My Transition Map: A Free CBT Worksheet and Weekly Tracker for Menopause and Perimenopause

What it helps with

• Seeing how a flush or night sweat, the thoughts about it and the reaction to it fit together.
• Measuring how much symptoms bother, which is where the evidence for CBT is clearest.
• Finding what helps and what makes things worse before choosing a skill.
• Preparing questions for a GP or menopause specialist.

How clinicians use it

• Use it at Session 1 and keep the client's own words.
• Map one recent episode and look for avoidance, hiding and self-criticism.
• Agree the 0 to 10 bother rating as the main outcome and revisit it each week.
• Treat a blank day in the tracker as missing data, never as zero.

Clinical Implementation Guide

1. Tick what has been showing up lately.
2. Map one recent episode step by step.
3. Rate the bother from 0 to 10 and write questions for the GP.

What the worksheet looks like

Clinical cautions

Not a diagnostic or medical tool. Psychological support sits alongside medical care: encourage review by a GP or menopause specialist, especially for heavy or unusual bleeding, new or sudden symptoms or any symptom that worries the client, and never advise on starting, stopping or choosing hormone therapy. Screen for depression, anxiety and suicidal thoughts with your usual risk protocol before and during the work, because mood can worsen in the transition. Avoid pathologising a normal life stage or implying that symptoms are psychological in origin, and use inclusive language. Heat, sweating and breath focus can be activating for clients with trauma or panic, so go slowly, offer choice and let the client keep their eyes open. Breathing is taught to settle the body and the fear response and must not be promised to reduce hot flushes (Huang et al., 2015). Sleep window work needs the checks in the guide: avoid or modify it for bipolar disorder, seizure disorder, safety-critical work and suspected untreated sleep apnoea, and keep time in bed at or above about five and a half hours without specialist guidance. After breast cancer treatment or surgical menopause, coordinate with the oncology or medical team.

References

1. 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. https://doi.org/10.1097/gme.0b013e31823fe835.
2. Mann, E., Smith, M. J., Hellier, J., Balabanovic, J. A., Hamed, H., Grunfeld, E. A., & Hunter, M. S. (2012). Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): A randomised controlled trial. The Lancet Oncology, 13(3), 309-318. https://doi.org/10.1016/S1470-2045(11)70364-3.
3. Norton, S., Chilcot, J., & Hunter, M. S. (2014). Cognitive-behavior therapy for menopausal symptoms (hot flushes and night sweats): Moderators and mediators of treatment effects. Menopause, 21(6), 574-578. https://doi.org/10.1097/GME.0000000000000095.
4. Ye, M., Shou, M., Zhang, J., Hu, B., Liu, C., Bi, C., Lv, T., Luo, F., Zhang, Z., Liang, S., Feng, H., Qian, C., Cao, S., & Liu, Z. (2022). Efficacy of cognitive therapy and behavior therapy for menopausal symptoms: A systematic review and meta-analysis. Psychological Medicine, 52(3), 433-445. https://doi.org/10.1017/S0033291721005407.
5. National Institute for Health and Care Excellence. (2015). Menopause: Identification and management (NICE guideline NG23). Updated 2024. https://www.nice.org.uk/guidance/ng23.

Copyright and use in research

© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.0, approved 20 October 2026, revised as the evidence develops.

Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady Through the Transition: A third-wave protocol for menopause and perimenopause (Version 1.0) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/

Part of

Steady Through the Transition

Related worksheets

• Therapist Guide: Steady Through the Transition
• Settling the Heat
• Sleep and Night Sweats

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