What it is
Cognitive Behavioral Therapy (CBT) for mood is a structured, evidence-based talk therapy used for depression, anxiety, and emotional distress. It focuses on thoughts, which are assumed to shape emotions and behavior, and uses techniques to change unhelpful thinking. During perimenopause, women can have physical and psychological changes attributed to hormonal changes, and depressive symptoms are among the most prominent. Programs studied in menopausal women ran 6 to 8 weekly sessions and combined psychoeducation, relaxation exercises, and cognitive and behavioral strategies for coping with symptoms. CBT does not involve medication and can be delivered face-to-face or remotely, one-on-one or in groups.
How well it works
A 2024 systematic review and meta-analysis published in the Journal of Clinical Medicine examined 9 RCTs of CBT for depression and sleep problems in climacteric women; 4 of those RCTs were included in the meta-analyses (2 depression, 2 sleep). The pooled difference in depressive symptoms favored CBT and was statistically significant (reported as 3.55; 95% CI -5.48 to -1.61, P<.05). Individual trials support this: a 2019 randomized controlled trial in India found that six weekly group CBT sessions significantly reduced depression scores over 6 months compared to a control group. A 2024 Korean pilot trial of 40 women found significant differences in anxiety (GAD-7) and menopausal symptom scores compared with treatment as usual; the authors concluded that CBT kept these symptoms from getting worse.
The evidence base is limited. The review authors advise caution because methods and study quality vary across trials, and they call for larger studies, so the size of the benefit for menopause-related mood symptoms is still uncertain.
The NAMS 2023 position statement recommends cognitive behavioral therapy as a Level I intervention (good and consistent scientific evidence) for vasomotor symptoms, not specifically for mood. It cites a trial of 72 women with hot flashes and depressed mood in which 12 weeks of group CBT improved depressive symptoms compared with a waitlist, and notes that women with VMS and psychosocial complaints reported improvement with antidepressants or CBT for insomnia. The American College of Physicians recommends CBT or a second-generation antidepressant as initial treatment for moderate to severe major depressive disorder, and suggests CBT alone for mild major depressive disorder. The UK’s NICE menopause guideline suggests considering CBT for depressive symptoms that come with hot flashes.
Side effects and cautions
CBT does not involve medication. The UK’s NICE depression guideline advises asking people with depression directly about suicidal thoughts, and urgent referral to specialist mental health services for anyone at considerable immediate risk. It also advises against withholding depression treatment because of suicide risk.
Where to get it
In the trials reviewed, clinical psychologists, psychiatrists, and trained researchers delivered CBT, in person or online. NICE lists face-to-face or remote, individual or group, and self-help options. Marketplace health plans must cover psychotherapy and counseling as essential health benefits. Employee Assistance Programs (EAPs) through employers may offer free short-term counseling. Check our provider directory for clinics near you.
