Depression & moodFor yourself55 min read

Menopause: mood, sleep and hot flushes, and what psychology can do

Hot flushes in the middle of a meeting, nights broken by sweats, a mood that wobbles for no obvious reason: the perimenopause can shake up far more than the body. This guide explains what is happening, what the large studies say about mood and sleep, and what cognitive behavioural therapy can change, with a step-by-step method for hot flushes, nights, low spirits, work, self-image and sexuality.

Reviewed on October 25, 2026
Dr Zayan Al-Falasi, psychiatrist

In short

This guide is for women, and for everyone, going through the perimenopause or the menopause, whether it is natural, early or brought on by a treatment. It explains in plain words what changes in the body, why hot flushes bother some people far more than others, and what the large studies have shown about sleep, anxiety and the risk of depression. It describes the medical treatments without naming any of them, then what psychology has demonstrated: cognitive behavioural therapy for menopausal symptoms, which the British guideline has put forward since 2024, cognitive behavioural therapy for insomnia, and clinical hypnosis. Finally, it offers a concrete method, week after week, and says when to seek help without waiting.

Topic: Depression & mood · Sleep · Anxiety
Who it's for: For yourself
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The programme

This guide is psychoeducational content. It does not replace a consultation. If you are thinking about dying, if you feel that others would be better off without you, talk about it the same day to your doctor, to someone close to you or to a suicide prevention line, which is often free and available day and night: look up the one in your country now. In immediate danger, call the emergency services in your country. A very low mood or a loss of interest in everything that lasts more than two weeks deserves a prompt appointment, even if you think "it's just the menopause". Any vaginal bleeding that occurs after the menopause, that is, after twelve months without periods, must be shown to a doctor, even if it is very slight or has happened only once: it is most often benign, but it can be a sign of cancer, so its cause must be looked for. New palpitations, that is, a heart you can feel beating faster, slower or harder than usual, periods that become much heavier, or signs of the menopause before the age of forty-five also call for medical advice (section 19). This guide names no medicine: any treatment, hormonal or not, is decided with your doctor, and never change a current treatment on your own. Allow fifty-five minutes to read.

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1. Before you begin

It is three in the morning. A wave of heat starts in your chest, rises to your neck and floods your face. Two minutes later you are drenched; five minutes after that, you are shivering. You change your T-shirt in the dark so as not to wake anyone, then you lie there doing sums: only three hours left before the alarm, and tomorrow you are the one presenting the budget to senior management. You already know the heat will come back during the meeting, that your neck will go red, and that it will feel as if everyone is looking at nothing else.

In the evening, you hear yourself snap at your son over a sock left lying around. You search for the first name of a colleague you have known for ten years. And one question keeps coming back: is it tiredness, age, hormones, or is it you who is changing?

Three things, straight away.

The menopause is neither an illness nor an ordeal you are condemned to suffer. It is a stage that everyone whose ovaries function goes through, and the World Health Organization, or WHO, points out that it is not a disease. That does not mean you have to put up with everything. When the symptoms weigh on your nights, your work or your mood, there are medical and psychological treatments that have proved themselves, and you have every right to use them.

What weighs most is not always the number of hot flushes, but the way they are experienced. Two women who have the same number a day can suffer from them very differently, depending on their stress, their sleep, what they think about them and what they do to protect themselves. That is the part psychology works on, and its effects have been measured in rigorous trials.

A mood that collapses is not "just the menopause". The risk of depressive symptoms rises during the transition, especially in those who have had depression before. Depression can be recognised and treated at this age as at any other, and putting it down to hormones by default sometimes delays care.

2. What is happening, in plain words

The words

The menopause, in the strict sense, is a precise moment: that of the last period. It can only be dated afterwards, once twelve months have gone by without a period and without any other explanation. According to the WHO, it most often occurs between the ages of forty-five and fifty-five.

The perimenopause is the period surrounding it. It begins with the first changes in the cycle, ends a year after the last period, and often lasts several years. It is often the phase that is felt most intensely. The postmenopause refers to all the years that follow.

What changes in the body

The ovaries contain a reserve of follicles, the small structures that hold the eggs and make most of the oestrogens, the hormones that regulate, among other things, the menstrual cycle. With age, this reserve runs out. During the perimenopause, oestrogen production does not fall steadily: it fluctuates, rising and falling again, before declining for good. That is what explains cycles that are sometimes shorter and sometimes longer, and periods that are sometimes heavier and sometimes lighter.

Do you need a blood test?

Generally, no. The National Institute for Health and Care Excellence, or NICE, the public body that writes medical guidelines in the United Kingdom, states that after forty-five, in a person in good health, the perimenopause can be recognised without any tests: recent hot flushes and a changing cycle are enough. At this age, it even advises against several blood tests that measure hormones and against measuring the ovaries by ultrasound. Between forty and forty-five, a blood test can help to confirm the menopause. Before forty, the diagnosis rests on the symptoms and on two blood tests taken four to six weeks apart, never on a single one. Hormonal contraception can also mask the signs, since it changes or suppresses periods.

When it comes earlier, or is brought on

The term premature ovarian insufficiency is used when the ovaries stop working before the age of forty, and early menopause when this happens between forty and forty-four. This is not exceptional: a meta-analysis published in 2023, that is, a study that pools the results of many others, estimates that 3.5% of women worldwide experience premature ovarian insufficiency. The menopause can also be induced by removal of both ovaries, chemotherapy or radiotherapy. It is then abrupt, and it often comes on top of an illness. NICE asks that these women be offered the chance to talk about it, before and after treatment, with professionals who specialise in the menopause and in fertility (section 18).

Not only women

Transgender men and non-binary people born with ovaries also go through the menopause. The NICE guideline names them explicitly. Those who have taken gender-affirming hormone treatment in the past should be able to discuss it with a professional who knows about the menopause, and the cognitive behavioural therapy described later can be offered to them as to anyone else. Those who are taking it now are not covered by the guideline and should discuss it with the team that prescribes it. To stay readable, this guide speaks of women throughout, but it is addressed to all of these people.

Contraception is still needed

Pregnancy is still possible during the perimenopause, even when periods become less frequent. The WHO advises continuing contraception until twelve consecutive months have passed without a period. The precise guidance varies with age and from country to country: in the United Kingdom, the public health service, or NHS, advises keeping it for two years after the last period between the ages of forty and forty-nine, and for one year from the age of fifty. Hormone replacement therapy, or HRT, the hormonal treatment of the menopause, is not a form of contraception. When to stop, and which method suits your age, are decided with your doctor or your midwife.

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What the rest contains

3. Hot flushes and night sweats
4. Sleep
5. Mood, anxiety and concentration
6. Medical treatments: what you need to know to discuss them
7. What psychology can do: what the research says
8. What keeps the bother going: the hot flush cycle
9. Step 1: observe for a week
10. Step 2: easing the background tension
11. Step 3: responding to a hot flush as it arrives
12. Step 4: reviewing the thoughts that make hot flushes harder to bear
13. Step 5: stepping out of avoidance
14. Step 6: the nights
15. Step 7: mood
16. Step 8: work
17. Step 9: self-image and sexuality
18. Particular situations
19. When to seek help, and from whom
20. Six weeks, step by step
21. Frequently asked questions
22. Key points
23. Sources and foundations

Frequently asked questions

How do I know whether I'm in the perimenopause? After forty-five, recent hot flushes and a changing cycle are generally enough, without a blood test. Before forty-five, the doctor may suggest some tests (section 2).

If CBT helps, does that mean my hot flushes are all in my head? No. Hot flushes are a physical phenomenon that can be measured with sensors. CBT works on what surrounds them, the thoughts, the tension, the avoidance and the night-time habits, which reduces the bother and, in some trials, the frequency of night sweats or hot flushes.

Can I have CBT and take HRT at the same time? Yes. Since 2024, the British guideline has suggested considering CBT in addition to HRT, or instead of it when HRT is contraindicated or not wanted. The two approaches work in different ways and do not cancel each other out.

Does slow breathing reduce hot flushes? Not on its own: in trials, it did no better than fast breathing or usual care, and The Menopause Society does not recommend it for hot flushes. It remains useful for calming down, and it is part of CBT programmes.

Do natural supplements work? The data are uncertain or negative, their composition varies from one product to another, and some interact with medicines. The frequent improvement seen with a placebo explains many enthusiastic accounts. Always tell your doctor what you are taking.

Is it the menopause, or is it depression? The two can exist side by side. A low mood or a loss of interest almost every day for more than two weeks should make you think of depression, especially if you have had it before. That is a reason to seek help rather than waiting for the transition to end.

I forget words and appointments. Is this the beginning of a memory disease? Most often, no: in the SWAN study, the slight decline in learning ability seen during the transition had disappeared after the menopause. If the difficulties get clearly worse or worry those around you, talk to your doctor.

Should I cut out coffee, alcohol and spicy food? No trial has tested whether avoiding these triggers reduces hot flushes; look instead in your notebook at what really applies to you. Alcohol, on the other hand, is worth cutting down in the evening, because it disturbs the second half of the night.

Is hypnosis serious? Yes, when it is practised by a trained professional. In a rigorous trial, it clearly reduced hot flushes, including those measured by sensors, compared with a group that received as much attention, and The Menopause Society recommends it. It has nothing to do with stage hypnosis shows.

Do I have to tell my employer that I'm going through the menopause? You are not obliged to. You can ask for simple adjustments without giving a medical reason, or go through the occupational health service where there is one, which is bound by confidentiality. If you choose to talk about it, a simple sentence prepared in advance is often enough.

menopauseperimenopausehot flushesnight sweatsinsomniamooddepressionanxietycognitive behavioural therapyhypnosissexualityworkearly menopause

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