Slow Breathing for Menopausal Hot Flashes (or Hot Flushes)
How slow breathing can help with the menopause
If you’re going through your menopause or perimenopause and having lots of hot flashes (or hot flushes, depending on what side of The Pond you’re on), doing something as simple as slow breathing for a short period each day may help. This can be particularly useful if you can’t have hormone replacement therapy for health reasons, or if you just prefer not to.
Quite a few studies now show that deliberately breathing more slowly and regularly for even just fifteen minutes a day can reduce both the frequency and the severity of hot flashes. Indeed, the North American Menopause Society recommends doing paced slow breathing for easing hot flashes.
There’s also new intriguing evidence that listening to relaxing music can also reduce hot flashes. You could even do slow breathing and listen to relaxing music together.
First though, let’s look at slow breathing for hot flashes / hot flushes.
How slow breathing for hot flashes works
Most people breathe at a rate of about 12 to 14 breaths per minute, ‘breath’ being one cycle of breathing in and out. (This refers to your ‘resting’ breathing rate – i.e., the rate you habitually breathe at when you’re not engaged in physical activity or exercise, which increases your breathing rate). ‘Slow breathing’ or ‘paced breathing’ is when you deliberately breathe at a regular and slower rate than usual.
Many studies now show that slow paced breathing reduces stress and enables your mind and body to relax. This isn’t just a subjective mental response but a physiological one. Steady slow breathing reduces the activity of the part of your nervous system responsible for stress and action. Conversely, it stimulates the part of your nervous system responsible for rest and relaxation. These are the called the sympathetic and parasympathetic nervous system, respectively. By breathing slowly, you’re enabling your body to reduce its heart rate and blood pressure, produce less stress hormones, produce more ‘feel-good’ hormones (including endorphins and serotonin), and relax.
How does this affect hot flashes though? Well, some research suggests that hot flashes are linked to excessive activity of the sympathetic nervous system. One reason for this is that adrenaline, produced by the sympathetic nervous system, narrows the body’s “temperature neutral zone” – the temperature range within which you neither shiver nor sweat. As such, any slight rise in body temperature can trigger a hot flash. Body temperature can be raised by any number of things, including exercise, smoking, and even stress itself, as well as being in a warm environment of course. Keeping yourself cool can thus help limit hot flashes. However, this isn’t always possible or desirable. Since breathing slowly reduces sympathetic nervous activity (and thus reduces adrenaline levels), it helps directly to reduce the likelihood of hot flashes.
Another way in which slow breathing may help to reduce hot flashes is through stress reduction more generally. Indeed, there’s evidence that stress itself can trigger hot flashes. And then you can get into a vicious circle of being stressed by your hot flashes and thus having more, and so on.
You can read more in our article here about slow breathing to reduce stress.
Does it really work? How effective is slow breathing for hot flashes?
Some evidence shows that paced breathing may be effective in reducing menopausal hot flashes, including how often they occur and how severe they are.
This is according to Dr Sood, who has researched slow breathing for hot flashes. The key words here are “may be”. Paced slow breathing clearly reduces hot flashes for some women in some conditions, but it may not be effective for everyone all the time. Here’s the evidence.
First of all, several small experiments involved training women who were experiencing menopausal hot flashes (but were otherwise healthy) to do paced slow breathing. These studies found that regularly doing slow breathing reduced the severity and frequency of their hot flashes.
Some larger studies have confirmed these findings to some extent. For example, the Mayo Clinic in Rochester, Minnesota (in the US), had 68 menopausal women do paced breathing daily for nine weeks. A third of the participants practiced breathing at six breaths per minute (a slower-than-usual breathing rate) for fifteen minutes once a day. A third did the same twice a day. The final third of the participants practiced breathing at fourteen breaths per minute for ten minutes once a day (this is most people’s usual breathing rate, so this was considered to be normal breathing).
The paced breathing certainly helped as all the participants reported that they experienced reductions in their hot flashes for the duration of the study – both in terms of how often they got hot flashes, and how severe the hot flashes were. The hot flashes were reduced the most in those doing the paced slow breathing twice a day (those women experienced an average 52% reduction in symptoms). However, they were also reduced in those doing the slow breathing once a day (42% reduction), and those doing the breathing at a more normal rate (46% reduction).
In other words, while the slow breathing helped, it wasn’t dramatically more effective than paced breathing at a more normal breathing rate. On the plus side, this suggests that doing paced breathing (rather than specifically slow breathing) daily can improve hot flashes. It was also more effective if you practiced it twice a day rather than just once.
So far so good. However, another study found that doing guided slow breathing didn’t decrease menopausal women’s hot flashes (compared to doing rapid shallow breathing). Indeed, in view of these inconsistent experimental results, some doctors are now questioning whether slow breathing really is effective for reducing hot flashes. So what’s going on?
Different methods for using slow paced breathing
One of the issues here could be the different protocols and methods used for slow breathing in the different studies.
For example, in the study just mentioned which found that doing guided slow breathing did not decrease hot flashes, the women were instructed to do the slow breathing just whenever a hot flash came on. They were not practising slow breathing any other time.
However, in the other studies discussed, women have been doing slow breathing once or twice a day – not in response to a hot flash but just maintaining a regular practice. And in the small initial studies which initially demonstrated the effectiveness of slow breathing, women were doing slow breathing twice a day AND whenever a hot flash came on. The women in these early studies were also given one-on-one training in how to do slow breathing effectively, and this may also have contributed to its positive effects.
So it’s unclear what level of practice and usage of slow breathing is required for it to be effective. And of course this could vary for each of us.
Further questions about slow breathing for hot flashes
Indeed, in a 2012 overview of the research so far on menopausal hot flashes and slow breathing, Dr Debra Burns and Dr Janet Carpenter noted that there are several issues that need clarification:
Can women learn this on their own with printed or electronic instructions or is a trainer required? […] There are also questions about the active component of the protocol: is it the twice-daily practice, the application at the time of the hot flash, or both that is required? Does paced respiration have physiological effects that might prevent hot flashes or is this simply a method to manage severity or duration of a hot flash at the time it occurs? Is it equally effective for women with more severe versus milder hot flashes?
It does seem that the benefits are mainly to be found if you’re willing to put in the time to practice daily. Summarising their overview of the research on paced breathing and menopausal hot flashes, Burns and Carpenter conclude:
Evidence to date suggests that paced respiration at 6 to 8 breaths per minute when practiced 15 minutes twice per day and applied at the onset of hot flashes can be helpful for healthy peri- and postmenopausal women in decreasing both the number and severity of this bothersome menopausal symptom. Women who are unwilling or unable to practice twice daily or apply it at the onset of hot flashes are not likely to find this therapy feasible or acceptable and may benefit from discussion about other alternatives.
How to do slow breathing for hot flashes most effectively
In other words, doing slow breathing for hot flashes is most effective when you practice regularly and do it whenever a hot flash comes on. The North American Menopause Society (NAMS) also makes this point.
NAMS recommends this technique as a first line therapy for women with menopausal hot flashes. [However] for this to be effective, women should commit to two 15-minute practice sessions per day, and then apply the breathing technique with the onset of each hot flash.
So says Constance Young, MD, assistant professor of obstetrics & gynecology at Columbia University Medical Center.
So if you do try it, give it a good couple of months to see if you notice any effect. The women in the various studies did the slow breathing for at least ten minutes most days, and for at least eight weeks. They also often kept diaries recording their hot flashes (both how often and how severe they were). This could be a good idea too, so you can really see clearly if there are any changes, rather than relying only on your general impressions. If there is gradual improvement in your hot flashes, you might not notice it if you’re not keeping track of them.
How slow should I go?
As for how slowly you should be breathing, under 6 to 8 breaths per minute is a good rate to aim for. This is the rate used in most of the studies mentioned. And there’s a physiological reason for this. It’s generally the case that if you slow your breathing down to under about 8 breaths per minute, then your breaths will naturally become a bit deeper, so that you’re using your diaphragm more (the diaphragm is a wall of muscle underneath your lungs). It’s this kind of slower and deeper breathing that most effectively triggers the level of relaxation in your body which will help with hot flashes.
Is it safe for me to do slow breathing?
For most people, paced and slow breathing is a safe and effective way of relaxing. However, if you sometimes get dizzy, or hyperventilate, or have other breathing problems, then you should check with a doctor or other medical professional before trying slow breathing. Slow deep breathing could worsen some respiratory conditions, for example.
Slow breathing is considered a good method for women who cannot have hormone replacment therapy (or don’t want to) for whatever reason. As Constance Young of NAMS says, paced slow breathing “represents a safe option for women who are not candidates for hormone replacement therapy, or who cannot take hormones due to a history of breast cancer.”
Listening to music can reduce hot flashes
Another method you can try is listening to relaxing music. Yes, just this can reduce hot flashes as well! This was discovered by a San Francisco team of researchers when they were conducting a study on slow breathing for hot flashes.
The study worked like this: 123 women going through their menopause or perimenopause who had at least four hot flashes a day were given an audio device to use for fifteen minutes each day for twelve weeks. For half of the women, the device was programmed with slow breathing exercises (at under ten breaths per minute). For the other half, the device played relaxing music while the women just breathed spontaneously. As well as playing breathing prompts or music, the devices were also measuring the women’s breathing rates. (This showed that the women listening to the slow breathing exercises did indeed slow down their breathing while those listening to relaxing music did not.)
After the twelve weeks of the study, all the women who took part reported that their hot flashes were less frequent and less severe. The women who had been doing the slow breathing reported, on average, a 21% reduction in the number of hot flashes they had. However, the women listening to the relaxing music reported an average 35% reduction in the number of their hot flashes. And while all women, on average, reported a reduction in the severity of their hot flashes, this effect was twice as great in the women who had been listening to relaxing music compared to those doing the guided slow breathing.
The researchers obviously concluded that listening to relaxing music was an even more powerful method of easing hot flashes than doing slow paced breathing, though clearly that helped too. (Incidentally, this was not what they had expected. They had originally only included the music-listening intervention as a control with which to compare the effects of guided slow breathing.)
So does this mean that listening to any music can help with hot flashes? The researchers note that their music “featured a specific series of tonal nonrhythmic melodies” and as such, the effects of listening to it “may not be generalizable to other types of commercially available music” (Huang et al, 2015). Also, the women were setting aside time to sit quietly to listen to the music, which in itself is somewhat relaxing and may account for some of the hot flash-reducing effect. Still….
Well worth a try: slow breathing and listening to relaxing music
Listening to music you find relaxing is both pleasant and cheap or free and easy to do. So why not try it? Unlike medications, it’s also without known negative side effects!
Even better, why not try listening to relaxing music while doing slow breathing? Since there’s evidence that both can work, this seems to be a win-win situation 🙂
Find a quiet spot, put on some music that you find relaxing, and then focus on slowing down your breathing. Simple. No?
Well, the thing about doing any kind of paced breathing breathing is that it can be tricky to keep your breathing rate regular, especially if you’re trying to breathe at a different pace to usual. And especially if you’re trying to listen to music at the same time.
This is where guided breathing aids can be very useful. In the San Francisco study discussed above, women were given a device called RespErate which monitors your breathing while playing tones into headphones which you breathe along in time with. This device is undoubtedly useful but is extremely expensive at over $300 USD. (At current exchange rates that’s over £220 or €250).
A simpler and cheaper way to do guided slow breathing is to listen to audio tracks which give you regularly paced breathing prompts, which you simply breathe in time with. This is what was used in the Mayo Clinic study discussed above.
And it just so happens that we have guided audio tracks for paced slow breathing…
But what about listening to music? Well, because of the benefits of listening to relaxing music (it can also lower high blood pressure), our audio tracks also have relaxing background music as well as the breathing prompts. And there are some audio tracks with no relaxing music, so you can put on your own choice of music and then play the audio tracks over the top.
Breathe Slow guided audio tracks
The fastest is 10 breaths per minute (breathing in and out is counted as one breath). This is just a bit slower than many people’s natural breathing rate. The other sets of tracks are paced at 8, 6, 5, and 4 breaths per minute. This means you can select a pace that suits you. It also enables you to gradually work your way down to slower breathing rates for more profound relaxation and hot flash reduction. (Remember, between 6 and 8 breaths per minute were used in most of the menopause studies.)
For each breathing pace, there are four audio tracks which you can select from. Three audio tracks have background music of different sorts. This is because – as discussed – listening to music is also beneficial for lowering stress and reducing hot flashes. And it’s also just quite pleasant. The fourth audio track consists of only the breathing prompts. You can listen to these on their own or you can play your own music in the background.
With the whole set of Breathe Slow audio tracks, you can find a pace which suits you, and select a music (or your own) which suits you.
The full Breathe Slow collection of guided slow breathing audio tracks is now available for $17 USD (about £13 or €15).
The Breathe-Slow audio tracks come with a 60 day no-questions-asked 100% money-back guarantee if you’re not completely satisfied with your investment.
Note that this is a digital download ONLY. No CDs will be sent to you.
Slow breathing for hot flashes: Some references
General information on breathing and health – http://www.thehealthsite.com/diseases-conditions/blood-pressure-insomnia-weakness-heres-how-deep-breathing-can-help-deal-with-many-health-problems-f0216/
Mayo Clinic paced breathing study – https://www.ncbi.nlm.nih.gov/pubmed/22990758
Slow breathing versus listening to music study –
Slow breathing during hot flashes study –
Overview of studies on paced slow breathing and hot flashes –
Stress, breathing exercises, and hot flashes –
Biology of hot flashes –