Self-hypnosis with cooling mental imagery could ease hot flashes

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A gentle breeze. Water trickling over a fountain. Crisp mountain air. Such scenes sound cool — and simply imagining them could help people feel cooler, too. 

For women experiencing hot flashes, self-guided hypnosis using cooling mental imagery may provide some relief, scientists report November 11 in JAMA Network Open. In a clinical trial of 250 postmenopausal women, hypnosis delivered via self-administered audio recordings offered greater improvements in hot flash symptoms than listening to white noise.

Previous studies have built a case for hypnosis as an effective therapy for hot flashes, but they typically involved in-person sessions, says Gary Elkins, a clinical health psychologist at Baylor University in Waco, Texas. In his team’s trial, women learned how to hypnotize themselves — no professional hypnotists required. 

Skipping the in-person component could make it easier for women to get help, says JoAnn Manson, an endocrinologist at Harvard Medical School. Scientists are “moving in the direction of making hypnosis more accessible,” she says.

Hot flashes are a symptom of perimenopause and menopause, when women’s bodies dial down the production of key hormones and menstrual periods eventually end. Some 85 percent of women experience hot flashes during menopause, and symptoms can flare up even years later. Though severity varies, some women find hot flashes to be “very bothersome and distressing,” Manson says. For instance, they can disrupt sleep and drench women with sweat in the middle of the night.

Effective hot flash treatments exist, but they’re largely pharmaceutical. People can take hormone replacement therapy, recently backed by the U.S. Food and Drug Administration. Doctors may also recommend nonhormonal options, like the drug Lynkuet, approved in October. But some women prefer to avoid taking meds, Manson says, so doctors need more behavior-based treatment options, like hypnosis.

Elkins’s therapy guides people into a state of deep relaxation and offers therapeutic suggestions and mental imagery specific for hot flashes. Forget hypnosis tropes from movies. There’s no swinging pocket watch here. Instead, a short recording directs people to relax and notice a feeling of calm in their bodies. Sprinkled in is imagery evoking coolness and comfort.

For six weeks, women listened daily to either the hypnosis recordings or recordings of white noise. All kept track of their hot flashes in a diary. At the end of the six weeks, women in the hypnosis group saw a 53 percent reduction in hot flash scores, which factor in frequency and severity. That’s compared with a 41 percent reduction in the white noise group.

It’s typical to see placebo effects like these in hot flash trials, Manson says. Sometimes people in randomized trials make other changes in their lives that can improve symptoms. But the benefit observed in the hypnosis group is substantial, she says, even compared with the control group.

What’s more, the effect seemed to grow after the study ended. At the three-month follow-up, women in the hypnosis group had a 61 percent reduction in hot flash scores, compared with 44 percent in women in the white noise group. That “really makes the point that once you learn [self-hypnosis], you keep doing it, and the benefits continue over time,” Elkins says.

For people interested in hypnosis for hot flashes, Elkins recommends Evia, a paid hypnotherapy app he helped develop. It requires about 15 to 20 minutes per day and a quiet place where users won’t be disturbed. That sounds simple, but he recognizes that carving out even a little alone time can be difficult. The average age of menopause is 51, a time when women may be managing busy careers and households and taking care of teenagers, elderly parents and grandchildren.

Beyond hot flash relief, self-hypnosis may also ease stress and improve sleep, as some study participants found. In the trial, Elkins says, women’s “overall quality of life improved.”