Yoga and menopause

Symptoms of menopause may vary considerably between different women, as will their choice of how to manage them. Liz Davidson looks at the role yoga can play during this natural life transition.

Prior to the twentieth century, menopausal women who sought help for hot flushes, difficulty sleeping and forgetfulness were stereotyped as being hysterical, hypochondriacs and, sometimes, insane. However, in a paradigm shift from illness to wellness, menopause has become understood for what it is – a natural life transition. Today there is a plethora of medical and complementary treatment available for relief of menopausal and peri-menopausal symptoms, among them yoga.

How a woman wants to feel, and the lengths to which she will go in order to ‘cope’ and feel ‘in control’ can differ considerably. Symptoms are debilitating for some, while minimal or absent for others. Although it is difficult to predict who will experience which symptoms, and to what extent, we now know that lifestyle factors play a role in the menopausal experience. The absence of a ‘one-size-fits-all’ treatment plan, however, means that management of symptoms can differ from one woman to another.

Table 1. Symptomatic experience of menopause

The MOST COMMON SYMPTOMS The % of women who will experience these

Hot flushes and night sweats

40-60%

Vaginal dryness

25-35%

Table 2. Incidence of symptoms

The % of women experiencing symptoms
(The severity of these symptoms may vary from 2 – 20 years.)1

60%

Mild

20%

Severe

20%

None


Figures obtained from Jean Hailes Foundation (www.managingmenopause.org.au – Jean Hailes Foundation)

EXTRA ARTICLE: ‘Training menopausal clients’

For more information on symptoms of menopause and training considerations for this demographic, click HERE to read the Network article ‘Training menopausal clients’ by Lyn Miller.


Expectations of what lies ahead

Menopause is a time that captures the essence of what a woman’s life is about. It’s a time when she looks at her own expectations of what lies ahead and how she wants to play out the rest of her life.

Part of the wellness journey during menopause and peri-menopause (the menopause transition years) involves embracing it as a natural transition and being mindful about the experiences, expectations and opportunities that come with it. Staying well during menopause is helped by a holistic, multidisciplinary approach to symptomatic relief.

Use of HRT

The most effective treatment for severe menopausal symptoms includes hormone replacement therapies (HRT) involving oestrogens and progestagens2. In 2002, however, the Women’s Health Initiative study in the US linked HRT to increased risk of breast cancer and heart disease, sending women worldwide scrambling for alternatives. Although a coalition of medical groups has since concluded that HRT can be safely used by many women, but on a case-by-case basis3, a degree of scepticism remains. Women concerned with the risks of HRT may consider natural therapies as an alternative to, or in addition to, HRT as a method of reducing dosage requirements. Recent trends in research support the combination of complementary therapies in the management of menopausal symptoms.

Use of yoga

McBane (2008) found that lifestyle changes, including exercise and relaxation strategies, showed significant reductions in symptoms.4 Similarly, Dr Vicki Kotsirilos, in A guide to evidence-based integrative and complementary medicine, espouses lifestyle and non-pharmacological approaches for symptomatic relief. In particular, she reports on the efficacy of yoga as a treatment option for reducing menopausal symptoms.5

Yoga is a holistic way of living dating back over 3,000 years. The word ‘yoga’ literally means, ‘to join, or unite’ all levels of oneself. As a pathway towards health and wellness, yoga harmonises body, mind and living.6

As BKS Iyengar7, one of the world’s leading yoga teachers, explains; ‘Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.’

The compiler of yoga sutras, Patanjali Muni, describes the eight limbs of yoga as a systematic method for achieving inner stillness and harmony. In menopause, yoga represents a therapeutic tool for positive health and wellness where meditation (dhyana), breath work (pranayama) and postures (asanas) contribute to symptomatic relief.

Table 3. Eight limbs of yoga8

Limbs of yoga Meaning

Yama

Social code (truthfulness and gentleness)

Niyama

Self-discipline – observances

Asana

Yogic posture

Pranayama

Breathing

Pratyahara

Withdrawal of the senses

Dharana

Concentration

Dhyana

Meditation

Samadhi

Complete absorption – ecstasy


Randomised clinical trials show that specific yoga asanas can improve symptoms.9 In a study of peri-menopausal women, yoga therapy helped to reduce hot flushes, night sweats, and improve cognitive functioning, attention and concentration.10 Similarly, a mainstream exercise and yoga group were compared across eight weeks, where the yoga group practiced dhyana, pranayama and asanas. The yoga group reported a significantly greater decrease in menopausal symptoms, stress and instability, than the control group.11 In a study employing progressive asanas, postmenopausal Brazilian women experienced a reduction in insomnia and improvements in overall quality of life.12 These findings show the benefits of yoga across the peri-menopausal and menopausal spectrum.

Find out more
  • Yoga is a non-invasive, non-pharmacological and effective treatment for managing peri-menopausal and menopausal symptoms. Regular practice can enhance physical, mental, emotional and spiritual wellness.
  • If you are suffering from menopausal symptoms, ask questions, research the topic and shop around. Seek out a registered yoga therapist with specialised skills and knowledge of women’s health. Know that you are not alone, and that symptoms are manageable.
  • Get more information from:
    www.managingmenopause.org.au – Jean Hailles Foundation
    www.menopause.org.au – Australasian Menopause Society
    www.menopause.org – North American Menopause Society

The asanas illustrated below were used in a yoga intervention in a study by Cohen et al in 20079 exploring the feasibility and acceptability of restorative yoga for the treatment of hot flushes. The yoga activity was designed by two expert certified yoga instructors who both published books specialising in the use of yoga with peri and post-menopausal women13,14. Drawing from their extensive experience, the instructors agreed the most suitable postures for the relief of hot flushes in peri-and postmenopausal women are those derived from restorative yoga, a branch of yoga focusing on deep relaxation and using props to provide total body support.

These seven essential poses for crossing the menopausal bridge – which are suitable for beginners – are listed below (with kind permission from Suza Francina and adapted from her book, Yoga and the Wisdom of Menopause). For further information visit www.suzafrancina.com/yoga_for_menopause.shtml

1. Supported Lying Down (Reclining) Bound Angle Pose (Supta Baddha Konasana)

 

2. Supported Child's Pose (Adho Mukha Virasana)

3. Downward Facing Dog Pose (Adho Mukha Svanasana) (supported)

 

4. Supported Shoulder Stand with chair (Salamba Sarvangasana)

5. Supported Half Plow Pose with chair (Ardha Halasana)

 

6. Supported Bridge Pose – The ‘Menopausal Bridge Pose’ (Setu Banda Sarvangasana)

7. Supported Legs-up-the-Wall Pose – The Great Rejuvenator (Viparita Karani)

References

  1. SHRADER SP, RAGUCCI K. 2006. Life after the women's health initiative: evaluation of postmenopausal symptoms and use of alternative therapies after discontinuation of hormone therapy. Pharmacotherapy, 26, 1403-1409
  2. NELSON, HD, 2008. Menopause. Lancet, 371, 760-770.
  3. www.nlm.nih.gov/medlineplus/news/fullstory_127043.html
  4. MCBANE, SE. 2008. Easing vasomotor symptoms: Besides HRT, what works? Journal of the American Academy of Physician Assistants:, 21, 26-31.
  5. KOTSIRILOS V, VITETTA, L, SALI A. 2011. Chapter 25 - Menopause. In: SERVICES, FP. (ed.) A guide to evidence-based integrative and complementary medicine. Australia: Elsevier.
  6. VAZE N, JS. 2010. Yoga and menopausal transition. Journal of Midlife Health, 1, 56-58.
  7. BKS IYENKGAR.  Yogarcharya B.K.S. Iyengar using a spiritual and intellectual foundation masterminded the techniques, which can be used by all practitioners of yoga.  Research based experience and experience based research helped him in evolving this technique which is now known as Iyengar Yoga.  He has made it possible for human beings to experience the wisdom of the yoga sutras.
  8. MICOZZI, MS. 2011. Yoga. Fundamentals of Complementary and Alternative Medicine. Saunders Elsevier.
  9. COHEN BE, KANAYA. AM, MACER JL, SHEN H, CHANG A, GRADY D 2007. Feasibility and acceptability of restorative yoga for treatment of hot flushes: A pilot trial. Maturitas, 56, 198-204.
  10. CHATTHA R, Nagarathna. R., PADMAIATHA V, NAGENDRA H. 2008. Effect of yoga on cognitive functions in climacteric syndrome: a randomized control study. BJOG, 115, 991-1000.
  11. CHATTHA R, RAGHURAM. N., VENKATRAM P, HONGASANDRA NR 2008. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study. Menopause, 15, 862-70.
  12. ALFONSO RF, HACHUL. H., KOZASA EH, OLIVEIRA DDE S, GOTO V, RODRIGUES D, TUFIK S, LEITE JR 2012. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial. Menopause, 19, 186-193.
  13. FRANCINA S. Yoga and the wisdom of menopause: a guide to physical, emotional and spiritual health at midlife and beyond. Deerfield Beach: Health Communications, Inc.; 2003
  14. Lasater JH. Relax and renew: restful yoga for stressful times. Berkley: Rodmell Press; 1995.

Liz Davidson
Liz has a 30 year background in personal and group training. Combining her PT and group training skills with her desire to inspire wellness, she educates and supports her clients to optimise their well-being via her vision board workshops. She is currently augmenting this passion through her studies in the Master of Wellness at RMIT University.