Thursday, April 30, 2015

Yoga for Menopausal Women: Quality of Life and Sexual Functions

Menopause-related symptoms such as hot flashes, night sweats, and fatigue negatively affect the quality of life of millions of women.

Can yoga offer relief? Yes and no. According to two recent studies, regular yoga practice may relieve some symptoms of menopause, but not others.

To get a deeper understanding of the effects of yoga on menopausal symptoms, a multidisciplinary group of researchers conducted a large clinical trial to examine the unique benefits of yoga when compared to exercise or no activity, in addition to taking an omega-3 supplement or a placebo.

Study participants included 355 peri- and postmenopausal women aged 40-62 years, who were randomized to one of three groups: yoga (107 participants), exercise (106), or usual activity (177). These women were also randomized to receive either 1.8g/day of an omega-3 supplement (177) or an olive oil placebo capsule (178).

Those in the yoga group attended weekly, 90-minute yoga classes and were asked to complete a home practice daily for 20 minutes. Yoga practices entailed “cooling” pranayama, 11-13 asanas, and yoga nidra (guided meditation).
The exercise group engaged in 40-60 minute personal aerobic training sessions, three times per week.  Their aerobic output was monitored to ensure that their energy expenditure was consistent.

Women in the usual activity group were asked to engage in their typical behavior, and to refrain from beginning a new exercise regimen or taking yoga classes.

Yoga Boosts Quality of Life and Sexual Function

In the first study, published in Menopause, authors examined changes in the frequency and perceived bother of vasomotor symptoms (hot flashes and night sweats) by group (yoga, exercise, or usual activity controls). No differences were found for vasomotor symptoms, however, women in the yoga group reported modest improvements in sleep quality and a reduction in insomnia and depressive symptoms. 

In the second study, recently published in American Journal of Obstetrics and Gynecology, authors focused on women’s self-reported quality of life (QOL) 

Study participants were asked to complete the Menopause Quality of Life (MENQOL) measure, and questionnaires regarding sleep quality, stress, pain, enjoyment of life, activity, sexual function, depressive, and anxiety symptoms, and hot flash interference with daily activities at the beginning of the study and after the 12-week intervention.

Compared to the usual activity group, those in the yoga group reported improved quality of life (QOL) and better sexual function and less hot flash interference compared to controls after the 12-week program. These changes were not observed for the exercise or omega-3 groups compared to controls. Members of the exercise group reported improvements in their physical quality of life.

It is important to note that the first study published in Menopause reported no effects on vasomotor symptoms, while the second study indicated modest improvement. The initial study examined the frequency of hot flashes and night sweats (average number of occurrences). The second study examined women’s subjective experience of whether hot flashes affected their activities. 
When evaluating any study it is important to note what was measured and how, as well as the types of yoga practices that were employed. At present, findings from yoga research are hampered by the inconsistency of the types of practices used, and the ways in which researchers measure their outcomes of interest. As such, most studies should be interpreted with a certain degree of caution.

Relative to the study published in American Journal of Obstetrics and Gynecology, the authors concluded that, “relative to usual activity, a 12-week program of yoga somewhat improved menopause related QOL and reduced the extent to which hot flashes interfered with a woman’s daily function among women with VMS, but that exercise and omega-3 supplements had no effect on these measures. Among the individual MENQOL domains, we found modest benefit for VMS and sexual function domains from the yoga intervention and benefit for the physical domain for the exercise intervention.”

The Complexities of Menopause

Their findings draw attention to the fact that menopause and its symptoms are complex. Hormonal changes lead to a cascade of physical and emotional adjustments that are often experienced as destabilizing and distressing. They can profoundly affect a woman’s physical, psychological, and psychosocial landscape.

While conventional therapies address specific correlates of these symptoms, they fail to address a woman as a holistic system in which factors including diet, relationship quality, employment, and social support influence her ability to successfully navigate this change.

Symptoms of Menopause and Related Yoga Prescriptions

Here are descriptions of the most common symptoms and specific recommendations for taming them.

Hot Flashes

One of the most common (and mysterious) symptoms; nearly 80 percent of all women experience them during perimenopause. Characterized by a rise in core body temperature coupled with a rapid pulse rate, these “power surges” produce a blushing that begins in the face and spreads down the neck and arms. Hot flashes can disappear as quickly as they appear, often leaving a woman feeling chilly and clammy as her body tries to correct the temperature fluctuation.

No one really knows what causes hot flashes, although theories abound. Some say the hypothalamus plays an important role; another possibility is that the hormonal fluctuations in the body irritate the blood vessels and nerve endings, causing the vessels to overdilate and producing a hot, flushed feeling. Most researchers (as well as many menopausal women) agree that stress, fatigue, and intense periods of activity tend to intensify these episodes.

Experts suggest incorporating more cooling and restorative poses. Any gripping or tension in the body can make hot flashes worse, so using props such as bolsters, blankets, and blocks to help support the whole body is a good idea. Placing the head on a bolster or chair during forward bends, for example, helps calm the brain and relax the nerves. Supported reclining poses can also help promote complete relaxation. Supta Baddha Konasana and Supta Virasana, for instance, allow the abdomen to soften and any tightness in the chest and belly to release; Ardha Halasana (Half Plow Pose) with the legs resting on a chair calms jittery nerves.

Headaches and Migraines

Migraines and headaches are probably the most disruptive of all menopause symptoms. You know the feeling. You have to take care of the family, go to work, or scratch ten things off your “to-do” list. But the pain is unbearable.
Menopause migraines are all too common as the hormonal changes take over. What triggers your headaches? Maybe stress, anxiety, certain foods, or lack of sleep? There are a variety of products and treatments to help ease the pain, but yoga can be the right natural solution for you.

Headaches during menopause can often result from tight and contracted muscles in your head, neck, and back. Or from high levels of stress. There are numerous health benefits of yoga, as a simple yoga routine can produce a calming effect on the nervous system and reduce stress. Yoga can provide relief from sensory overload. Relax your mind so that your body can effectively combat the pain of menopause migraines and headaches.

The Child’s Pose is ideal to calm your emotions and nerves. Blood gently flows to your head and helps relieve the tension that can cause menopause headaches and migraines. Supported with a good bolster or blankets, the Child’s Pose is a basic yoga position and provides an escape from your everyday demands.

Anxiety, Irritability, and Insomnia

During perimenopause, estrogen spikes (or progesterone plummets), causing anxiety, nervousness, and irritability. Adrenal glands that are exhausted and overtaxed can also produce bouts of anxiety and intense irritability. (Many alternative healers believe that the adrenals can wear themselves out by constantly responding to stress, a poor diet, and lack of sleep.)

When a person is under stress, the sympathetic nervous system responds by accelerating the heart rate, slowing down the muscles of the digestive tract, and increasing blood circulation to the brain to fight the stressor.

Once the stress dissipates, the parasympathetic nervous system responds by doing just the opposite-slowing the heart rate back to normal, stimulating the smooth muscles of the digestive tract, and bringing the body’s systems back into balance.

When the body is under continual stress, the sympathetic nervous system and the adrenals-which manufacture stress—fighting hormones along with the male hormones that get converted into estrogen—can get stuck in overdrive.
Forward bends, such as Uttanasana (Standing Forward Bend) and Prasarita Padottanasana (Wide-Legged Standing Forward Bend)—in both cases with the head resting on a bolster or blankets—can help reduce irritability and mental tension, because bending forward and shutting out external distractions and stimuli can soothe the mind and reduce the effects of stress. The nervous system then receives the signal that all is well, and the adrenals and sympathetic nervous system stop working so hard.

If insomnia is a problem, inversions can sometimes help, because they ground the body’s energy and burn off excess anxiety. When followed by restorative postures, they encourage a deep state of rest.


Of all the symptoms women complain about during perimenopause, fatigue is second only to hot flashes. Plunging progesterone could be the culprit, especially if the fatigue is coupled with depression and lethargy; if a woman feels inexplicably weary for days or weeks on end, depleted adrenal glands could be part of the problem.

Either way, gentle supported backbends are recommended, because they encourage the chest and the heart to open and often bring renewed energy, determination, and joy. One of the proper examples for this is Supta Baddha Konasana. A deeply restorative posture, it can instill feelings of safety and nourishment. It also opens the chest, improves respiration and circulation, and helps lift the spirits while completely supporting the body.

Depression and Mood Swings 

Menopause signals the end of the childbearing years; for many women, it is a time to mourn the end of their youth. Long periods of fatigue, coupled with a melancholy attitude or a sense that the life they once knew is now over, can trigger bouts of depression. Too much progesterone (or a drastic drop in estrogen) can also contribute to everything from a bad case of the blues to severe clinical depression.

But yoga practitioners have long known that everything you do with your body can affect your thoughts and attitude. Sometimes something as subtle as a shift in posture can lighten a dark mood. If a woman stands tall, with dignity—opening and broadening her chest—and walks with confidence, she announces to the world (and, most important, to herself) that she is grounded, happy, and in tune with her surroundings.

Specific poses were confirmed to create a mental state that positively affects the mind. Backbends, especially if supported, allow a sense of lightness into the body. They stimulate the adrenals and massage them into action. Also, the heart and lungs open and take in more oxygen. Chest-expanding poses energize the body by improving respiration and circulation, and thus counter feelings of depression. And many yogis have discovered that inversions, such as Sarvangasana, can help improve a depressed mood. By turning everything upside down, inversions influence your emotional being in a positive way.


At times during menopause, some women suddenly lose their train of thought or find themselves unable to organize their thoughts. This “fuzzy” thinking often happens at moments of great hormonal fluctuation. Girls going through puberty, pregnant women, and those who have just given birth often suffer similar levels of fogginess. Many women find that yoga helps clear the cobwebs, especially if their condition is exacerbated by lack of sleep or increased agitation. The same postures that counter depression, such as backbends, chest openers, and inversions, can help collect fragmented thoughts.

Chair Yoga

While there are many yoginis are able to improve their lifestyle and ease difficulties of navigating through numerous menopause symptoms, for some, it is still not acceptable for some menopausal woman. It might be physically challenging for the beginners mid-life women, who has never been physically active and not used to the intensive exercises. If that is a case for you, do not jump into the water, as that might be difficult and discouraging at the beginning. Start from small steps on your way to the better health. Start with Chair Yoga. While having numerous health benefits, it is suitable for any physical conditions, and is a good starter do break through the psychological barrier.

Please review the video presentation (the session is just 3 minutes):

Sources and Additional Information:

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