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Dealing with psychological problems

For some women the menopause can be a time of mood swings, sadness, irritability, unpredictability or anxiety and depression. It can sometimes be difficult to know whether these feelings are due to the menopause or to other changes occurring in your life.

Ageing. It can be hard to come to terms with ageing in a society that puts such a high value on youthfulness. Leaving fertility and child-bearing behind can feel like a real loss too. And your body may be changing in ways you don’t like very much. But if getting older leaves you feeling sad or angry, it could be more about your attitude to aging than about hormonal changes. We are all living longer these days. If ‘sixty is the new forty’ there will certainly be life after the menopause – possibly for several more decades. Think about what you need to do to move forward, accept what’s changed and explore new possibilities. Getting older may bring new opportunities as well as challenges.

Hormones. Some women are very sensitive to changes in hormone levels. Problems such as premenstrual tension and post-partum depression aren’t all in the mind; they may be linked to falling oestrogen levels. If you’ve been sensitive to hormone dips in the past then this may happen again around the menopause. Oestrogen also helps regulate production of serotonin, a brain chemical that helps stabilise mood. When your oestrogen levels start to drop, so might your supplies of mood-smoothing serotonin. If you think this might apply to you, ask your doctor about possible treatments including the possibility of trying HRT.

Sleep. Night sweats can deprive you of refreshing sleep. And if you snore, sleep apnoea might be stopping you from getting as much sleep as you need. In addition, during the menopause years you are more likely to feel anxious or depressed, and this will disturb your sleep. Tiredness and irritability go hand in hand but these problems can be diagnosed and treated.

Too much going on. Mid-life is often the busiest time of life. Changes are inevitable and they can feel stressful. House moves, children leaving, job changes, marital issues or loss of a partner, ageing parents; the list goes on. There may be no escaping major shifts in your life, but you can still learn to calm your body and mind down. Getting support, learning to relax and manage your time, and choosing a healthy lifestyle, will all help make you more resilient.


Previous depression

If you have been treated for depression before, then you’re more likely to feel this way again during the menopause. If you suspect that you are not just feeling low, but may be depressed, get advice from your GP or counsellor at an early stage.

Symptoms of depression include:

  • sadness throughout the day, nearly every day
  • loss of interest in or enjoyment of your favourite activities
  • feelings of worthlessness
  • excessive or inappropriate feelings of guilt
  • thoughts of death or suicide
  • trouble in making decisions
  • fatigue or lack of energy
  • sleeping too much or too little
  • change in appetite or weight
  • trouble concentrating
  • feelings of restlessness or being slowed down.

See also our section on DEPRESSION for more information and ways to help yourself.


Supported care options


Acupuncture is a traditional form of treatment that began in China thousands of years ago. Thin needles are inserted into the skin at special points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.

Some studies suggest that acupuncture can help, but all the studies have been small and only a few have been carried out. The results overall don’t prove that acupuncture helps with hot flushes.

Acupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).

A session may cost £40-£60. Frequency of treatment will depend on you and your practitioner.

Find out more
The following professional organisations can help you find a qualified practitioner:

Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society

View the evidence

Acupuncture for vasomotor menopausal symptoms: a systematic review.
Cho SH, Whang WW. Menopause. 2009 Sep-Oct;16(5):1065-73.
SR of 11 studies (764 participants). Conclusions: There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture. Some studies have shown that acupuncture therapies are better than hormone therapy. However, the number of RCTs is small, and the methodological quality of some of the RCTs was poor.
Link to Abstract

Acupuncture for treating menopausal hot flushes: a systematic review.
Lee MS, Shin BC, Ernst E. Climacteric 2009; 12(1): 16-25
SR of 6 RCTs (309 participants). Five studies found no difference in frequency, severity or frequency x severity of hot flushes between the intervention and control groups. Conclusions: There was no convincing evidence that acupuncture was beneficial for menopausal women who experienced hot flushes.
Link to Abstract

The effect of acupuncture on postmenopausal symptoms and reproductive hormones: a sham controlled clinical trial.
Sunay D, Ozdiken M et al. Acupunct Med 2011;29:27–31.
RCT involving 53 postmenopausal women. Half were given sham acupuncture, half received traditional Chinese acupuncture twice a week for 10 weeks. After treatment, total MRS, and the somatic and psychological subscale scores were significantly lower in the acupuncture group than the sham group (all p=0.001). The severity of hot flushes was found to be significantly decreased after treatment in acupuncture group (p=0.001). In the acupuncture group LH levels were lower and oestradiol levels were significantly higher than sham group (p=0.046 and p=0.045, respectively) after treatment, but there was no difference in FSH levels.
Link to Abstract


The basic principle of homeopathy is that like cures like. Homeopaths use tiny amounts of medicine, which are supposed to jolt the body’s self-healing processes into action. Homeopathy has been called ‘unscientific’ because homeopathic remedies are sometimes diluted (watered down) so many times that no detectable trace of medicine remains. Their response is that they capture a non-material trace of the original material.

A large study carried out in eight countries seemed to show that treatment with homeopathy helped women with hot flushes. But the study did not prove this fully because homeopathy was not tested against another treatment. Homeopathy does not seem to be effective for flushes experienced by women being treated for breast cancer..

Homeopathic medicines prescribed by trained professionals are safe. Some patients complain of mild worsening of their symptoms but this generally only lasts a short time. There is potential risk that an enthusiastic pursuit of such a radically different approach can mean that the need for other treatments may be ignored.

The monthly cost will depend on how regularly you receive treatment. A session with a qualified homeopath varies from £25-£60.

Further information
There are a number of professional organisations covering homeopathy:
The British Homeopathic Association
Faculty of Homeopathy
The Society of Homeopaths

View the evidence

Treating hot flushes in menopausal women with homeopathic treatment: results of an observational study.
Bordet M., Colas A., Marijnen P., Masson J., Trichard M. Homeopathy. 97 (1) (pp 10-15), 2008.
Open, multi-national prospective, pragmatic and non-comparative observational study (98 physicians in 8 countries, 438 patients). Conclusions: The results of this observational study suggest that homeopathic treatment for hot flushes in menopausal women is effective.
Link to Abstract

Non-hormonal interventions for hot flushes in women with a history of breast cancer.
Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, Vera C. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD004923. DOI: 10.1002/14651858.CD004923.pub2.
Cochrane SR. Two studies of homeopathy showed no evidence of benefit.
Link to Abstract

Psychological therapies

When people think of ‘talking therapies’ they usually mean either counselling or psychotherapy. Counselling and psychotherapy aim to help people change thoughts, feelings and attitudes. Counsellors help you talk about difficult feelings and understand conflict. It can be helpful just to have time alone with a counsellor to talk in confidence about how you feel. Spending time reflecting on problems often brings insight and puts things into perspective. Psychotherapy helps people learn better ways of thinking or behaving that can reduce their symptoms, disability and distress. Some psychotherapists are trained to help you explore possible causes of distress or symptoms in your past. Cognitive behavioural therapy (CBT) is the type of psychotherapy that is currently most widely available in the NHS.

Instead of exploring causes of distress or symptoms in the past (like many other types of therapy), CBT looks for ways to improve your state of mind right now. The therapist does this by helping you spot unhelpful thought processes and change them. The Royal College of Psychiatrists says “CBT can help you to change how you think (‘cognitive’) and what you do (‘behavioural’)”. For instance, CBT can help you make sense of what seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

CBT is effective for depression, but it also appears to help women with hot flushes.

Psychological treatment may help symptoms of menopause. But women included in some of the studies also took medication so it is difficult to be certain.

CBT techniques are generally safe if carried out by or under the guidance of a qualified counsellor or psychologist.

In most areas your GP can refer you for CBT or a psychological therapist in the NHS. There are often long waiting lists. A session of CBT or psychological therapy may cost between £20-£50. Frequency will depend on you and your therapist. A typical course of CBT lasts between 6-12 weekly sessions

Further information
It is important to find a qualified counsellor or psychologist. Contact The British Psychological Society.

View the evidence

Psychoeducational interventions to alleviate hot flashes: a systematic review.
Tremblay A, Sheeran L, Aranda SK Menopause. 2008 Jan-Feb;15(1):193-202.
SR including 5 studies that evaluated psychoeducational interventions, including education, counseling, cognitive-behavioral strategies, and mindfulness-based stress reduction. All showed an improvement but in the two largest studies, participants also received drug therapy too.
Link to Abstract


Yoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.

It is not clear whether yoga will help with hot flushes but many yoga classes include relaxation, which is likely to be helpful.

Yoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.

You will have to pay for the classes but once you have learned this technique you can practise it at home at no cost.

Further information
Classes are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.

View the evidence

Mind-body therapies for menopausal symptoms: A systematic review.
Innes K.E. Selfe T.K. Vishnu A. Maturitas. 66 (2) (pp 135-149), 2010.
SR or 18 trials (12 RCTs) of various interventions (yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy). Conclusions: findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy.
Link to Abstract

Yoga for menopausal symptoms: A systematic review.
Lee M.S., Kim J.-I., Ha J.Y., Boddy K., Ernst E. Menopause. 16 (3) (pp 602-608), 2009.
SR of 7 studies. Conclusions: The evidence is insufficient to suggest that yoga is an effective intervention for menopause.
Link to Abstract