NHS watchdog rows back on controversial order that some women could get counselling instead of HRT drugs – but one top expert insists talking therapy really works
Menopausal women will be offered counselling on the NHS as well as hormone replacement therapy (HRT) drugs.
A leading expert has welcomed the move by the National Institute for Health and Care Excellence (NICE) to help tackle debilitating symptoms such as hot flushes, insomnia, brain fog and low mood. Aimee Spector, professor of the clinical psychology of ageing at University College London, said: “I am pleased that the guidelines clarify that cognitive behavioural therapy (CBT) might be a useful addition to HRT, or an alternative for the many people unable to take it – myself included as someone who has recovered from breast cancer and has struggled with menopausal symptoms.”
The strengthened guidance from NICE confirmed HRT remains the first choice option for the menopause. Earlier draft guidance had suggested CBT could be offered instead but this had sparked anger among some campaign groups. The new update said it should be only offered as well as HRT or if women were unable to take HRT.
Professor Jonathan Benger, chief medical officer at NICE, told a briefing in central London: “We have revised the guideline to be really clear that CBT is an adjunct, it’s an add-on therapy, and it can help people manage the symptoms… in addition to HRT, or some women may choose not to take HRT, or they may not be able to take HRT, and therefore that’s where CBT can be useful. What we’re not saying is that these are not real symptoms that women are experiencing. The purpose of CBT is it can help people manage those symptoms.
“I agree there is a challenge with access to CBT services [on the NHS ] but NICE’s job is to recommend the best care for women, to ensure that they have choices and an understanding of what should be available.”
The draft NICE guidance had caused anger among campaigners who argued women still struggle to get HRT on the NHS amid concerns some would now be prescribed CBT instead. NHS data shows women are three times more likely to be offered HRT in wealthier areas than in less well off parts of the country. Campaigners have warned that women too often have to be “sharp elbowed and middle-class” to persuade GPs to prescribe the drugs.
CBT is a talking therapy designed to help people manage their problems by changing the way they think and behave. Techniques include learning to break free from unhelpful thinking habits and developing coping strategies.
Prof Aimee Spector, the director of the International Cognitive Stimulation Therapy centre at UCL, explained: “Whilst the symptoms of menopause are undoubtedly caused by hormonal changes, the way that we perceive them, the way they make us feel and how we might alter our behaviour are something that CBT can help us with. An example is sleep. Whilst HRT might eliminate the hormonal impact on sleep and for many the problems will resolve, others may develop long-term insomnia – triggered by menopause but then maintained by the thoughts and feelings experienced whilst lying awake all night.
“The knock-on effect might be severe ‘brain fog’ the next day, an increased lack of confidence over time, and ultimately result in leaving work. We know that around one in ten women leave work permanently during menopause transition, not just because of the symptoms, but the consequences including shame and loss of cognitive skills. In this scenario, CBT and HRT could complement each other beautifully, by developing techniques that may manage and overcome the insomnia.”
The new NICE guidance will be delivered to doctors across the NHS in the form of a “discussion aid” to help them advise women considering starting HRT.
