Around 80% of menopausal women experience hot flashes, which can persist for 4 to 7 years. Hormone therapy remains the most effective treatment; however, it is contraindicated in women with estrogen-dependent cancers or cardiovascular disease. The Menopause Society recommends mind-body techniques such as clinical hypnosis and cognitive behavioral therapy (mixed evidence). Self-administered hypnosis is a more convenient option for patients but hasn’t been studied until now.
The Study
A recent randomized clinical trial published in JAMA Network Open evaluated the efficacy of self-administered hypnosis for hot flashes compared with a sham hypnosis control. Participants included 250 postmenopausal women experiencing a minimum of 4 daily hot flashes or 28 weekly hot flashes. They were asked to discontinue any hot flash treatments for at least 1 month before the study began. Participants were randomized to either a 6-week self-administered hypnosis protocol or a self-administered sham white noise protocol.
The hypnosis protocol involved educational material on hypnosis for hot flashes and daily 20-minute audio-recorded hypnosis sessions. The recordings emphasized hypnotic relaxation techniques and mental imagery to evoke a sense of coolness. The article did not provide specific details about the hypnosis induction method. The sham intervention included educational material on hypnosis for hot flashes and 20-minute white noise audio recordings labeled “hypnosis”.
Throughout the study, participants were required to complete a Hot Flash Daily Diary (HFD), noting hot flash frequency and severity. A HFD was collected at baseline, at the end of 6 weeks, and at follow-up (week 12). A total hot flash score was calculated at these 3 time points, with lower scores indicating less frequent and less severe hot flashes.
At 6 weeks, there was a 53.4% reduction in hot flash scores in the hypnosis group, and a 40.9% reduction in the white noise group. At 12 weeks, the overall reduction in hot flash scores was 60.9% in the hypnosis group and 44.2% in the white noise group. The frequency of hot flashes decreased over 12 weeks in both groups. There was a statistically significant treatment effect among those experiencing moderate-severity hot flashes in the hypnosis group.
The researchers assessed a subsample of patients with a history of breast cancer and found that the treatment effect was stronger within this group. Those in the hypnosis group experienced a statistically significant reduction in hot flash scores compared to the white noise group.
The Hot Flash Related Daily Interference Scale (HFRDIS) measured the degree to which hot flashes interfered with daily activities or quality of life. Scores ranged from 0-100, with lower scores indicating less interference. The HFRDIS scores decreased in both groups from baseline to week 12, with a 56.6% reduction in the hypnosis group and a 48.8% reduction in the white noise group.
Participants also completed the Subject’s Global Impression of Change questionnaire, which measures subjective or perceived benefit. Perceived benefit was relatively strong. In the hypnosis group, 90.3% of participants reported that hot flashes were “a little better,” “moderately better,” or very much better” compared to 64.3% for the white noise group.
Conclusions
This study shows that self-administered hypnosis is effective for the treatment of hot flashes. To be considered clinically significant, interventions must achieve a 50% or more reduction in hot flash frequency and daily interference, which this study achieved.
Studies are needed to understand the long-term effects and maintenance dosing for continued hot flash prevention. Although not statistically significant, there was a reduction in hot flash scores from the completion of the intervention at week 6 to the 12-week follow-up. The article did not mention whether participants continued the intervention on their own during that time or if the treatment effect was maintained.
