January 07, 2024, 05:49:41 PM
I understood that the idea was to offer CBT in the first instance for what is basically a hormonal upheaval.

Goodness, they would not have the resources for that!
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on January 07, 2024, 05:50:04 PM
?? 'they ??  ..........
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: dangermouse on January 07, 2024, 05:51:15 PM
NHS.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: CLKD on January 07, 2024, 05:53:35 PM
" CBT was found to reduce the frequency and severity of hot flushes and night sweats and should be considered alongside or as an alternative to HRT, the draft guidance says.

It was also found to help sleep problems related to menopause, including, how long it takes to fall asleep and how long before waking".

There is no reference = 'found to reduce ...... "  :-\

Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: suzysunday on January 07, 2024, 06:39:06 PM
I can't see CBT reducing hot flushed at all.  I went on what was basically CBT that a Canadian therapist who was training asked for a couple of clients on this forum a couple of months ago.  I lasted 3 sessions but it didn't work out.  I have tried it many years ago but I can't seem to put my heart into it.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: sheila99 on January 08, 2024, 06:39:53 AM
I can visualise the scenario. You can have hrt but we'll try cbt first. The wait for cbt is 18 months...
Maybe I'm just too cynical.
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: discogirl on January 08, 2024, 07:06:57 AM
No your not cynical sheila99 you're spot on.

I couldn't see the male population standing for all this malarky x
Title: Re: Updated Draft NICE Guidelines on Menopause - CBT for hot flushes!
Post by: Katymac on January 09, 2024, 06:54:34 AM
I've had cbtbfor 'living with a long term illness' 3 or 4 times

The first time was honestly useful - it have me techniques to deal with hopeless spirals

The second time the counsellor took some of the techniques I'd developed and asked to use them on other clients

The 3rd was for a different issue and the counsellor felt that my concerns and reactions were perfectly rational and reasonable so we just chatted instead and I respond very well to talking therapy - it gives me opportunities to hear how I sound and rationalise outside of my head

The most recent was a zoom group session and I knew more than the facilitators & I am still supporting people on WhatsApp even now a year on

It cannot change physical symptoms it can change your response to them, but hot flushes? They are so visceral I'm not sure you can rationalise them away