The doctors who think conquering hot flushes may be all in the mind

By
Chloe Lambert

Last updated at 11:28 PM on 20th February 2012

Lynne Collins wasn’t too concerned when she hit 50 and realised she was beginning the menopause.

‘I just thought your periods stopped, which would be rather nice,’ says Lynne. ‘I wasn’t really sure what to expect.’

But over the next few years she started to suffer increasingly from symptoms — most notably hot flushes and night sweats — which affected every aspect of her life.

'There wasn't a single night I slept all the way through and often I'd go off and sleep in another room,' said Lynne Collins of the menopause

‘By the time I was 54 I was having several flushes a day,’ she says.

‘They would creep up on me, starting in my chest and then go up to the neck and skull until I was overheating, and my skin would go red and blotchy.

‘Even the smallest thing — someone pulling out in front of me while driving or putting a laptop on my lap — would set one off.

'At night, as soon as I got under the duvet I’d instantly feel too hot. I’d wake in the night with sweat trickling down my neck and my back and have to go and have a wash.

‘My husband Clive was getting more and more worried, and of course it would disturb him too.

'There wasn’t a single night I slept all the way through and often I’d go off and sleep in another room.’

Lynne, 58, of Hadleigh, Essex, became so exhausted and unable to concentrate she started taking more and more days off from her job as a project manager. Her world began to shrink, she says.

‘I’d get worried about being in public places, and when I travelled to London on business I had to avoid going on the Underground because it was so hot I knew I’d have a flush.

'I started taking HRT when I was 54 which helped a bit, but I felt worried about the long-term impact of the hormones.’

Then two years ago Lynne read that doctors at King’s College London were trialling a novel treatment for the menopause — counselling — and asked if she could be involved.

Lynne noticed a difference within days of starting the counselling

Last week the much-anticipated results of that trial were published in the journal Menopause.

The study, involving 140 menopausal women, assessed the effects of cognitive behavioural therapy (CBT) on hot flushes and night sweats.

CBT aims to replace negative thoughts with more balanced ones.

For instance, the women were helped to replace thoughts such as ‘I can’t cope with this hot flush’, and ‘I look ridiculous’, with ones such as ‘Lots of women have flushes’, ‘I know this will pass’ and ‘I’ve always managed before’.

After just four sessions, 65 per cent of women reported reductions in the numbers and severity of their flushes and night sweats — compared with 12 per cent in a control group who had no treatment.

Follow-up research found the women who had the therapy continued to experience fewer symptoms six months after they finished the treatment.

Another study, published last week in The Lancet, found that women with menopausal symptoms as a result of breast cancer treatment also benefit from CBT.

Hot flushes are one of the most common symptoms of the menopause, affecting one in four women.

It’s thought that falling levels of the hormone oestrogen cause the narrowing of the brain’s thermoneutral zone, which regulates body temperature.

As a result women are prone to overheating — even being under a duvet can cause their temperature to swing out of control.

Evidence suggests that women who suffer from hot flushes have a more significant narrowing of this region of the brain.

So how could a talking therapy ease what is a physical symptom?

Myra Hunter, professor of clinical health psychology at King’s, who led the study, says women’s perceptions of the menopause affect how they experience the symptoms.

‘A lot of women have overly negative reactions to hot flushes — they feel self-conscious and become stressed about it.

‘It’s a vicious circle. If you think these things it makes you focus on the flush so it feels more severe.’

A large study in 2010 found that women in Britain and other Western cultures have more menopausal symptoms and suffer from them more than women in countries such as Japan and China.

Professor Hunter believes this is partly down to negative stereotypes surrounding the menopause in the West.

Historically the menopause has been associated with madness, she says.

‘I do think there’s also some ageism and sexism thrown in, in the sense that women’s value in most Western cultures is about being young, fertile and attractive.

‘In other cultures women’s status improves as they get older and there are fewer social taboos.

‘Here there are myths that menopausal women age very suddenly, and are chaotic, less attractive and that it’s an ending.’

In the trial Professor Hunter began by encouraging the women to challenge the ideas they had about the menopause.

‘Many of the women said they felt embarrassed if they had a hot flush at work in front of men and young people.

'We showed them a survey we did among young men and women in which the majority said that if they saw a woman at work having a hot flush they wouldn’t assume they were going through the menopause, and that their reactions were empathic and not negative.

‘Evidence has shown that while there are usually signs of a flush, such as redness or sweating, women think it shows more than it does.’

In the trial Professor Hunter began by encouraging the women to challenge the ideas they had about the menopause (picture posed by model)

Some women received the CBT in a group session with trained therapists, while others were given self-help books which taught the same techniques.

All the women (including those not offered therapy) were taught breathing exercises to distract their thoughts during a hot flush and slow their heart rate, reducing feelings of anxiety.

They practised these each week and were also encouraged to exercise and have a regular sleep pattern — previously shown to help women manage hot flushes.

The women all noticed a drop in the number of night sweats.

Professor Hunter says this may be because they felt less anxious about their symptoms as they went to sleep, so they were less likely to be woken up by them.

‘We found that CBT also had a small but significant effect on the women’s mood, memory and concentration problems, also symptoms associated with the menopause. This is probably because of reduced stress.’

Professor Hunter was surprised by the results: ‘We thought the group therapy would have more of an effect, but in terms of how problematic hot flushes were, the women with self-help books had the same reduction.’

Lynne Collins noticed a difference within days of starting the counselling.

‘I started having fewer night sweats. Although I still wake in the night sometimes, it’s much less disturbed and I have so much energy,’ she says.

‘I’m back at work, my husband’s happier and our social life is better.

‘One of the most helpful things was realising I didn’t have a psychological problem but it’s something everyone experiences.

'When I have a flush I breathe through it now and tell myself it will pass.’

Professor Hunter stresses this research does not suggest the menopause is all in the mind.

‘We’re using psychology to manage the symptoms,’ she explains.

Indeed, psychological treatments such as CBT are being used for a range of other conditions including tinnitus, acne, chronic pain and irritable bowel syndrome — all of which are difficult to treat and are characterised by symptoms which affect quality of life and self-esteem.

For instance, a U.S. study found people with psoriasis who were played meditation tapes while having ultra-violet light treatment (a standard therapy for psoriasis) found their skin cleared up as much as four times faster than those who had only light therapy.

‘The meaning of pain affects how bad it feels,’ says Dr Amanda Williams, a clinical health psychologist at University College London.

‘If you have a symptom that tells you you’re getting old and makes you feel excruciatingly embarrassed, it feels overwhelming.’

She says some studies have shown that women who have negative ideas about the menopause from listening to mothers, sisters or close friends are more likely to suffer too.

‘In this sense it’s not unlike the arguments over the expectations women have of childbirth,’ she says.

‘Your expectations can affect how you physically experience it.’