Q: I have difficulty concentrating and suffer from anxiety, and I can feel I am losing my confidence. What can I do?

A: Prof Aimee Spector is professor of clinical psychology of ageing at UCL Most studies of menopause symptom management focus on hormonal replacement therapy (HRT) and physiological symptoms. This restricts treatment options for women who are concerned about the risks of HRT and overlooks the wellbeing of women with non-physiological symptoms, such as brain fog and mood problems, which are highly prevalent. We have just published in the Journal of Affective Disorders the most up-to-date study of its kind, providing a meta-analysis of 30 studies involving 3,501 women who were going through menopause in 14 countries. The researchers found that women showed statistically significant improvements in anxiety and depression following cognitive behavioural therapy (CBT) and mindfulness-based interventions (MBI) when compared to no or alternative treatments. This equates to small to medium changes in everyday life. Evidence showed that CBT could help reduce symptoms such as hot flushes, brain fog and night sweats, depressive symptoms and problems sleeping. You don’t have to suffer.

A: Dr Zoe Schaedel is a GP with expertise in menopause care and sleep problems In perimenopause, both oestrogen and progesterone production are chaotic and affect sleep. In menopause, you can also suffer all sorts of sleep problems due to symptoms such as hot flushes or night sweats, where you wake up drenched in sweat. You can choose to stabilise those hormones with HRT, but you can also help yourself holistically, too. Make sure you are active enough in the day to really build up something called “sleep pressure” by building up a neurotransmitter called adenosine, which helps you fall asleep and stay asleep throughout the night. Get physically and mentally active in daylight hours. Keep caffeine to the morning hours, as it can make palpitations and anxiety worse. Limit alcohol, which can reduce sleep quality significantly. It will cause micro awakenings during the night. Evidence shows that breathing techniques can help to get you back to sleep and reduce anxiety. CBT has also been proven to help with menopausal insomnia.