Does Paced Breathing Reduce Hot Flashes?What Three Trials Found

Advice to breathe slowly through a hot flash can turn into another task: practice every day, count the breaths and wait for fewer flashes. The technique has been tested, including studies that checked whether women learned it and kept practicing. The results do not support prescribing paced breathing as a hot-flash treatment.¹²³

Paced breathing here means deliberately slowing the breath according to a specified rhythm. These findings should be attached to the hot-flash outcomes tested, rather than used to judge every breathing exercise for every purpose.

A percentage reduction needs its comparison group

The nine-week feasibility trial published in 2013 tested slow breathing at six breaths per minute for 15 minutes once or twice daily, against usual breathing at 14 breaths per minute for 10 minutes daily. Of 92 eligible participants, 68 completed the study.⁴

Hot flashes decreased in every arm: 52% with twice-daily paced breathing, 42% with once-daily practice and 46% with usual breathing. The original abstract describes an initial feasibility and efficacy study and calls for a larger trial.⁴

The 52% figure cannot stand alone as the treatment’s effect. Almost as much improvement occurred with the comparison exercise. A reduction after starting a routine is not the same as a reduction attributable to that routine.

The 218-woman trial found no significant advantage

Another trial published in 2013 randomized 218 women, including 96 breast cancer survivors. It compared paced breathing, fast shallow comparison breathing and usual care over 16 weeks. Instructions targeted 6–8 breaths per minute, two daily 15-minute sessions and use at the beginning of a hot flash.¹

At eight and 16 weeks, there were no significant group differences in hot-flash frequency, severity or bother. Nor was paced breathing significantly better at producing a sustained reduction of at least half the flashes.¹

Learning and practice were assessed. Most intervention participants demonstrated the target breathing rate; 75% reached eight or fewer breaths per minute at the 16-week assessment. Practice averaged approximately once daily, below the twice-daily instruction.¹

That adherence limit belongs in the interpretation. So does the finding that women could demonstrate the technique while the primary comparisons remained nonsignificant. It would be unfair to describe the outcome simply as participants failing to breathe correctly.

The device trial favored music listening

Published in 2015, the device-guided trial² enrolled 123 participants with at least four hot flashes daily. A chest sensor and musical cues guided breathing below ten breaths per minute, for at least 15 minutes daily over 12 weeks. The comparison device looked identical and played nonrhythmic relaxation music without directing the breath.²

Diary-recorded flashes fell by 1.8 per day with paced breathing and 3.0 with music listening. The difference favored music listening and was statistically significant. At follow-up, 91% of retained breathing participants were confirmed to have practiced at least six times weekly; average practice breathing slowed from 12.7 to 8.5 breaths per minute.²

The study did have a secondary insomnia-score result favoring paced breathing. That does not reverse the hot-flash result. It also had no untreated arm, so the improvement with music cannot establish a general music prescription for hot flashes. The melodies and structured daily sessions were specific to this experiment.²

What the evidence review recommends

The Menopause Society’s³ 2023 position statement places paced respiration in its “not recommended” category for vasomotor symptoms, with Level I evidence. Level I means good and consistent scientific evidence in this grading system; it does not mean every intervention receiving that grade is recommended.³

The same statement recommends menopause-focused cognitive behavioral therapy and clinical hypnosis among nonhormone options. Those approaches should not be collapsed into slow breathing because all involve a behavioral skill. They use different protocols and have their own trial results.³

Our articles on self-help CBT for hot flashes at work and clinical and self-guided hypnosis examine their measured outcomes and delivery methods.

Take the symptom burden to the appointment

If you enjoy a breathing routine, these trials do not oblige you to discard it. They do give you a reason to question a promise that daily breath counting will substantially reduce hot flashes, or that buying a breathing device supplies a proven menopause treatment.

When flashes keep interrupting your work or sleep, describe those effects to a clinician. A useful opening is: “I’m still having repeated hot flashes despite daily breathing practice. I want to discuss treatment options and how we’ll judge whether they help.” You do not need to complete another month of practice to make that conversation legitimate.

My Body Changed. Now What?, Chapter 5’s “Skills With Trial Results,” distinguishes menopause-focused CBT and clinical hypnosis from paced breathing and explains the evidence grading. Use that distinction when comparing programs: name the treatment being offered and ask which hot-flash outcome its supporting study improved.