Hot flushes and night sweats affect most women going through menopause, and for some they go on for years. Hormone replacement therapy (HRT) is the most effective treatment, but not everyone can or wants to take it. Among the non-hormonal options, one of the best supported is a surprise to many people: clinical hypnosis.
The evidence
Most of the research comes from Gary Elkins and colleagues at Baylor University in Texas.
Breast cancer survivors (2008). Sixty women who had been treated for breast cancer, and who were having at least 14 hot flushes a week, were randomly assigned to five weekly hypnosis sessions or to no treatment. Hot flush scores, combining frequency and severity, fell by 68 per cent in the hypnosis group. Anxiety, low mood and sleep also improved.
Postmenopausal women (2013). In a larger trial, 187 women having at least seven hot flushes a day received either five weekly sessions of clinical hypnosis or a “structured attention” control of the same length. At 12 weeks, hot flush frequency had fallen by about 74 per cent in the hypnosis group, compared with 17 per cent in the control group. Sleep and day-to-day interference from flushes improved too.
What the experts say
In its 2023 position statement on non-hormonal treatment, The Menopause Society (formerly the North American Menopause Society) gave clinical hypnosis its highest level of recommendation for hot flushes, alongside cognitive behavioural therapy and certain prescription medicines. Many popular remedies, including several herbal supplements, were not recommended.
How might it work?
Hot flushes are thought to arise because falling oestrogen narrows the body’s “thermoneutral zone”: the range of core temperature it tolerates before triggering sweating and flushing. Small changes that would once have gone unnoticed now set off a full cooling response. Stress makes this worse.
Hypnosis may help in two ways:
- Calming the stress response, which reduces triggers.
- Cooling imagery, which may influence how the brain’s temperature regulation responds.
The exact mechanism is not yet established.
What a course involves
The protocol tested in the trials runs for about five weekly sessions.
- Induction and relaxation.
- Cooling imagery that you choose yourself: a mountain lake, a cool breeze, snow, walking into an air-conditioned room.
- Suggestions for coolness, calm and control.
- Dissociation from the heat of a flush as it begins.
- A recording for daily practice at home. This matters: practice was part of the tested treatment.
- Self-hypnosis to use when you feel a flush starting.
A simple version to try
- Sit comfortably and take a few slow breaths.
- Relax your body from head to toe.
- Picture somewhere cool in as much detail as you can. Feel cool air on your face and neck.
- Tell yourself: “With each breath, a cool calm spreads through me.”
- Stay there for ten minutes, once or twice a day.
- When a flush begins, breathe slowly and go straight to the image.
Who it suits
- Women who cannot take HRT, including many who have had breast cancer
- Women who prefer not to take hormones
- Women who want something to use alongside other treatment
Sensible cautions
- See your doctor first. Flushes and night sweats usually mean menopause, but they can have other causes.
- Discuss all your options, including HRT. For many women its benefits outweigh the risks.
- Give it time. The effect in the trials built up over several weeks.
- Look for a clinician with a healthcare background and training in this protocol.
The bottom line
For hot flushes, hypnosis has good trial evidence and a top-level recommendation from menopause specialists. It is safe, drug-free and worth asking about.
Next in the series: Hypnosis in the Operating Theatre: Surgery Without a General Anaesthetic
This article is for general information and is not medical advice. Speak to your doctor about managing menopause symptoms.