IN THE WORLD of menopause treatment, there are many options available beyond Menopause Hormone Therapy (MHT) – also called hormone replacement therapy (HRT). While MHT remains an effective and appropriate choice for some women, it’s not suitable or desirable for everyone.

This article was included in issue 107 (Winter 2025/26) of The Menopause Exchange newsletter.

Many women seek holistic or integrative approaches that address not only the physical symptoms of the menopause but also the psychological, emotional and relational changes that often accompany this life stage.

Among the most impactful non-hormonal interventions are distinct forms of psychotherapy: cognitive behavioural therapy (CBT), systemic psychotherapy and mindfulness. These approaches share the goal of supporting women through the menopause, but they differ in structure, focus and style. Many women benefit from combining them. For example, using CBT for immediate symptom management, systemic psychotherapy for deeper relational exploration, and mindfulness for ongoing emotional balance and resilience.

Cognitive behavioural therapy

CBT is a structured, short-term and goal-oriented form of psychotherapy that focuses on the relationships between thoughts, emotions and behaviours. It’s grounded in the idea that by changing unhelpful thinking patterns and behaviours, people can improve their emotional wellbeing and reduce distressing symptoms.

During the menopause, many women experience symptoms such as anxiety, low mood, irritability, sleep disruption and difficulties with concentration or memory. These aren’t always directly caused by hormonal changes but can be worsened by the way women interpret and respond to them. CBT may help to break this cycle by identifying these thoughts, evaluating their accuracy, and replacing them with more balanced and helpful alternatives.

CBT also incorporates behavioural techniques such as:

• relaxation training to manage stress and anxiety
• sleep hygiene practices to address insomnia
• behavioural activation to combat low mood and encourage re-engagement with enjoyable activities
• mindfulness techniques to build present-moment awareness and reduce rumination

Evidence suggests that CBT can be particularly effective in reducing the severity and impact of hot flushes, improving sleep quality and enhancing overall mood.

Systemic psychotherapy

Systemic psychotherapy takes a broader lens than CBT. It’s rooted in the understanding that people are embedded within complex systems, such as families, partnerships, workplaces and cultural communities that shape and influence their experiences. Systemic psychotherapy is less about fixing a set of symptoms and more about exploring patterns of interaction, communication and meaning, although it often contributes to symptom reduction.

During the menopause, women often find themselves navigating not only physical or emotional changes, but also shifts in identity, roles and relationships. These transitions may involve re-evaluating one’s place in a family or career, processing ageing or confronting long-held beliefs about femininity and worth. Systemic therapy provides a space to explore these dimensions in depth. It invites reflection on questions such as:

• How do my relationships support or strain my experience of the menopause?
• Which cultural or familial messages have I absorbed about ageing and womanhood?
• How can I communicate my needs and emotions more clearly within my family or partnership?
• Which stories do I carry about this stage of life, and how might they be reshaped?

Unlike CBT, systemic therapy often includes other people (such as family members), although it can be conducted individually. It’s especially helpful when the menopause coincides with other challenges, such as caring for elderly parents, relationship changes or teenage/adult children leaving home.

Mindfulness

Mindfulness is an evidence-based practice that can significantly improve mental wellbeing. It can help to reduce stress, anxiety and emotional reactivity, while enhancing coping in difficult situations. It’s defined as a mental state achieved by focusing attention on the present moment – and calmly acknowledging thoughts, feelings and bodily sensations.

Mindfulness has been incorporated into recommended therapies for depression and anxiety. At the menopause, it can help symptoms such as irritability, sleep disturbance and mood changes by fostering greater self-awareness and acceptance. For many women, developing a mindfulness routine provides a sense of calm and resilience. This offers not only symptom relief but also a supportive way of navigating the broader psychological and relationship changes of this stage of life.

Support at the menopause

The menopause is often portrayed narrowly as a biological or hormonal process, but this stage of life can challenge a woman’s sense of identity, autonomy and purpose. It can bring unresolved issues to the surface or activate shifts in values and priorities. By offering tools for symptom relief and opportunities for self-reflection, CBT, systemic psychotherapy and mindfulness play crucial roles in supporting women through this time of life.

There’s growing recognition in modern menopause care that one size doesn’t fit all. Whether a woman chooses MHT, non-hormonal medicines, psychotherapy, or a combination of these, the goal is the same: to support her in navigating the menopause with dignity and resilience.

About the author

Liz Tatham is a systemic psychotherapist at The Menopause Consortium (TMC). She has over 20 years of practice, including as a family and relationship therapist.

Created Winter 2025/26
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