What it is
Cognitive behavioral therapy (CBT) for vasomotor symptoms is a structured, evidence-based talk therapy. It teaches skills to manage the physical and emotional impact of hot flashes and night sweats, including relaxation and paced breathing, spotting and managing triggers, and cognitive strategies for unhelpful thoughts about hot flashes. It has been shown to reduce how much hot flashes bother you and interfere with daily life.
How well it works
In the MENOS-2 randomized controlled trial (n=140, baseline problem rating 5.87 out of 10), CBT reduced hot-flush problem ratings by an adjusted mean of about 2.1 points compared with no-treatment controls at 6 weeks (group and self-help CBT both statistically significant), with benefits of about 1.2 to 1.3 points maintained at 26 weeks. “Problem rating” means how bothersome the flushes feel, not necessarily a drop in the raw number of hot flushes. The NAMS 2023 position statement lists CBT as a Level I recommendation. The UK’s NICE NG23 guideline says to consider menopause-specific CBT for hot flashes, either alongside hormone therapy or for people who cannot or prefer not to take it.
Where to get it
In the MENOS-2 trial, group CBT ran as four weekly 2-hour sessions led by a CBT therapist, and self-help CBT used a booklet worked through over 4 weeks. NICE lists face-to-face, remote, group, and self-help options. Clinical psychologists and trained nurses have delivered it in trials. Check our provider directory for clinics near you.
Daily practice
CBT programs include practice between sessions. In MENOS-2, the self-help version included weekly homework and a CD for daily relaxation and paced-breathing practice. Paced breathing on its own is unlikely to reduce hot flashes, so programs combine it with cognitive and behavioral strategies. Your therapist will give you specific exercises to practice between sessions.
