Menopause Brain Fog Toolkit: Helper Cards, Hot Flash Breathing and CBT Thought Cards

Three calm tools for menopause: slow breathing through a hot flash, CBT thought cards for flashes, sleep and mood, and a personal brain fog card. Not medical advice.

AdultsLife situationsCBT
2–10 minutesIn person and on video
Free interactive tool
Designed by Michael Thompson, MSc

Link copied – paste it to your client

In crisis? Call or text 988 (US and Canada). In an emergency, call 911 or your local emergency number. Elsewhere, find a helpline in your country.
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New or severe symptoms, heavy or unexpected bleeding, or memory problems that worry you need a doctor. Perimenopause can bring new or worsening depression, and premenstrual mood changes can intensify; low mood that lasts two weeks or more, or any thoughts of suicide, need a doctor or mental health clinician promptly. If low mood includes thoughts of suicide, call or text 988 in the US or Canada, or your local crisis line or emergency number elsewhere.

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How to play

  1. Pick a tool at the top.
  2. Hot flash breath: rate how bothered you feel if you like, then breathe with the circle as the colors cool.
  3. Thought cards: read the thought, pick the balanced answer, keep the cards that help.
  4. Brain fog helpers: tap up to 5 helpers onto your card.
  5. Copy or print your result.

About the technique

Cognitive behavioral therapy for menopausal symptoms was developed by Myra Hunter and Eleanor Mann at King’s College London. Their cognitive model proposes that how women appraise hot flashes and night sweats, through beliefs about embarrassment, control and coping, and how they respond to them, shapes how distressing and disruptive the symptoms become (Hunter & Mann, 2010). The treatment that grew from it combines psychoeducation, paced breathing for stress, and cognitive and behavioral strategies for flashes, sleep and mood (Ayers et al., 2012).

The evidence is moderate and specific. In randomized trials, group and self-help CBT reduced how problematic hot flashes and night sweats were for women in the general population (Ayers et al., 2012), and group CBT did so after breast cancer treatment (Mann et al., 2012), and NICE lists menopause-specific CBT as an option to consider for hot flashes, sleep problems and low mood (National Institute for Health and Care Excellence, 2024). The trials mainly measured how bothersome symptoms were. Paced breathing on its own did not reduce hot flashes in a randomized trial (Carpenter et al., 2013), and The North American Menopause Society does not recommend it for that purpose (The North American Menopause Society, 2023), so here it is a calming aid, not a treatment.

It suits adults in perimenopause and menopause, alone or alongside medical care. Brain fog strategies are practice-based. It does not replace medical care: new or severe symptoms, unexpected bleeding, or memory problems that worry the client need a physician, and suicidal thoughts need a safety assessment.

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For therapists: how to run it

Goal

Feel more in control during a flash, swap unhelpful thoughts for balanced ones, and leave with a personal brain fog card.

In session

  1. Share your screen or send the client link. Start with whichever symptom bothers the client most.
  2. Thought cards: ask “Which of these thoughts sounds like you?” and add the client's own thought at the end.
  3. Practice the breathing in session first, so it's ready when a flash comes.
  4. Encourage a doctor or menopause clinic visit for treatment options; this tool sits alongside medical care.

As homework

  1. Use Hot flash breath at the start of a flash and rate before and after.
  2. Read your thought cards on a hard day or at night.
  3. Tap Copy for my therapist, then paste it into your therapist's secure messaging (client portal) or bring it to your next session. Nothing you type is saved, so copy before closing.

With a group

  1. Menopause groups: share your screen and go through the thought cards together, voting on the balanced answer out loud.
  2. Each person picks their own brain fog helpers on their phone and shares one with the group.
Good to know

Based on the cognitive model of menopausal symptoms (Hunter and Mann): how we think about flashes, night sweats and sleep changes how much they bother us. The UK NICE menopause guideline lists CBT along these lines as an option to consider. Thought cards use our own wording. This is not medical advice: a doctor or nurse can talk through hormonal and non-hormonal treatment.

Worksheets that pair with this tool

CBT Thought Record Worksheet

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Self-Care Assessment Worksheet

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Behavioral Experiment Worksheet

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Sources & credibility

Method
Cognitive behavioral therapy for menopausal symptoms (cognitive model of hot flashes and night sweats)
Developed by
Myra Hunter and Eleanor Mann, King's College London
First described
2010
Approach
Cognitive behavioral therapy
Evidence
Supported by studies and guidelinesRandomized trials (MENOS 1 and 2) found that group and self-help CBT reduced how problematic hot flashes and night sweats were, and the NICE guideline lists menopause-specific CBT as an option to consider for hot flashes, sleep problems and low mood. Paced breathing alone did not reduce hot flashes in a randomized trial, and the 2023 North American Menopause Society statement does not recommend it for that, so here it is a calming aid, not a treatment. Brain fog strategies are practice-based.

References

  1. Hunter, M. S. & Mann, E. (2010). A cognitive model of menopausal hot flushes and night sweats. Journal of Psychosomatic Research, 69(5), 491–501. Source
  2. Ayers, B., Smith, M., Hellier, J., Mann, E. & Hunter, M. S. (2012). Effectiveness of group and self-help cognitive behavior therapy in reducing problematic menopausal hot flushes and night sweats (MENOS 2): a randomized controlled trial. Menopause, 19(7), 749–759. Source
  3. Mann, E. et al. (2012). Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncology, 13(3), 309–318. Source
  4. National Institute for Health and Care Excellence (2015, updated 2024). Menopause: identification and management (NG23). Source
  5. Carpenter, J. S. et al. (2013). Paced respiration for vasomotor and other menopausal symptoms: a randomized, controlled trial. Journal of General Internal Medicine, 28(2), 193–200. Source
  6. The North American Menopause Society [now The Menopause Society] (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590. Source

How it was made

Built by the Mentalyc team from the original method and the published sources listed here. Nothing you enter is stored.

Questions people ask

How do you get rid of brain fog in menopause?

Good sleep, regular exercise, managing stress and practical memory aids like lists and routines can help. Talk to your doctor about treatment options and to rule out other causes such as thyroid problems.

How long does menopause brain fog last?

For many people, memory and concentration problems are worst around perimenopause and improve after menopause. If symptoms are severe or getting worse, see a doctor.

Is it menopause brain fog or dementia?

Menopause-related brain fog is common, usually mild and tends to improve with time. Memory problems that worsen steadily or affect daily life should be checked by a doctor.

Can CBT help with hot flashes?

CBT has evidence for reducing how bothersome hot flashes and night sweats feel, and for improving sleep and mood during menopause. Paced breathing is often taught alongside it as a calming aid, though on its own it has not been shown to reduce hot flashes.

What does CBT for menopause involve?

CBT for menopausal symptoms, developed by Myra Hunter and colleagues, combines psychoeducation, paced breathing during hot flashes and work on unhelpful thoughts about hot flashes, sleep and mood. Trials show it reduces how much hot flashes bother women and other people going through menopause, and can improve sleep, alongside any medical care.

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Your game designer
Michael Thompson

Michael Thompson, MSc

Michael's background combines doctoral training in clinical psychology with research on motivation, learning, and emotional regulation.

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Table Of Contents
  1. About the technique
  2. For therapists: how to run it
  3. Worksheets that pair with this tool
  4. Sources & credibility
  5. Questions people ask
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