NHS talking therapy recommended for menopause symptoms

[John Mac]

Women should be offered talking therapy instead of, or as well as, hormone replacement therapy (HRT) for problematic menopause symptoms, new draft guidance for the NHS says.

The advice - the first update in almost a decade - says cognitive behaviour therapy (CBT) can help with hot flushes, and sleep and mood changes.

Health watchdog The National Institute for Health and Care Excellence (NICE) says this will give women more choice.

But critics called it "disappointing".

NICE says the evidence on HRT has become clearer since its last guidance on menopause in 2015. Its new one lists the pros and cons of different formulations that are available.

But it makes no new mention of testosterone therapy, which some menopausal women have been seeking from private clinics.

NICE says women should pick which treatments from its guidelines work best for them, weighing the risks and benefits with the help of their doctor.

And if they opt for HRT, use the lowest effective dose.

Some might want to use individual or group talking therapy sessions, either in person or online, the draft says.

According to some studies, coping skills taught by CBT can help sleep problems related to menopause, including how long it takes to nod off.

https://www.bbc.co.uk/news/health-67438995

 

[Peter T]

This is an issue I know nothing about, but wonder if this is a situation that aligns to what we argued for in relation to the NICE guidelines review. That general support may be required but that it would best be provided by a specialist nurse who could respond to medical issues, practical management issues as well as general psychological support needs. Then only those with very specific needs would be referred on to specialist psychological or psychiatric help.

I am not saying there is never a value in CBT, but its blanket use will I suspect become a way for doctors to dispose of what they see as awkward female patients when most would be better served by someone able not only listen but also to give sensible practical advice.

 

[Mij]

This is where CBT and mild/moderate exercise can be helpful to relieve some symptoms. Nothing helps with sleep for me except meds.

My doctor told me that HRT doesn't work for everyone anyways, but when it does work, it works well for controlling hot flashes/night sweats and benefits proper sleep.

Walking helps with hot flashes/night sweats, but either way I'm in constant 'slow roast'.

 

[Jonathan Edwards]

The evidence comes from waitlist or treatment as usual controlled open label trials with subjective questionnaire rating outcomes. Complete waste of time.

The defenders of CBT might ask how they are supposed to get a more robust result with a purely subjective symptomatic problem and CBT. My answer would be that they need to show that one sort of 'test' treatment is better than another in a context where nobody knows which test treatment is supposed to be better. It is not that hard to do. Another option is to do a dose-response study varying the number of sessions. That might be less relevant to this particular situation.

I am doubtful whether in fact the treatments being tested merit being called 'CBT'. One was a booklet. Others have involved nurse counselling. Why is this called 'CBT'?

 

[Trish]

I can't see any point to CBT for menopausal symptoms any more than for ME/CFS. Sure, if someone is finding her life difficult to cope with, some supportive counselling from someone who understands what she's experiencing, along with things like work adjustments may be helpful. But why CBT? Women with menopause symptoms are not suddenly prone to wrong thinking that needs to be corrected.

I can't really comment from my own experience as it was 30 years ago, and I was lucky to have relatively mild hot flushes and few other symptoms, though I was diagnosed with ME only a few years before my menopause, so it was hard to know which caused which symptoms. For me menopause was a positive thing, as I was hugely relieved not to have to deal with very painful, irregular and heavy periods and pre-menstrual misery any more.

 

[shak8]

A couple of years of hormone replacement therapy seemed to help me a great deal. This was way way back when the harms of unopposed estrogen replacement had just been published. Thus, just replacement therapy for the worst part of the transition and then off the drugs.

(During these transition years, my FM symptoms slowly began to appear.)

But a pamphlet instead of hormone replacement. Hmm, which might be more effective really, because it does cause prolonged suffering in many women.

I tried testosterone but not for menopausal symptoms; rather, for FM muscle pain. I felt like one of the guys and I fell in love with my car. Did nothing for pain.

 

[rvallee]

cognitive behaviour therapy (CBT) can help with hot flushes, and sleep and mood changes

That's ridiculous at a "water has memory of the molecules it comes in contact with and you can cure ill with small bits of ill memory by shaking it a lot or whatever" level. MDs should be mocking this stuff mercilessly, seem to have stopped being able to call out blatant bullshit. Science has quietly been replaced by secretive committees working behind closed doors.

I think that one of the reasons why the ME NICE guideline is facing such hostility is just how exceptional it is. Every other NICE guideline about chronic health issues we have seen in the last few years is a political document promoting the biopsychosocial model, on the same model as the old ME guideline. It's not even worth the paper it's rarely printed on.

And those are all in line with the dystopian approach we have seen from the UK about disability and illness: just because you are too disabled to work doesn't mean we can't leave you no choice but to work. All on the back of this growing belief system in medicine that only disease is real, symptoms are only a signal, sometimes generated by the mind itself, and it's the reaction to them that causes, uh, distress, I guess is how they want to put it. Only proper disease blessed by a MD can cause disability. The rest can be overcome by motivation, diet and exercise. Because they say so.

So the ME guideline stands out sharply against this. This is likely why they got so many professional bodies engaged in rejecting something they don't even care about. It's the wrench in the giant people-crushing machine.

This is basically the full politicization of medicine, and by proxy a rejection of science as the only valid paradigm to determine what is true. Instead committees of biased people can simply decide what they want to be true by mere assertion and a veneer of cheap pseudoscience. It's like the USSR model, except with the pretense that it has expert validity. It's taken pseudoscience to a level never seen before. No wonder there is such a crisis of confidence in experts, and it will only grow worse. Even though all the other expert professions are progressing soundly and scientifically, producing evermore and better things.

Although this is far from restricted to the UK, Scandinavian countries all appear to follow the same path. And ironically, labor markets are about to essentially be destroyed, so the need for above full employment (by forcing people too disabled to work regardless of their ability to work) is all the more absurd. We are about to see mass unemployment because most jobs will be automated, there will be too many workers. And by the calculation of too many people: too many people as well.

And because a lot of this falls into folklore superstition territory, it's pretty popular in the general public. It's a lot easier to understand than hard science. So it passes through, despite having zero validity. What an absolutely weird time to be alive.

 

[Arnie Pye]

Instead committees of biased people can simply decide what they want to be true by mere assertion and a veneer of cheap pseudoscience.

 

[Sean]

I am doubtful whether in fact the treatments being tested merit being called 'CBT'. One was a booklet. Others have involved nurse counselling. Why is this called 'CBT'?

Marketing.

It's like the USSR model, except with the pretense that it has expert validity.

Yep. It really is not fundamentally different to the function of Soviet era psychiatry. It is still basically about providing a pseudo-scientific pseudo-medical pseudo-compassionate justification for social control, not for actually treating health problems.

 

[Andy]

New menopause therapy guidance will harm women’s health, say campaigners

New official guidance on treating menopause will harm women’s health, experts, MPs and campaigners have warned.

Last month, new draft guidelines to GPs from the National Institute for Health and Care Excellence (Nice) said that women experiencing hot flushes, night sweats, depression and sleep problems could be offered cognitive behavioural therapy (CBT) “alongside or as an alternative to” hormone replacement therapy (HRT) to help reduce their menopause symptoms.

But critics have castigated the guidance, saying it belittled symptoms through misogynistic language, and women’s health would suffer as a result of failing to emphasise the benefits of HRT on bone and cardiovascular health as opposed to CBT.

In its response to the guidance, Mumsnet said Nice’s recommendations – shared exclusively with the Guardian – used “patronising” and “offensive” language and would be “detrimental” to women’s health.

....

Dr Nina Wilson, a GP in Sussex and founder of the One Woman Health women’s clinic, said advocating CBT could increase the stigma around menopause. “By recommending psychological therapy, people may see this as a signal to women and society that symptoms are ‘all their heads’,” she said.

“If a man with erectile dysfunction experiences stress and anxiety due to performance worries, CBT could help with that, but it wouldn’t open up the blood vessels – the underlying issue – like Viagra would. It’s similar with HRT. The CBT can minimise the stress response but the underlying cause – the drop in oestrogen – is only addressed with HRT.”

https://www.theguardian.com/society...dance-will-harm-womens-health-say-campaigners

 

[Arnie Pye]

Dr Nina Wilson, a GP in Sussex and founder of the One Woman Health women’s clinic, said advocating CBT could increase the stigma around menopause. “By recommending psychological therapy, people may see this as a signal to women and society that symptoms are ‘all their heads’,” she said.

Has anyone ever recommended CBT for erectile dysfunction, prostate cancer, testicular cancer or for fears over vasectomy? It does always seem to be conditions that are majority female that get CBT recommended as a general rule, and in some cases is claimed to be curable.

 

[Andy]

Has anyone ever recommended CBT for erectile dysfunction, prostate cancer, testicular cancer or for fears over vasectomy? It does always seem to be conditions that are majority female that get CBT recommended as a general rule, and in some cases is claimed to be curable.

Yes, you could probably find examples of CBT being recommended to treat all of those somewhere, but if we are talking mainstream current recommendations,

CBT for erectile dysfunction

Yes, of course.

prostate cancer

Only as support.

testicular cancer

Only as support.

fears over vasectomy

Yes, of course.

While I don't disagree that, on average, women are treated more badly than men, that doesn't mean that all 'male' conditions are immune to the plague of CBT-as-a-treatment.

 

[Jonathan Edwards]

It is interesting to see others, faced with the same problem, who have not had the benefit of the lobbying that turned things around at NICE for ME.

Five years ago I underestimated the degree to which my colleagues would wave through stuff like PACE, including the president of RCP. But with luck if others are at least making a noise the lack of emperor's clothes may get acknowledged one day.

 

[shak8]

In order to cut costs, will the NHS consider chest pain to first be treated by emergency CBT or should I post this in the dumb question category.

 

[bobbler]

New menopause therapy guidance will harm women’s health, say campaigners

New official guidance on treating menopause will harm women’s health, experts, MPs and campaigners have warned.

Last month, new draft guidelines to GPs from the National Institute for Health and Care Excellence (Nice) said that women experiencing hot flushes, night sweats, depression and sleep problems could be offered cognitive behavioural therapy (CBT) “alongside or as an alternative to” hormone replacement therapy (HRT) to help reduce their menopause symptoms.

But critics have castigated the guidance, saying it belittled symptoms through misogynistic language, and women’s health would suffer as a result of failing to emphasise the benefits of HRT on bone and cardiovascular health as opposed to CBT.

In its response to the guidance, Mumsnet said Nice’s recommendations – shared exclusively with the Guardian – used “patronising” and “offensive” language and would be “detrimental” to women’s health.

....

Dr Nina Wilson, a GP in Sussex and founder of the One Woman Health women’s clinic, said advocating CBT could increase the stigma around menopause. “By recommending psychological therapy, people may see this as a signal to women and society that symptoms are ‘all their heads’,” she said.

“If a man with erectile dysfunction experiences stress and anxiety due to performance worries, CBT could help with that, but it wouldn’t open up the blood vessels – the underlying issue – like Viagra would. It’s similar with HRT. The CBT can minimise the stress response but the underlying cause – the drop in oestrogen – is only addressed with HRT.”

https://www.theguardian.com/society...dance-will-harm-womens-health-say-campaigners

What is it with the sane side of the debate where they feel they need to throw fake bones like ‘the CBT can minimise the stress response but…’

there isn’t any proof of that either! So they shouldn’t be saying it. Not half because if someone had a ‘stress response issue’ there is certainly no good research showing this nonsense wouldn’t make it worse, cause deterioration or harm and is either logical or relevant vs other probably more rationally obvious options

these people get their foot in the door due to this politeness etiquette (which actually isn't polite and is just an etiquette that has been pushed by the same people who get advantage from it as a 'fake norm', just like 'not pulling up people who do something bad' is actually being a bad person, but is sold as if it is 'nice') in arguing, for which there is no place when you think about patient impact. And saying that something that doesn't work should be done 'for mental health' isn't being respectful of mental health at all either.

A one-liner for ‘CBT’, for the sake of showing whatever allegiance, on a guideline for something different (when it hasn't been well investigated as helpful) turns into, as we’ve seen, some then using this as a foot in the door for lobbying for ‘balance’ at future guidelines where they demand these irrelevancies make up 50% of those on the next committee


It’s a tactic it seems


Goodness knows why someone is allowing it other than utter misplaced paternalism and arrogance of someone flippantly deciding they are well-placed to make the decision’oh well what harm could it do’ for someone else with so little care (callous disregard) and time to checking they actually honour that statement they don’t even notice the area REFUSES to MEASURE HARM it causes ON PRINCIPLE- so they couldn’t be more inaccurate saying that

 

[bobbler]

It is interesting to see others, faced with the same problem, who have not had the benefit of the lobbying that turned things around at NICE for ME.

Five years ago I underestimated the degree to which my colleagues would wave through stuff like PACE, including the president of RCP. But with luck if others are at least making a noise the lack of emperor's clothes may get acknowledged one day.

It sounds like they don't need it in the early stages because people don't see the harm coming from putting their foot in the door, however, I would be intrigued if there were FOI requests and the like for other guidelines where these things have suddenly been included.

For a start I do not understand why 'this 'CBT'' even if it was about something in that arena they should have better-defined what the issues are and what the offering options would be that could fit those best.

I fail to see that professionals, if they cared hard enough even if it 'isn't their turf' to start including anything in the first place on their own guideline, genuinely think that bunging down a few dodgy associations from 'research' that stands up so little it isn't better than no research for claiming 'evidence' - indeed not using the term evidence would be more honest - means one mode like this should get pride of place. These are people who do work in areas that have regulations for research design and so should be thinking it is obvious they'd never be allowed to do research with such flaws?