Hypnosis for Hot Flashes: The Evidence and a Cooling Practice

Imagine walking along a mountain path in early winter. Cool air touches your face, snow crunches underfoot, and a fresh breeze moves through your clothes. For many women going through menopause, an image like this has become part of an unexpectedly well-evidenced treatment. Hypnosis for hot flashes is one of the strongest examples I know of the mind influencing a physical process, and it deserves to be far better known.

Why hot flashes respond to the mind

Hot flashes, also called hot flushes or vasomotor symptoms, are sudden waves of heat, often with sweating, flushing and a racing heart. They are thought to involve changes in the brain's temperature regulation as oestrogen levels fall, so that the body's thermostat triggers cooling responses too easily. Stress and anticipation can make them more frequent and more distressing, and night sweats can disrupt sleep for years.

Because the thermostat sits in the brain, it makes sense that attention, imagery and relaxation can influence it. Hypnosis offers a structured way to do exactly that.

Hypnosis for hot flashes: the evidence

The landmark study was led by psychologist Gary Elkins at Baylor University and published in Menopause in 2013. In a randomised controlled trial, 187 postmenopausal women who had at least seven hot flashes a day received five weekly sessions of either clinical hypnosis or a structured-attention control of equal length. The hypnosis sessions combined relaxation, suggestions and individualised imagery of coolness, with an emphasis on learning self-hypnosis.

At 12 weeks, reported hot flash frequency fell by an average of 74 percent in the hypnosis group, compared with 17 percent in the control group. A combined hot flash score, which also reflects severity, fell by 80 percent compared with 15 percent. The hypnosis group also reported better sleep and less interference with daily life. In an early conference report on the trial, the team also described reductions in hot flashes measured physiologically through skin conductance, which matters because it points to a measurable change in the body as well as in how women rated their symptoms.

In 2023, The North American Menopause Society, now The Menopause Society, published its position statement on nonhormone therapies for vasomotor symptoms. Clinical hypnosis was listed among the recommended treatments at Level I, the category for good and consistent scientific evidence, together with cognitive behavioural therapy and several medications.

Honest limits: the evidence base is smaller than for medications, much of it comes from one research group, and we know less about how long the benefits last after treatment ends. Hypnosis is one option among several, best chosen together with a doctor or menopause specialist, especially since hot flashes can have other causes.

Cooling in the yogic tradition

The yoga tradition has its own cooling practices. The Hatha Yoga Pradipika, a fifteenth-century manual, describes sitali, a breath drawn in through the curled tongue, as cooling, and the tradition associates it with soothing heat in the body. Many yoga teachers also teach sitkari, a similar cooling breath drawn in through the mouth with a soft hiss.

I offer these as traditional practices; the research on them for hot flashes is limited, and their claims belong to the tradition. What they share with clinical hypnosis is a beautiful idea: that the breath and imagination are doorways to the body's regulation, and that we can meet heat with calm attention.

A practice: the snow path

This self-hypnosis exercise draws on the kind of coolness imagery used in clinical hypnosis. It complements medical care, and it works best practised daily, so that it is available when a hot flash begins.

1. Settle. Sit or lie comfortably. Close your eyes and take three slow breaths, letting each exhale lengthen.
2. Relax downward. Let a wave of relaxation travel from the top of your head to your feet, softening the face, shoulders, belly and legs.
3. Find the path. Imagine standing at the start of a quiet mountain path in winter. Notice the colour of the sky, the crisp air, the sound of your steps.
4. Feel the coolness. Let the cool air touch your face and hands. Imagine it moving gently through your whole body, from your chest down to your feet.
5. Add a cue. As the coolness spreads, touch your thumb to your forefinger and silently say "cool and calm."
6. Stay a while. Walk the path for a few minutes, letting the sensations grow more vivid.
7. Return. Count from one to five and open your eyes, bringing the coolness with you.

When a hot flash starts during the day, use the cue: touch your fingers, breathe out slowly and recall the path. With practice, many people find the cue alone brings a sense of calm and coolness.

The Hypnosis Library holds guided recordings to help you build a daily self-hypnosis habit.

Related reading

• Self-Hypnosis for Stress: What Two New Studies Reveal
• When the Clocks Go Back: Sleep Science and the Wisdom of Winter
• Hypnotherapy for IBS: What the Latest Evidence Shows

Sources

• Elkins, G. R., Fisher, W. I., Johnson, A. K., et al. (2013). Clinical hypnosis in the treatment of postmenopausal hot flashes: A randomized controlled trial. Menopause, 20(3), 291 to 298. Summary
• MDedge (2012). Hypnosis chills out severe postmenopausal hot flashes. Conference report on the Elkins trial. Report
• Shufelt, C. L., Brown, V., Carpenter, J. S., et al. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573 to 590. DOI: 10.1097/GME.0000000000002200
• Svatmarama, Hatha Yoga Pradipika, chapter 2.