Imagine trying to function in the world when, at any moment, you can be randomly dropped into a self-generating sauna. That’s what it’s like for women who have hot flashes.

While hormone therapy, hands down, works the best for most women, it’s not a universal answer. Some women don’t want to take hormones because the treatment has been linked to increased risk for breast cancer and heart disease. And hormone therapy is inappropriate for women who have had an estrogen-sensitive cancer or a history of blood clots.

Scientists have begun solving some of the mystery of what causes hot flashes. And research has recently revealed which nonhormonal treatments really help against hot flashes.

Solving the Mystery

New research has changed what we know about hot flashes. Key findings…

Before: Experts believed that symptoms of menopause lasted only about six months to two years.

Now: Research published in the April 2015 edition of JAMA Internal Medicine revealed that hot flashes go on for much longer than anyone thought—7.4 years, on average…and the earlier the symptoms started in perimenopause, the longer they were likely to continue after menopause.

Before: Hot flashes were believed to be an unfortunate but benign “side effect” of menopause.

Now: Recent research from the University of Pittsburgh School of Medicine published in Obstetrics & Gynecology suggests that hot flashes may be a marker for more serious disease processes. For example, studies have shown that women who have hot flashes are more likely to have higher levels of triglycerides and LDL “bad” cholesterol, putting them at greater risk for cardiovascular problems. This was true for all women who experienced hot flashes, but the risk was greater for women who had them frequently—on at least three days a week.

Another important study found that women with physiologically measurable hot flashes at night have more white matter hyperintensities—changes in the cerebral white matter (nerve fibers that connect brain cells) that could indicate a loss of blood flow in the brain.

Best Drug-Free Therapies

In November 2015, The North American Menopause Society (NAMS) published the results of its review of hundreds of scientific studies focusing on nonhormonal treatments for hot flashes. The goal was to determine which treatments really worked. In the NAMS review, two therapies stood out as providing significant relief from hot flash symptoms without hormones or other medication…

• Cognitive behavioral therapy (CBT). CBT is designed to help people change their underlying emotions, thinking and behavior patterns. The first step in CBT for hot flashes is relaxation—a clinical psychologist trains women in paced, slow breathing and stress-reduction techniques. Then women talk about their experience with hot flashes and learn how to manage their reactions. For example, instead of thinking, Hot flashes are ruining my life or I hope I don’t get a hot flash in the middle of the meeting, women might learn to change their thoughts to, Hot flashes are temporary…They last only  a few seconds…I know how to handle this. Over time, negative beliefs recede and the experience is less upsetting.

CBT can take a number of forms—individual or group therapy, or even take-home books or recordings. This is short-term therapy, usually requiring no more than eight hours spread over four to eight weeks.

Studies showed that after CBT, though the number of hot flashes didn’t change, about 75% of participating women perceived the hot flashes differently and seemed psychologically better able to handle them. This improvement remained steady even six months later.

CBT is covered by some health insurance, but check with your provider. To find a therapist familiar with CBT, talk with your primary care physician or gynecologist. Or you can search for a therapist in your area by visiting the website for the Association for Behavioral and Cognitive Therapies.

• Clinical hypnosis. This is a newer therapy for hot flashes that may provide even greater relief than CBT. You start by getting into a deeply relaxed state. Then the therapist uses individualized mental imagery (such as coolness, relaxation or a safe place) and suggestions to change the body state—in this case, from one that is susceptible to hot flashes to one that is not.

Two studies from Baylor University showed remarkable results from clinical hypnosis. Participants had about a 55% drop in hot flash frequency and a 65% drop in hot flash intensity. Hypnosis has also been shown to improve sleep.

The downside of clinical hypnosis is the effort required. In the study, participants attended weekly training sessions for five weeks and had to practice with an audio recording at home every day. Plus, not everyone can enter the state of deep relaxation necessary for hypnosis. The first step is to find a qualified practitioner through the National Board for Certified Clinical Hypnotherapists. Before your first visit, ask if the hypnotherapist has experience treating menopause symptoms.

For More Help

If you need more help for bothersome hot flashes, see a menopause expert (find one in your area at under the “For Women” tab). The physician can do an evaluation of the severity of your symptoms and work with you to find the best solution, whether or not that includes hormone therapy.

Women who have more than seven hot flashes per day or 50 per week, which disrupt their ability to function or sleep, or who experience heavy sweating are often good candidates for therapy. Don’t suffer in silence. Ask for help!