Yoga and Menopause

     The peri-menopausal years, several years before cessation of menses and immediately after menopause, typically occurs between the ages of 45 and 55.  This period of time is characterized by fluctations of estrogen and progesterone that cause many uncomfortable symptoms.  The most common of these are hot flashes, anxiety and irritability, insomnia, fatigue, depression and mood swings, memory lapses, and an erratic menstrual cycle. 

     Before menopause the menstrual cycle is set off each month by the hypothalamus within the brain which also regulates body temperature and appetite.  The hypothalamus stimulates the pituitary gland to produce follicle stimulating hormone which in turn triggers the ovaries to produce estrogen and progesterone.  Beginning a few years before menopause the ovaries and pituitary begin a more erratic pattern of hormonal production.  As the ovaries produce less hormones, the pituitary secrets more to try to stimulate ovary hormonal production again.  This leads at times to too much estrogen production which speeds up the body metabolism and then to resultant increases in progesterone which slows the body down in many ways.  The uterus responds with irregular bleeding, and the sleep, mood, and memory may all be affected.  After menopause the body still needs estrogen to promote bone health and prevent vaginal dryness and tissue integrity, so the adrenals secret male hormones in low levels which are converted in fat cells to estrogen.  The estrogen level is still however lower than before menopause. 

      Initially, in the 1960’s scientists suggested simple estrogen replacement to control hot flashes and irritability.  Then as years progressed with this treatment, it was found this could increase susceptibility to uterine cancer.  Combination estrogen and progesterone therapy was then initiated to protect the uterine lining.  At first it was thought from initial studies and case reports that combination therapy also reduced osteoporosis, heart disease, and even Alzheimer’s.   However, with a larger double blind study and a control group in the Women’s Health Initiative Study (ages 50-79) begun in 1993, it became apparent that Prempro was actually increasing heart disease, blood clots, and stroke.  Along with an increased risk of breast cancer, it was determined best to that postmenopausal women stop participation, and the trial was stopped 3 years early.  More research is being done to determine if premenopausal women can safely benefit from combination therapy for a short period of time. 

     While yoga may not directly influence estrogen production, specific poses can ease unpleasant symptoms.  Through relaxing the nervous symptoms, the body’s response to hormonal shifts can be reduced.  Yoga may also improve functioning of  the endocrine system (hypothalamus, pituitary gland, thyroid, and parathyroid), smoothing other hormonal fluctuations. 

     During menopause it is best to turn to restorative, gentle and supported poses to avoid stimulating the sympathetic nervous system, and exacerbating symptoms like hot flashes and insomnia.  Two recent publications deal with menopause directly, providing sequences of yoga poses and breathing that will allay symptoms.  The Woman’s Book of Yoga and Health: A Life-Long Guide to Wellness (Shambala, 2002) by Linda Sparrow and Patricia Waldon and Yoga and the Wisdom of Menopause (Health Communications, 2003) by Suza Francina. 

     Hot Flashes 

       These are due to a rise in core body temperature and rapid pulse rate, producing blushing in the face and arms, appearing and disappearing quickly, producing profuse sweating at times and a cool, clammy feeling afterward.   Most research supports that these symptoms are worsened by stress, fatigue, and intense periods of activity.   Cooling restorative poses work well, and using supports such as bolsters, blankets and blocks.  Supporting the head when doing forward folds calms the mind and relaxes nerves. 

      Anxiety, Irritability and insomia

     Estrogen spikes and progesterone  plummets can stimulate the sympathetic nervous system leading to anxiety and irritability.  Adrenal gland stimulation and exhaustion can lead to roller coaster bouts of emotional lability.  Forward folds ease this tension, blocking out external stimuli and communicating to the brain that all is well, breaking this cycle of overstimulation.  Inversions as appropriate to the students ability can also be calming, and reframe your point of reference and perspective. 

     Fatigue

Plunging progesterone can cause feelings of fatigue, as well as depression and lethargy.  Gentle supported backbends are helpful to improve respiration and lift the spirits in a supported way.

     Depression and mood swings

     Too much progesterone and drops in estrogen can cause blues to severe clinical depression.  Changes of body posture through standing mountain pose and gentle backbends offer support and reverse this tendency to depression.

     Memory

Hormonal shifts often lead to forgetfulness, and general thought disorganization.  Gentle inversions such as down dog and corpse pose increases blood flow to the brain, quiet thoughts, and restore clarity.