Can Yoga relieve menopausal symptoms?
Menopause is the stage in every woman’s life when the monthly menstrual cycle permanently stops. A woman between the ages of 40 and 60 years experiences (peri) menopause and this is accompanied by hormonal, physical, and psychological changes.
The changes can happen gradually or suddenly and can start as early as the age of 30 years or not until as late as 60 years. The average age for menopause for European and North American women is 51 years. Menopause can also occur when the ovaries are removed or have stopped functioning.
During (peri) menopause most women report symptoms that negatively affect their quality of life. In the United States alone more than 38 million women ages 45 to 64 years old experience daytime hot flashes or night sweats during this period. If untreated, for most women, hot flashes will naturally discontinue after 5 years, although some women continue to experience it for over 30 years.
Hot flashes and night sweats or vasomotor symptoms (VMS) are the most common symptoms (60-80% prevalence), however other menopausal symptoms may include irregular menstruation, changes in sexual desire, sleep and mood disturbances, (joint) pain, difficulty concentrating, fatigue, vaginal dryness and urinary problems, changes in appearance, palpitations, and backache. These symptoms are likely to affect day to day functioning in work, social, leisure and sexual activities.
Estrogen and progesterone levels play the biggest part in menopause. In this stage of a woman’s life, the ovaries make less estrogen and progesterone. When the body produces less of these hormones, the parts of the body that depend on estrogen to keep them healthy will react, and this often causes discomfort.
Since menopause is a natural biological process, it does not require medical treatment. However, the treatments available focus on relieving symptoms and preventing any chronic condition that may occur during the postmenopausal years, such as heart disease and osteoporosis.
Although hormone replacement therapy has been shown to effectively manage symptoms, the risks and side effects has resulted in increasing need for non-hormonal therapies. Hormonal therapy has been shown to increase the risk of breast cancer, stroke, coronary heart disease, and venous thromboembolism.
Non-hormonal therapies for menopausal symptoms include lifestyle practices such as exercise regimens, yoga and the use of herbal supplements. An appropriate diet, not smoking, and reduction of stress are also effective ways to make menopause more bearable.
Yoga, which means to unite, is an ancient holistic science that includes physical, mental, moral and spiritual aspects. In modern times, it has been studied as a method to help people manage various health conditions, including menopause.
Yoga Asana’s have a physiological effect on the body by relaxing and gently stretching every muscle, thereby improving blood circulation and oxygenation to all cells and tissues. This helps improve the function of the endocrine glands and female reproductive system.
Additionally, in various studies, yoga postures, breathing techniques and meditation has been shown to help to calm the nervous system and reduce stress in menopausal women. Yoga has also been proven to alleviate anxiety and depression.
A study carried out in India in 2014 titled “Complementary health approach to quality of life in menopausal women: a community-based interventional study” concluded that yoga was effective at improving the quality of life of menopausal women. In this study, a group of 128 participants underwent yoga training for 1.5 hours a day on 5 successive days (126 participants in the control group).
After the 5-day intensive yoga training program, the menopausal women practiced yoga daily at home for 35 to 40 minutes a day. Along with daily yoga practice, they underwent group yoga practice for 2 days a week under the supervision of one of the investigators for 18 weeks.
The postures practiced were Tadasana, Ardhakatichakrasana, Badrasana, Paschimothasana, Bhujangasana, Ardha Salabhasana, Ardhahalasana (repeated five times for 25–30 minutes) and Shavasana. Furthermore, pranayama techniques like Nadi sodhana and Sitali were repeated 8 to10 times for 5 to10 minutes. Additionally, women were asked to chant “AUM” during meditation for 5 to 10 minutes.
Another study carried out in 2014 with 54 participants by Wake Forest School of Medicine in the United States titled “A Pilot Study of Integral Yoga for Menopausal Hot Flashes” entailed weekly 90-minute Integral Yoga classes for 10 weeks.
Integral Yoga was chosen in this study as it is considered to be suitable for women experiencing hot flashes because of its focus on stress reduction and the decreased likelihood of increasing heat.
Each class included the same basic elements (adapted from Satchidananda) in the following three categories:
1. Breathing/centering meditation (15 minutes). This included centering the body in a comfortable seated position, paying attention to any physical sensations and noticing the breath.
2. Physical postures (45 minutes) including: Cat pose; modified sun salutations; standing poses like Warrior I or II, Dancer’s pose; backward bending postures like Cobra, Boat pose, Bow pose. Forward bending postures like head- to-knee pose, forward bend, half spinal twist; inverted poses like half shoulder stand, legs up the wall, downward-facing dog; fish pose or supine spinal twist; upright spinal twist; and yoga mudra.
3. Deep relaxation (Savasana) for 30 minutes that included Yoga Nidra (sleep) and afterwards breathing techniques like alternate nostril breathing (Nadi Shodana).
The results of this study suggest that yoga can be considered beneficial in reducing hot flashes.
In 2016, another study titled “Hatha Yoga practice decreases menopause symptoms and improves quality of life: A randomized controlled trial” was conducted in Brazil with 40 participants in the yoga group, and 48 participants in two control groups.
For 12 weeks, participants in the yoga group practiced the following poses: cobra pose (Bhujangasana), downward facing dog pose (Adho-Mukka-Svanasana), easy pose (Sukhasana), fish pose (Matsyasana), grasshopper pose (Shalabhasana), forward bending pose (Padahastasana), legs-up-the-wall (Viparitakarani), mountain pose (Tadasana), Nataraj pose (Natarajasana), tree pose (Vrkasana), warrior pose (Virabhadrasana), and wheel pose (Chakrasana).
Additionally, breathing exercises were performed as follows:
1. During Ujjayi pranayama subjects were instructed to prolong inhalation and exhalation in a comfortable way, maintaining the ratio of 1:2 for inhale and exhale respectively.
2. During Bhastrika pranayama subjects performed Kapalabhati pranayama (exhaling through both nostrils, with a fast abdominal contraction, followed by an immediate relaxation of those muscles for a passive inspiration).
3. During Nadi sodhana pranayama subjects performed a slow inspiration through the left nostril followed by a slow expiration through the right nostril, and interchange sides, repeatedly. Afterwards, during relaxation, subjects were encouraged to remain in the corpse pose (Shavasana).
Additionally, a meditation technique (Dhyana) was conducted by instructing subjects to focus attention on self-observation of the body’s movement. The program consisted of 75 minutes of supervised practices twice a week.
The results of this study suggest that yoga promotes positive psychophysiological changes in post-menopausal women and can be applied as a complementary therapy.
Apart from the scientific evidence above, all my students experiencing menopausal symptoms have also noticed positive changes in their sleep, mood and physical fitness after just 6 weeks of yoga practice once a week for 60 minutes. By incorporating the postures and breathing techniques above in the classes that I teach, even students that only recently started practicing yoga, quickly noticed positive changes. This suggests that even if yoga practice begins later in life, the benefits can still be experienced.
Avis, N. E., Legault, C., Russell, G., Weaver, K., & Danhauer, S. C. (2014). Pilot study of integral yoga for menopausal hot flashes. Menopause,21(8), 846-854. doi:10.1097/gme.0000000000000191
B.jayabharathi, B., & Dr.a.judie, D. (2012). A Prospective Randomized Interventional Study to Evaluate The Effect of Yoga on Quality of Life of Menopausal Women. Global Journal For Research Analysis,3(7), 207-209. doi:10.15373/22778160/july2014/74
Beezhold, B., Radnitz, C., Mcgrath, R. E., & Feldman, A. (2018). Vegans report less bothersome vasomotor and physical menopausal symptoms than omnivores. Maturitas,112, 12-17. doi:10.1016/j.maturitas.2018.03.009
Cramer, H., Peng, W., & Lauche, R. (2018). Yoga for menopausal symptoms—A systematic review and meta-analysis. Maturitas,109, 13-25. doi:10.1016/j.maturitas.2017.12.005
Jayabharathi, B., & Judie, A. (2014). Complementary health approach to quality of life in menopausal women: A community-based interventional study. Clinical Interventions in Aging,1913. doi:10.2147/cia.s70064
Jorge, M. P., Santaella, D. F., Pontes, I. M., Shiramizu, V. K., Nascimento, E. B., Cabral, A., . . . Ribeiro, A. M. (2016). Hatha Yoga practice decreases menopause symptoms and improves quality of life: A randomized controlled trial. Complementary Therapies in Medicine,26, 128-135. doi:10.1016/j.ctim.2016.03.014
Reed, S. D., Guthrie, K. A., Newton, K. M., Anderson, G. L., Booth-Laforce, C., Caan, B., . . . Lacroix, A. Z. (2014). Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. American Journal of Obstetrics and Gynecology,210(3). doi:10.1016/j.ajog.2013.11.016
Shepherd-Banigan, M., Goldstein, K., Coeytaux, R., Mcduffie, J., Goode, A., Kosinski, A., . . . Williams, J. (2017). Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis. Complementary Therapies in Medicine,34, 156-164. doi:10.1016/j.ctim.2017.08.011