Settling the Heat: A Free Hot Flush Plan and Breathing Worksheet for Menopause

CBT · CBT · Practice-informed

A one-page flush plan with a before and after bother rating and a daily breathing practice tick-box. Breathing is taught to settle the body and the fear, not to switch flushes off.

Underlying mechanism: CBT and Mindfulness-Informed Flush Plan with Slow Breathing for Arousal Regulation

What it helps with

  • Meeting a hot flush with a calm, practised response instead of fear and hiding.
  • Settling the body and the fear response with gentle breathing.
  • Seeing, with a before and after rating, whether the plan changes how much a flush bothers.
  • Building a short daily practice that is simple to keep up.

How clinicians use it

  • Teach the six steps in the room and practise the breathing together.
  • Say plainly that breathing settles the body and does not stop flushes.
  • Ask for one real-life use of the plan with before and after ratings.
  • Offer resonance breathing only later and only if the client wants it.

Clinical Implementation Guide

  1. Learn the six-step flush plan.
  2. Rate the bother before and after using it.
  3. Practise the gentle breathing a few minutes a day when calm.

What the worksheet looks like

Settling the Heat — worked example
StepWhat I do
1Notice and name it: "This is a hot flush."
3Breathe in low and slow through the nose

Clinical cautions

Not a diagnostic or medical tool. Psychological support sits alongside medical care: encourage review by a GP or menopause specialist, especially for heavy or unusual bleeding, new or sudden symptoms or any symptom that worries the client, and never advise on starting, stopping or choosing hormone therapy. Screen for depression, anxiety and suicidal thoughts with your usual risk protocol before and during the work, because mood can worsen in the transition. Avoid pathologising a normal life stage or implying that symptoms are psychological in origin, and use inclusive language. Heat, sweating and breath focus can be activating for clients with trauma or panic, so go slowly, offer choice and let the client keep their eyes open. Breathing is taught to settle the body and the fear response and must not be promised to reduce hot flushes (Huang et al., 2015). Sleep window work needs the checks in the guide: avoid or modify it for bipolar disorder, seizure disorder, safety-critical work and suspected untreated sleep apnoea, and keep time in bed at or above about five and a half hours without specialist guidance. After breast cancer treatment or surgical menopause, coordinate with the oncology or medical team.

References

  1. Carmody, J. F., Crawford, S., Salmoirago-Blotcher, E., Leung, K., Churchill, L., & Olendzki, N. (2011). Mindfulness training for coping with hot flashes: Results of a randomized trial. Menopause, 18(6), 611-620. https://doi.org/10.1097/gme.0b013e318204a05c.
  2. Huang, A. J., Phillips, S., Schembri, M., Vittinghoff, E., & Grady, D. (2015). Device-guided slow-paced respiration for menopausal hot flushes: A randomized controlled trial. Obstetrics & Gynecology, 125(5), 1130-1138. https://doi.org/10.1097/AOG.0000000000000821.
  3. Laborde, S., Allen, M. S., Borges, U., Dosseville, F., Hosang, T. J., Iskra, M., Mosley, E., Salvotti, C., Spolverato, L., Zammit, N., & Javelle, F. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711. https://doi.org/10.1016/j.neubiorev.2022.104711.
  4. Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: How and why does it work? Frontiers in Psychology, 5, 756. https://doi.org/10.3389/fpsyg.2014.00756.
  5. Stefanopoulou, E., & Grunfeld, E. A. (2017). Mind-body interventions for vasomotor symptoms in healthy menopausal women and breast cancer survivors: A systematic review. Journal of Psychosomatic Obstetrics & Gynecology, 38(3), 210-225. https://doi.org/10.1080/0167482X.2016.1235147.

Copyright and use in research

© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.0, approved 20 October 2026, revised as the evidence develops.

Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady Through the Transition: A third-wave protocol for menopause and perimenopause (Version 1.0) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/

Part of

Steady Through the Transition

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