Ask Dr. Pat · General Medical · Health · Menopause

Cognitive Behavioral Therapy for Management of Hot Flashes and Night Sweats: Ask Dr. Pat

The first study to demonstrate that CBT did make a difference in the management of vasomotor symptoms (hot flashes, night sweats) in menopausal women was MENOS 1. This randomized, controlled trial was conducted in London at King’s College in the Department of Psychology at the Institute of Psychiatry, Psychology and Neuroscience and published in 2012. The trial included women with breast cancer who developed vasomotor symptoms as a result of their treatment.

This study included psycho-education, paced breathing and relaxation, and CBT to help women to manage symptoms like yours. This intervention has been shown to be acceptable to women and has shown promise in exploratory trials of one-to-one and group CBT. “The treatment is based on a model of the hypothesized causal mechanisms and maintaining factors of hot flashes and night sweats, which include anxiety, stress, embarrassment, negative beliefs, catastrophic thoughts, and avoidance behaviors,” the study notes.

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Group CBT consisted of weekly 90-minute sessions for six weeks and included psycho-education, paced breathing, and cognitive and behavioral strategies for managing vasomotor symptoms. These findings suggest that CBT is safe, acceptable, and effective in helping women to manage hot flashes and night sweats after breast cancer treatment, with additional benefits to mood, sleep, and some aspects of quality of life. After group CBT, women reported less problematic hot flashes and night sweats than did those receiving usual care, and these improvements were maintained at both the 9-week and 26-week follow-up.

The MENOS 2 study included peri-menopausal and menopausal women without breast cancer who had hot flashes and night sweats that caused them distress. CBT was effective for reducing complaints of vasomotor symptoms regardless of age, body mass index, menopause status, or psychological factors at baseline.  The greatest improvement at 6 weeks was related to fully reading the manual and completing most homework assignments.  The researchers determined that the positive effects of CBT on vasomotor symptoms were mediated by changes in cognitions (beliefs about coping with and control of hot flushes, beliefs about night sweats and sleep) but not by changes in mood.


A four-week self-help guide is available on Amazon: Managing Hot Flushes with Group Cognitive Behaviour Therapy: An evidence-based treatment manual for health professionals by Myra Hunter and Melanie Smith. 



Now we need to increase the number of therapists who are trained to use this special form of CBT to work with the large group of women who need control of symptoms but may not want or need drugs. Given the encouraging results from these and supporting studies of this intervention, all women who are entering the menopausal transition should be informed of CBT and its potential for drug-free management of vasomotor symptoms.

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Based on this evidence, CBT is recommended as an effective non-hormonal management option for vasomotor symptoms in a recent position statement  by the North American Menopause Society.

I hope that this new form of non-drug therapy for hot flashes and night sweats is helpful to you, Linda.

Dr. Pat  



MENOS 1 Study
Lancet Oncol:  2012 Mar, 13(3): 309-318
doi:  10.1016/S1470-2045(11)70364-3
PMCID: PMC3314999, Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial
Eleanor Mann, Melanie J  Smith, Jennifer Hellier, Janet A Balabanovic, Hisham Hamed, Elizabeth A Grunfeld, and Myra S Hunter

MENOS 2 Study
Managing Sleep Problems in Menopausal Women: What Are the Options? By MGH Center for Women’s Mental Health on June 29, 2015 in Menopausal Symptoms, Sleep Disorders

Position Paper, The North American Menopause Society
Menopause: The Journal of The North American Menopause Society Vol. 22, No. 11, pp. 000-000 DOI: 10.1097/GME.0000000000000546 2015 by The North American Menopause Society POSITION STATEMENT Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society



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  • Maria Jasmine Freeman February 23, 2016 at 7:17 am

    Here you are Linda, another heroine out of numberless ladies chosen by the legacy of gender! I certainly would not advise you go to Hormonal treatment of any sort; your genes are rampant for any cancer stimulation, and at least u can evade what is plausible to be evaded! Over CBT, eat a lot of grains, nuts, legumes, and veggies, and fish-natural sources of compensatory estrogens, vitamins, and omegas, and exercise, especially if ur symptoms are not invalidating( like it was in my case). Over and above, keep your huge resolve and prayers, and I will add my prayers too ??
    Maria Jasmine Freeman