Perimenopause and menopause can coincide with changes in sleep, mood, concentration, confidence, energy, temperature regulation and anxiety. Those changes can be distressing, but an online guide cannot determine their cause. Similar experiences can also relate to physical health, medication, thyroid changes, pain, life events, depression, anxiety, trauma or disrupted sleep. New, severe, persistent or changing symptoms need appropriate medical advice. An assessment led conversation can explore the full context rather than assuming that every difficulty is caused by hormones. What has changed, when, and how is it affecting work, relationships, sleep and day to day life? What medical support is already in place? Are there concerns about medication, HRT, physical symptoms, safety, work demands or caring responsibilities? A therapist cannot diagnose menopause, prescribe, alter medication, advise whether HRT is suitable or replace a GP, menopause specialist or other medical clinician. NICE guidance includes CBT as one possible psychological support for menopausal symptoms in some circumstances. That does not mean CBT is a substitute for medical assessment or a universal alternative to HRT. Decisions about hormone treatment, tests and physical symptoms need a discussion with an appropriate medical professional. The role of therapy is different: it may offer a space to explore worry, low mood, self criticism, avoidance, sleep related distress, changed identity and the impact of symptoms on everyday life. CBT based therapy may be considered after assessment where appropriate. It cannot guarantee improvement, prove that a symptom is psychological, or decide a medical treatment pathway. Any behavioural work should be collaborative and adapted to health, energy, medication effects and safety. Urgent appropriate help is needed if you feel unable to stay safe, have thoughts of suicide or self harm, experience psychosis, notice a sudden marked change in mental state or have acute physical symptoms. For related information, see anxiety support at lyceumclinic.co.uk/therapy/anxiety/ and depression support at lyceumclinic.co.uk/therapy/depression/. You can enquire about current arrangements and whether CBT based therapy may be suitable alongside medical care.