Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Diagnosis and management of menopause: summary of NICE guidance

BMJ 2015; 351 doi: (Published 12 November 2015) Cite this as: BMJ 2015;351:h5746

Rapid Response:

NICE guidance on menopause: CBT is an effective non-hormonal intervention for managing vasomotor symptoms

Dear Editor,

The first National Institute for Health and Care Excellence (NICE) guideline on diagnosis and management of menopause1 is welcome.

The full document recommends (page 18) that GPs should:
“Give information to menopausal women and their family members or carers (as appropriate) about the following types of treatment for menopausal symptoms:
• hormonal, for example hormone replacement therapy (HRT)
• non-hormonal, for example clonidine
• non-pharmaceutical, for example cognitive behavioural therapy (CBT)."

The evidence for CBT as a treatment for depressed mood and anxiety is included in the guidance, but CBT has also been developed specifically to help women to self-manage vasomotor symptoms (VMS), and this evidence is not provided. Group and self help CBT have been shown to reduce the impact of VMS significantly, in three clinical trials with over 600 women (well women and breast cancer patients).2-4 Improvements are maintained 26 post randomisation, there are additional benefits to quality of life and no reported adverse effects. The treatment is brief and available in self-help format5 and a group manual is available for health professionals6.

Based on this evidence, CBT is recommended as an effective non-hormonal management option for VMS in a recent position statement by the North American Menopause Society.7 Non-hormonal management of VMS is an important consideration when hormone therapy is not an option, either because of medical contraindications or a woman’s personal choice.

1. National Institutes of Health and Care Excellence (NICE). NICE guidance on Diagnosis and Management of Menopause, November 2015.

2. Ayers B, Smith M, Hellier J, Mann E and Hunter MS. Effectiveness of group and self-help cognitive behaviour therapy to reduce problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause 2012;19,7:749-759.

3. Duijts SF, van Beurden M, Oldenburg HS, Hunter MS, Kieffer JM, Stuiver MM, et al. Duijts, Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled, multicenter trial. J Clin Oncol 2012; 30 (33): 4124-133.

4. Mann E, Smith MJ, Hellier J, Hamed H, Grunfeld B, Hunter MS. Efficacy of a cognitive behavioural intervention to treat menopausal symptoms following breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncology 2012;13(3):309–318.

5. Hunter MS, Smith M. Managing Hot Flushes and Night Sweats: a Cognitive Behavioural Self-Help Guide to the Menopause. East Sussex, UK and NewYork: Routledge, 2014.

6. Hunter MS, Smith M. Managing Hot Flushes with Group Cognitive Behaviour Therapy: an Evidence Based Treatment Manual for Health Professionals. East Sussex, UK and New York: Routledge, 2015.

7. Position Statement: Non-hormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause 2015; 22(11):1-20.

Competing interests: I am author of the research on CBT that is referenced in this letter as are Dr Mann and Dr Smith.

13 November 2015
Myra S Hunter
Professor of clinical health psychology
Professor Amanda Griffiths, University of Nottingham, Dr Eleanor Mann, Professor Rona Moss-Morris, King’s College London, Dr Melanie Smith, Salford Pain Centre, Manchester, Professor Pauline Slade, University of Liverpool.
King's College London
Institute of Psychiatry, Psychology and Neuroscience, Guy’s Campus, London SE1 9RT.