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For many women, menopause brings a cascade of symptoms that disrupt daily life, with hot flashes being one of the most challenging. While hormone therapy remains a cornerstone treatment, nonpharmacologic approaches are gaining attention for their ability to provide relief, especially for women who cannot or prefer not to use medications.
Charity Scott, a 51-year-old trauma therapist from Los Angeles, knows the struggle well. After experiencing hot flashes for over a decade, she tried hormone therapy but discontinued it after developing a venous thromboembolism, a rare but serious side effect. Despite exploring other medications like gabapentin and SSRIs, her options were limited by side effects and drug interactions. Instead, Scott turned to environmental strategies, such as cooling towels, ice rollers, and lightweight clothing, to manage her symptoms.
These practical solutions are part of a broader range of nonpharmacologic approaches endorsed by The Menopause Society in its 2023 updated position statement. Among the most effective options are cognitive-behavioral therapy (CBT) and clinical hypnosis, both of which have shown promise in reducing the impact of vasomotor symptoms on daily life.
A Growing Awareness of Nonpharmacologic Treatments
Despite the evidence supporting these therapies, many women and healthcare providers remain unaware of their benefits. “No medical provider ever mentioned CBT or hypnosis to me,” Scott said. Her knowledge of mindfulness and emotional regulation techniques came from her professional background as a therapist.
This gap in awareness may stem from a shortage of menopause specialists. While interest in menopause care is growing, only about 2,300 providers in the U.S. hold a menopause medicine certification, according to Dr. Stephanie Faubion, director of the Mayo Clinic Women’s Health program.
“A lot of people want a natural, holistic approach or need alternatives due to contraindications for hormone therapy,” said Dr. Karen Adams, a professor at Stanford Medicine.
For Angela Verzal, a 54-year-old office worker in Houston, hormone therapy and medications like venlafaxine helped to some extent, but her symptoms persisted. “These hot flashes are literally holding me hostage,” she said. Like Scott, Verzal had not been introduced to CBT or clinical hypnosis as viable options.
The Science Behind CBT and Clinical Hypnosis
CBT focuses on reducing the emotional and psychological distress associated with hot flashes. While it does not lower the frequency of symptoms, studies show it significantly decreases their interference in daily life.
A 2012 randomized controlled trial found that both group and self-guided CBT reduced the bother of hot flashes by 50% and improved mood and quality of life. “The goal is not to stop hot flashes but to change how women respond to them,” said Dr. Adams.
Clinical hypnosis, on the other hand, goes a step further. A 2013 study found that women who underwent hypnotherapy experienced a 74% reduction in hot flash frequency, compared to just 17% in a control group. The therapy works by guiding patients into a deeply relaxed state where they visualize cooling sensations, effectively reprogramming their brain’s response to perceived heat.
Barriers to Access and Emerging Solutions
Access to CBT and clinical hypnosis has traditionally been limited, but telemedicine and digital tools are breaking down these barriers. Apps like Evia now offer self-directed hypnotherapy programs, while virtual reality platforms for CBT are under development.
“These tools empower women to take control of their symptoms,” said Gary Elkins, PhD, a leading researcher in hypnotherapy.
A Holistic Approach
Cooling strategies, dietary adjustments, and mindfulness practices remain popular but lack consistent clinical evidence. Similarly, supplements like soy and black cohosh are widely used despite mixed results in studies.
The Menopause Society emphasizes the importance of combining approaches. For some, nonpharmacologic treatments can complement hormone therapy or other medications, providing a holistic path to symptom management.
As awareness grows, more women may find relief in these innovative, non-invasive options, reclaiming their quality of life during menopause.
This article highlights evidence-based alternatives for managing menopause symptoms. Consult a healthcare provider to determine the best approach for your needs.
