"It's important to remember that nothing is experienced until your brain tells you it's experienced. Emotions, mood, and probably even expectations affect levels of neurotransmitters, and these changes may heighten, dampen, create, or abolish many sensations including hot flushes. This is the mid-body connection." - Dr. Jen Gunter, The Menopause Manifesto
As a nurse practitioner with a healthy level of skepticism, hypnotherapy for medical conditions was simply not on my radar. That is, until The Menopause Society, a medical society that I highly respect, listed clinical hypnosis as one of a small handful of effective, non-hormonal treatments for hot flashes in its 2023 nonhormone therapy position statement (1). Then, a lightbulb went off over my head. Because there are so many people who either cannot or will not use hormone therapy for hot flashes. These include individuals undergoing treatment for estrogen-sensitive cancers, a condition in which the treatment itself may cause hot flashes. Only two of the treatments recommended by The Menopause Society are not medications: cognitive behavioral therapy and clinical hypnosis. So, I dug into the data myself.
How Does It Work?
Hypnotherapy is a mind-body technique that involves using suggestions and imagery to induce a state of focused attention and relaxation. Hypnotherapy has been shown to be an effective and safe alternative or complementary treatment for hot flashes, which are a common symptom of menopause and a side effect of some cancer treatments. Hot flashes are sudden sensations of heat, sweating, and flushing that can cause discomfort and distress. They are triggered by the hypothalamus, the part of the brain that regulates body temperature and becomes more sensitive to small changes in temperature during hormonal fluctuations.
Hypnotherapy can help reduce hot flashes by influencing the nervous system in several ways. First, hypnotherapy can help calm the stress response, which is often associated with hot flashes. By inducing a state of relaxation, hypnotherapy can lower the heart rate, blood pressure, and breathing rate, and reverse the physiological effects of the fight-or-flight response. Second, hypnotherapy can help modify the perception of temperature and the intensity of hot flashes. By using suggestions and imagery of coolness, comfort, and refreshment, hypnotherapy can help the subconscious mind adjust the neutral zone of the hypothalamus and reduce the frequency and severity of hot flashes. Third, hypnotherapy can help improve the quality of life and well-being of people who suffer from hot flashes. By enhancing self-confidence, self-control, and coping skills, hypnotherapy can help them deal with the emotional and psychological impact of hot flashes and improve their sleep, mood, and function.
Can Hypnotherapy Actually Help with Hot Flashes?
Several clinical trials have demonstrated the efficacy of hypnotherapy for hot flashes. In 2008, a study of 60 female breast cancer survivors randomized participants to either five weekly sessions of hypnosis or no treatment. The researchers found that five weeks of hypnosis decreased hot flash scores by 68% from baseline. There were also significant improvements in anxiety, depression, and sleep. However, this study did not have a proper control arm, which means that the result may have been due to placebo affect alone (2).
Therefore, a randomized controlled trial was devised in 2013. In this trial, 187 menopausal women reporting at least 50 hot flashes per week were randomized into either a hypnotherapy arm or a control arm. The hypnotherapy arm received five weekly sessions of hypnosis. The control arm was quite cleverly designed -- the women met with a clinician for five weekly sessions and were asked to discuss their hot flashes and the impact of hot flashes on their lives. The clinician then provided them with structured attention. Therefore, we can say that the results were not driven by having the opportunity to speak with a caring clinician about one's discomfort (3).
At the 12-week follow up, the control group did improve from the baseline. However, the participants who underwent hypnosis had significantly fewer reported hot flashes and significantly lower hot flash scores than the control group. They even physiologically monitored the participants' hot flashes with a small wearable device and found that the physiological hot flash number was reduced by 57% for the hypnosis arm vs. 10% for controls. Scores for hot flash interference, sleep quality, and treatment satisfaction were also significantly better in the hypnosis group (3).
Elkins GR et al (2013). Figure 2. Accessed from PubMed on 3/29/2024 at https://pubmed.ncbi.nlm.nih.gov/23435026/#&gid=article-figures&pid=figure-2-uid-1
Does Hypnotherapy Work as Well as Medication?
According to one study, it can. Although hormone therapy is considered the first-line treatment for menopausal hot flashes, it is not an appropriate option for everyone. One small randomized controlled trial placed 71 postmenopausal women in one of four groups: venlafaxine + hypnosis (an antidepressant that has been found to decrease hot flashes), placebo + hypnosis, venlafaxine + sham hypnosis, placebo + sham hypnosis. The hypnosis groups had four weeks of in-person hypnosis and three weeks of self-hypnosis practice at home. The sham hypnosis groups had four weeks of meeting with a clinician, listening to white noise, and thinking about hot flashes in a way they found helpful, followed by 3 weeks of practice while listening to white noise at home.
All groups experienced relief from their hot flashes, but the double placebo group (placebo + sham hypnosis) only had a 25% decrease in hot flash scores, while the other three groups had a 50% reduction. Therefore, the medication and hypnosis were equally effective, but combining medication and hypnosis together did not have an additive effect (4).
Does Hypnotherapy Only Work When I Expect it to Work?
No. A 2017 study explored whether participants' expectations that hypnotherapy does or does not work would influence their response to treatment. Analyzing data from the previously mentioned study of 187 women, the authors did not find that the response to treatment could be explained by participants' expectations of treatment efficacy. The authors conclude that the response cannot therefore be attributed to placebo effect alone (5).
Can Hypnosis Work if I'm Not Hypnotizable?
Yes, it can, but it may take longer to work. Hypnotizability is thought to be a relatively stable psychological trait (5). Therefore, it's reasonable to wonder whether hypnosis could work for you, especially if you don't believe yourself to be hypnotizable. In January 2024, a study was published that explored the question of whether one must be highly hypnotizable in order for hypnosis to positively influence hot flashes. The authors, which performed a post hoc analysis on the above study of 187 menopausal women, found that all hypnosis participants eventually reached a 50% reduction in hot flash frequency, regardless of hypnotizability. However, those participants who were less hypnotizable did not reach this 50% threshold until the 12-week follow-up, while highly hypnotizable participants crossed this threshold at only 3 weeks. Five weekly sessions were found to be sufficient in all subjects to improve hot flash frequency (6). Performance of hypnosis online vs. offline also does not seem to impact hypnotizability (7).
Next Steps
Hypnotherapy for hot flashes is a relatively simple and inexpensive intervention that can be delivered by trained hypnotherapists or self-administered. Hypnotherapy typically involves four to six weekly sessions of 45 to 60 minutes each, followed by daily practice of self-hypnosis at home. Hypnotherapy can be tailored to each individual's needs and preferences, and can be combined with other lifestyle modifications and treatments for hot flashes. Hypnotherapy has few contraindications or adverse effects, and is generally well-tolerated and appreciated by those who use it.
In conclusion, hypnotherapy is a promising and evidence-based treatment for hot flashes that can help people experiencing hot flashes and improve their quality of life. Hypnotherapy can reduce the frequency and severity of hot flashes by influencing the nervous system, and can also enhance psychological and emotional well-being. Hypnotherapy is a safe and effective alternative or complementary treatment for hot flashes that can be easily learned and practiced at home.
The evidence that I discussed here has convinced me to pursue training in clinical hypnotherapy.
Now, I am one of the few menopause specialists in the world who is also a licensed hypnotherapist!
Schedule your first session today, or order a 5-session plan so that you, too, can achieve a significant reduction in your hot flashes. You don't need to suffer for a minute longer.
Sources:
“The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society” Advisory Panel. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023 Jun 1;30(6):573-590. doi: 10.1097/GME.0000000000002200. PMID: 37252752.
Elkins G, Marcus J, Stearns V, Perfect M, Rajab MH, Ruud C, Palamara L, Keith T. Randomized trial of a hypnosis intervention for treatment of hot flashes among breast cancer survivors. J Clin Oncol. 2008 Nov 1;26(31):5022-6. doi: 10.1200/JCO.2008.16.6389. Epub 2008 Sep 22. PMID: 18809612; PMCID: PMC2652097.
Elkins GR, Fisher WI, Johnson AK, Carpenter JS, Keith TZ. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause. 2013 Mar;20(3):291-8. doi: 10.1097/gme.0b013e31826ce3ed. PMID: 23435026; PMCID: PMC3556367.
Barton DL, Schroeder KCF, Banerjee T, Wolf S, Keith TZ, Elkins G. Efficacy of a biobehavioral intervention for hot flashes: a randomized controlled pilot study. Menopause. 2017 Jul;24(7):774-782. doi: 10.1097/GME.0000000000000837. PMID: 28266949; PMCID: PMC5747247.
Sliwinski JR, Elkins GR. Hypnotherapy to Reduce Hot Flashes: Examination of Response Expectancies as a Mediator of Outcomes. J Evid Based Complementary Altern Med. 2017 Oct;22(4):652-659. doi: 10.1177/2156587217708523. Epub 2017 May 22. PMID: 28528570; PMCID: PMC5871284.
Alldredge CT, Sliwinski JR, Elkins GR. Treating Hot Flashes with Hypnosis: Does Hypnotizability Modulate Reductions? J Clin Psychol Med Settings. 2024 Jan 24. doi: 10.1007/s10880-023-09994-w. Epub ahead of print. PMID: 38265698.
Rasch B, Cordi MJ. The influence of experience and modality of presentation (online vs. offline) on hypnotizability. Front Psychol. 2024 Feb 28;14:1293070. doi: 10.3389/fpsyg.2023.1293070. PMID: 38481481; PMCID: PMC10936846.
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