COGNITIVE BEHAVIOURAL THERAPY AND BREATHING

MARIELLA Frostrup describes herself as an ‘HRT devotee’, but says that there were additional approaches she came across while researching her book, Cracking The Menopause While Keeping Yourself Together, that in her opinion ‘really do help’.

One of these is cognitive behavioural therapy (CBT), a form of psychotherapy that involves addressing ‘problematic’ thoughts and situations, and looking for new ways to think about them.

Mariella was initially sceptical that CBT could work for symptoms of the menopause. She says: ‘I thought it played to every kind of stereotype of the hysterical woman – this idea that you just breathe through it.’

But then she witnessed a group of eight menopausal women taking part in CBT sessions while filming her BBC documentary The Truth About... The Menopause.

She says: ‘They had a really positive reaction. I think it was partly that they were talking about what they were going through, because many of them had actually been suffering in silence until that point, but also because, during the menopause, it’s not just your body doing things that are unhelpful – it’s your brain as well.’

Finding a way to manage negative thinking, stress and night-time anxiety can be beneficial for menopausal women, she believes now.

‘CBT proved to be incredibly helpful for women having hot flushes. Just acknowledging that you know it is about stress, and if you just calm yourself and your heartbeat down, you can really help yourself.’

About three-quarters of menopausal women suffer hot flushes. In one trial, women with breast cancer who’d had a medically induced menopause due to treatment were given one 90minute session of CBT a week for six weeks. They had all been suffering from at least 10 episodes of severe hot flushes a week, and were given specific CBT techniques to help cope. After the course, the women all reported being significantly less troubled by the symptom, and six months later they still reported benefits.

Mariella says she has learned a technique when stressed of breathing in for five seconds and out for five seconds.

She adds: ‘I still do it in the middle of the night, if I wake up with one of those anxiety attacks. What you’re trying to do is clear your brain. And it might not work straight away – it’s not like popping a sleeping pill. But it’s probably a lot better for you, and it does work, it really does. If you keep focusing and you keep doing the breathing, it helps.’

She also sometimes listens to the Calm app, which aims to help users sleep, meditate and relax.

‘I’ll listen to a rainstorm, to help me go back to sleep. I find it works well in just distracting me and helping me to calm everything down.’

It doesn’t stop her waking up in the first place or experiencing anxiety, but it is useful. ‘It just helps you manage it that bit better,’ she says.

Studies also found that mindfulness – techniques similar to meditation – can significantly reduce hot flushes and night sweats, irritability, depression and anxiety.

There is also some evidence that yoga can help relieve the psychological symptoms of the menopause, and Mariella is a keen participant in online yoga classes.

She points out that strengthening your bones and muscles through exercise or weight training is very important if you cannot access your usual

‘Get a good hour’s worth of fresh air every day’

supply of HRT, because the medication is known to be beneficial in preventing osteoporosis and heart disease.

‘Yoga and weight training are really important for your bone density but also they keep you supple and calm,’ she says.

The other strategy she recommends is to get plenty of fresh air.

‘I know it sounds really boring, and patronising even, but if you make sure you get a good hour’s worth of fresh air every day – by going for a walk or a run, or doing some kind of exercise out in the open air – it has a hugely positive impact, certainly on mental health.’

While going through the menopause, Mariella would walk every day. ‘I do other forms of exercise, but that’s the thing I can’t live without – I have to go for a walk.’

Evidence suggests that women with high and moderate physical activity levels have less severe menopausal symptoms than inactive women. In one study, 80 women aged 40-65 who did 12 weeks’ exercise training felt it had a positive impact on their vitality and mental health.

Another of Mariella’s tips is to ask for a fan in your workplace if you get hot flushes. She says: ‘Don’t be ashamed. It’s just common decency to make an environment that works for everyone.’

She also stresses there isn’t a shortage of vaginal oestrogen: ‘Keeping the whole of that area lubricated and working properly is incredibly important. This is not about sex – you’ve got a lot of vital organs down there that need to be in a healthy state, and vaginal oestrogen keeps them in that state.’

She would like to see vaginal oestrogen made available without a prescription. ‘This is something that’s so fundamentally important to women’s lives. You should be able to walk into a chemist and buy it over the counter. And if you can’t afford it, it should be available on prescription for free. If we want to consider ourselves a civilised, equal society, that is the benchmark.’

Cracking the Menopause While Keeping Yourself Together by Mariella Frostrup and Alice Smellie, Pan Macmillan, €14.99.