The aim of this prospective randomized controlled study was to investigate whether Kneipp hydrotherapy with short cold water stimuli helps alleviate menopausal symptoms such as hot flashes, insomnia, or depressed mood. No prior studies investigating this topic could be identified.The study included 80 women (mean age 55.0±4.93 years) with menopausal symptoms (minimum score of 10 points on the Menopause Rating Scale II (MRS II), a validated 11-item questionnaire). Patients were randomized either into group 1, which immediately started 6 weeks of daily home-based hydrotherapy or group 2, which waited for 6 weeks before beginning the same intervention. The treatment consisted of at least two self-applied hydrotherapy sessions daily. Every patient received professional group instruction before beginning hydrotherapy. After 6 weeks of treatment, all patients were asked to continue for another 6 weeks.A total of 60 women completed the study. Mean baseline MRS II scores were comparable between the two groups (group 1: 20.8±6.0; group 2: 21.1±5.8 n.s.). After 6 weeks, means for MRS II showed improvements in favour of the intervention compared to the waiting list group (group1: Δ 6weeks : −6.1±6.6; group 2: Δ 6weeks : −4.0±3.0; group comparison, P=0.33, Mann–Whitney U Test).Group comparison of the relative differences between MRS II scores before and after intervention just failed to reach significance only by a small margin (group1: Δ 6weeks : 31.9±30.4%; group 2: Δ 6weeks : 18.9±14.8%; group comparison, P=0.052, Mann–Whitney U Test). After 12 weeks of therapy, both groups demonstrated marked improvements of 41.3% (group 2) and 41.5% (group 1) in MRS II scores (total score difference before and after hydrotherapy: −7.4±5.5, P< 0.001, Wilcoxon test). Altogether, 59 out of 60 patients expressed a strong interest in continuing hydrotherapy after completing the study.Cold stimuli such as those applied in Kneipp hydrotherapy appear to have moderate effects in alleviating of menopausal symptoms. Patient acceptance of hydrotherapy was remarkably high. Further studies are needed to examine the mode of action of hydrotherapy and long-term effects of hydrotherapy.