This is an exclusive excerpt from my book, The Physiology of Yoga.

Menopause is defined as the permanent cessation of ovarian function and is thereby the end the reproductive phase (Sherman 2005). It is characterized by at least 12 months of amenorrhea (the absence of menstruation) (Gracia et al. 2005). Most people experience menopause between ages 40 and 58 (average age is 51) according to The North American Menopause Society. Physical changes begin years before the final menstrual period. This transition phase is called perimenopause and may last for 4 to 8 years. It begins with changes in the length of time between periods and ends 1 year after the final menstrual period.

While it is an inevitable part of every woman’s life, about three out of every four people experience certain symptoms during menopause. Almost 90% of people to seek out their healthcare provider for advice on how to cope (Guthrie et al 2003). These symptoms are often categorized into four subsets; psychological symptoms, for example, irritability, depressive feelings and mood swings; vasomotor symptoms, for example, numbness and tingling, hot flashes and lack of appetite; somatic symptoms, for example, gaining weight, headaches and insomnia; and urogenital, for example, loss of sexual interest and pain during intercourse. These symptoms often persist for several years after menopause (Cramer et al. 2012).

During the menopausal transition period, the drop of estrogen leads to more bone resorption than formation, which can lead to osteoporosis. Osteoporosis is a systemic skeletal condition characterized by low bone mass and microarchitectural deterioration of bone tissue that increases bone fragility and risk for fractures (U.S. Department of Health and Human Services 2004). The major health threat of osteoporosis is osteoporotic fractures. The prevalence of osteoporosis and related fractures increases in postmenopausal people (Ji and Yu 2015). Menopause is also a risk factor for cardiovascular disease because estrogen withdrawal has a detrimental effect on cardiovascular function and metabolism (Rosano et al. 2007).

There are conflicting reports from the reviews that have been conducted on the topic of whether yoga can improve the various symptoms of menopause. A systematic review by Lee and colleagues (2009) concluded that yoga is ineffective in relieving any menopausal symptoms including psychological symptoms. A systematic review and meta-analysis by Cramer and colleagues (2012) found moderate evidence for short-term effectiveness of yoga for psychological symptoms in menopausal people. However, no evidence was found for improvements regarding somatic, vasomotor, urogenital, or total menopausal symptoms. Further, no group difference was found when comparing yoga to exercise. A qualitative systematic review on mind–body interventions concluded that there was moderate evidence that yoga might relieve common menopausal symptoms including vasomotor and psychological symptoms (Innes, Selfe, and Vishnu 2010). The most recent systematic review and meta-analysis by Cramer, Peng, and Lauche (2018) reported that yoga seems to be effective and safe for reducing psychological, somatic, vasomotor, and urogenital menopausal symptoms. They also noted that the effects were comparable to those of other exercise interventions. So, it appears that over the last decade, as the body of research on this topic has slowly grown, the benefits associated with practicing yoga for menopausal symptoms have become more evident.

Petra Coveney, founder of Menopause Yoga™, has been supporting people in the menopause for over 10 years. As a member of the British Menopause Society for health practitioners, and a senior yoga teacher and trainer, she is committed to sharing information about the impact of hormone changes and using yoga techniques that have been tried and tested in her workshops and classes. Petra says: 

“When I’m teaching Menopause Yoga, I make it clear that yoga can never replace the hormones estrogen, progesterone and testosterone that decline during the perimenopause to post menopause. So, any yoga teacher who claims to be able ‘rebalance your hormones’ is falsely selling snake oil to people, making claims that are not evidenced-based. People who are struggling with symptoms in the menopause transition can feel desperate and willing to try anything to improve their quality of life, so yoga teachers need to be careful not to over-sell or make false claims on the benefits of yoga.

This is why Menopause Yoga is more than a series of yoga postures or breathing techniques; the context of the yoga practice is important too and reframing it as a positive opportunity to improve our long-term health and wellbeing. People tell me they feel ‘scared, lost and alone,' and question if they are going ‘mad.’ So, Menopause Yoga includes circle discussions so that we can break the taboo by talking about menopause and enjoy a sense of community.

As you know, these hormones are not just for fertility; they support the whole body, including brain, bones and heart health. So, I encourage people to include yoga as part of a holistic selfcare approach that may include HRT, nutrition, herbal remedies, complimentary and talking therapies depending on the person's needs.

Although research shows that yoga can be as beneficial as other forms of exercise in managing menopause symptoms, what I found when researching my book Menopause Yoga, was that there was little information about what specific types of yoga, meditation or breathwork were used in the research studies, other than saying Hatha yoga. Simply saying yoga can or cannot help with menopause symptoms is too simplistic and reveals the researchers’ lack of insight into the different styles and practices. For instance, the faster-paced Ashtanga yoga practice may not be helpful for people experiencing anxiety and overwhelm or muscle and joint pain, but a somatic slow flowing practice leading to restorative yoga may help. Hot yoga will increase physical heat for people having hot flushes, but they may benefit from cooling and calming pranayama techniques. Restorative yoga can help people with fatigue and reduce stress levels, which can alleviate the sensation of some symptoms and benefits their general health, but to build bone density, muscle strength, and heart health, we need to practice longer held yoga poses that stack the joints, lift the heart rate and challenge your balance. This is why Menopause Yoga has specific classes with different content and styles of yoga for different groups of symptoms. I hope that the next level of research can look specifically at yoga practices and provide more meaningful insights that can therapeutically help yoga practitioners and teachers.”

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References:

Cramer, H., R. Lauche, J. Langhorst, and G. Dobos. 2012. “Effectiveness of Yoga for Menopausal Symptoms: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” Evidence-Based Complementary and Alternative Medicine 2012: 863905.

Cramer, H., W. Peng, and R. Lauche. 2018. “Yoga for Menopausal Symptoms—A Systematic Review and Meta-Analysis.” Maturitas 109:13-25.

Gracia, C., M. Sammel, E. Freeman, H. Lin, E. Langan, S. Kapoor, and D. Nelson. 2005. “Defining Menopause Status: Creation of a New Definition to Identify the Early Changes of the Menopausal Transition.” Menopause 12 (2): 128-135.

Guthrie, J., Dennerstein, L., Taffe, J., and Donnelly, V. 2003. “Healthcare-seeking for menopausal problems.” Climacteric 6: 112–117.

Innes, K., T. Selfe, and A. Vishnu. 2010. “Mind–Body Therapies for Menopausal Symptoms: A Systematic Review.” Maturitas 66 (2): 135-149.

Ji, M., and Q. Yu. 2015. “Primary Osteoporosis in Postmenopausal Women.” Chronic Diseases and Translational Medicine 1 (1): 9-13.

Lee, M., J. Kim, J. Ha, K. Boddy, and E. Ernst. 2009. “Yoga for Menopausal Symptoms: A Systematic Review.” Menopause 16 (3): 602-608.

Rosano, G., C. Vitale, G. Marazzi, and M. Volterrani. 2007. “Menopause and Cardiovascular Disease: The Evidence.” Climacteric 10 (Suppl. 1): 19-24.

Sherman, S. 2005. “Defining the Menopausal Transition.” American Journal of Medicine 118 (Suppl. 12): 3-7.

U.S. Department of Health and Human Services. 2004. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: DHHS.