With an estimated 85 percent of women experiencing hot flashes as they approach menopause, researchers are concentrating on finding effective treatments that don't include hormonal or other pharmaceutical therapies.

Now, a new Baylor University study has shown that women who specifically pictured images associated with coolness during hypnotherapy had a dramatic decrease in hot flashes, or flushes as they are called in medical circles.

In other recent studies, researchers found that a variety of non-hormonal treatments can offer women who have had breast cancer some relief from hot flashes and that an intensive weight loss intervention program can help overweight and obese women who suffer from them.

Many women enduring hot flashes regard the heat, sweat, and reddened upper body as an uncomfortable inconvenience. However, hot flashes also can greatly diminish a woman's quality of life, disrupting sleep at night or causing embarrassment as she goes about her daily business.

The results from the Baylor study outlining potential benefits from hypnotherapy appear in the International Journal of Clinical and Experimental Hypnosis.

"This is an interesting finding because it begins to shed light on what is it, specifically, about hypnotic relaxation therapy that reduces the hot flashes," says Dr. Gary Elkins, professor of psychology and neuroscience at Baylor.

Elkins has conducted several studies on hypnotic relaxation therapy. He says, "The finding may indicate that areas of the brain activated by imagery may be identical to those activated by actual perceived events. Consequently, it may be that while a woman suffering hot flashes imagines a cool place, she also feels cool rather than the heat of a hot flash."

While a previous Baylor study has shown that hot flashes can be reduced by up to 68 percent in breast cancer survivors by using hypnotic relaxation therapy, the specific mental imagery used for reducing hot flashes is a new finding.

The Baylor researchers surveyed the 51 breast cancer survivors who participated in a hypnosis intervention study for the treatment of their hot flashes. Participants were asked to identify their own personal preferences for mental imagery for reduction of hot flashes prior to each session. Some participants described actual places they had visited, while others described generalized imagery they preferred.

All participants showed a preference for images associated with coolness, while none used imagery associated with warmth. In fact, when a participant used mental imagery associated with a warm fire, she became relaxed, however, the hot flashes didn't decrease. The most common themes utilized by the participants included cool mountains, water, air or wind, snow, trees, leaves, and forests.

"These findings really give guidance to what women respond to," Elkins says. "This study supports the idea that the most effective images are those that are generated by the participant themselves, in relation to their own perceptions and life experiences."

The Cochrane Collaboration, a nonprofit medical-research organization, notes that hot flashes occur commonly in women with a history of breast cancer. The problem arises naturally in those women because of menopause; because of various treatments, such as the drugs tamoxifen and aromatase; and because of chemotherapy.

Breast-cancer patients

A newly published Cochrane review finds that a variety of non-hormonal treatments—mostly non-hormonal drugs—can offer women who have had breast cancer some relief from hot flashes. Side effects are frequent, though, and must weigh into any decisions to use the interventions.

Researchers in Chile analyzed 16 studies including nearly 1,500 women and found that several different non-hormonal drugs and one non-drug treatment—relaxation therapy—might help relieve symptoms.

Non-hormonal therapies included medications and complementary type interventions that don't appear to alter a woman's hormonal state. For this reason, several "holistic" remedies such as black cohosh and what are called phytoestrogens don't qualify as non-hormonal because they might alter a woman's hormonal balance, Cochrane says.

"Several non-hormonal alternatives have been proposed for managing hot flushes in these patients, but none is clearly superior. Our review was intended to review the existing evidence on several pharmacological and non-pharmacological treatments that can help," says lead author Dr. Gabriel Rada, who serves as the director of the Evidence-Based Medicine Unit at the Catholic University of Chile.

"We found that relaxation therapy, the antihypertensive clonidine, the anticonvulsant gabapentin, and some antidepressants that inhibit serotonin reuptake, have a mild to moderate effect," Rada says. "Our review is not able to say which alternative is superior, and some of them have adverse effects, so the choice must be made on an individual patient basis."

The pharmacological agents included were vitamin E, clonidine (used widely to treat high blood pressure), gabapentin (a seizure medicine), and various antidepressants. Non-drug interventions were magnetic therapies (devices placed on patients' skin), relaxation therapies (various stress management techniques), acupuncture, and homeopathy.

Because of inconsistencies in the ways that the 16 studies presented the data, the Cochrane researchers couldn't compare the relative strength of the beneficial effects of the different treatments.

Susan M. Cohen, an associate professor at the University of Pittsburgh School of Nursing studies acupuncture as an intervention for hot flushes.

"Because of the small number of studies used, they really can't make a recommendation that says that a certain intervention will help a large percentage of women," Cohen says. "The beneficial effects they found with the medications, with regard to the number, frequency, or severity of the flushes, were statistically significant, but it's not clear that those effects were clinically significant, and you have to ask if the side effects were worth those benefits."

For example, she says, anti-seizure medication might force a woman to give up driving. Also, she notes that clonidine lowers blood pressure even in women who don't have high blood pressure, and its possible side effects include dizziness, dry mouth, constipation, and a skin reaction.

"Women who are breast cancer survivors are often reluctant to take another medication because they are concerned about long-term effects," Cohen adds. She strongly agrees with the review authors that there is a need for more research into effective, safe, hot flash treatments in women with breast cancer.

Weight-loss study

Among overweight and obese women who suffer hot flashes during menopause, an intensive weight loss intervention program may lead to improvements in flushing, says a report published in July in the journal Archives of Internal Medicine.

"Hot flushes are among the most common concerns of women during menopause and persist for five or more years past menopause in as many as one-third of women," the authors wrote as background to the article. "In multiple observational studies, women with a higher body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) have reported more frequent or severe hot flushes compared with women with a lower BMI."

Dr. Alison J. Huang, of the University of California, San Francisco, and colleagues in a six-month controlled trial, used self-administered questionnaires to assess bothersome hot flashes. The authors studied 338 women, with an average age of 53, who were overweight or obese and had urinary incontinence.

Of the participants, 226 were assigned randomly to the intensive weight loss intervention and 112 were assigned to the control group. About half of the women in each group reported being at least slightly bothered by hot flashes at the beginning of the study.

Women in the intensive intervention group were assigned to a lifestyle and behavior change program designed to produce an average loss of 7 percent to 9 percent of initial body weight by six months. This included weekly one-hour group sessions with experts in nutrition, exercise, and behavior change during which participants were encouraged to increase physical activity to at least 200 minutes per week using brisk walking or activities of a similar intensity. Women were also instructed to follow a reduced-calorie diet and were offered sample meal plans providing appropriate food selections as well as meal-replacement products.

The authors say that in analyses of all women reporting bothersome hot flashes at the initial stages, decreases in weight, BMI, and abdominal circumference each were associated with improvement in hot flushes during six months.

"Our findings indicate that women who are overweight or obese and experience bothersome hot flushes may also experience improvement in these symptoms after pursuing behavioral weight loss strategies," the authors conclude.