"Joanne," aged 51, presents with hot flashes and vaginal atrophy. She feels depressed, anxious, irritable, fatigued and not as confident in herself as she once was. Somehow she feels out of control. Her body is behaving unpredictably: She doesn't know when her next hot flash is coming or how to control the fat that is shifting up toward her waist.
"Sandra" is only 37 years old and has experienced menopause prematurely. She has not yet had children. She is having severe physical and emotional adjustment problems, including extreme mood swings.
Like Joanne and Sandra, many women are seeking ways to cope with unpleasant menopausal symptoms—and many are turning to yoga and other mind-body practices. Yoga is among the most commonly used complementary therapies to drugs for menopausal symptoms and has minimal adverse effects (Cramer et al. 2012). If you work with women aged 40 and older, you're likely to have clients with menopausal challenges. Hot flashes, for example, afflict up to 80% of middle-aged women and may continue for up to 14 years (Belluck 2015).
Approximately 6,000 American women enter menopause daily—2 million annually (Brody 2016). The average age is 51 years (Brody 2016). While all women share similar biological stages, each woman's transition is unique.
Menopausal Signs and Symptoms
"Hot flashes seem to get all the attention," says Brenda Strong, CEO of Strong Yoga® 4Women, in Los Angeles, "but there are so many other symptoms of menopause. And just like pregnancies or other health issues, there's no one-size-fits-all for menopause. What one woman experiences, another may not."
Common issues include the following:
- vasomotor symptoms
- vaginal and urinary concerns
- sleep disturbance
- mood fluctuations
- cognitive function changes
- abdominal fat gain
Sources: Santoro, Epperson & Mathews 2015; Sussman et al. 2015; Davis et al. 2012.
Weight gain, distinct from abdominal fat gain, is intertwined with physical aging and can result from inactivity and poor diet (Simkin-Silverman et al. 2003). Researchers continue to tease out the effects of ovarian aging from those of aging overall, both to understand the mechanisms underlying menopausal symptoms and to better target therapies (Freeman 2015). Let's look at how mind-body practices in general, and yoga in particular, can help with symptom relief.
Hot Flashes, Night Sweats and Heart Palpitations
Vasomotor symptoms are related to nerves and muscles that cause blood vessels to constrict or dilate. In menopausal women, these symptoms include hot flashes, night sweats, heart rate increases and palpitations. The effects—sudden, profuse sweating; intense heat in the face, neck and chest; and core temperature increases—can cause sleep disturbances, fatigue and anxiety. While drops in estrogen level are involved, exact causes are not completely understood. Researchers hypothesize that the symptoms are related to increases in brain levels of norepinephrine, serotonin and other neuro-regulators that affect thermal regulation and to increased activation of the sympathetic nervous system (Freedman 2014; Kaunitz & Manson 2015). The good news is that once a woman's hormone levels have settled, these symptoms resolve, even without treatment.
On a practical level, the setpoint at which a woman becomes hot gets lower when she experiences vasomotor symptoms and she is therefore less heat-tolerant. Overheating the body can be a subsequent trigger. Maria Luque, PhD, MS, based in Austin, Texas, and a faculty member for the College of Health and Human Services at Trident University, says, "For someone with hot flashes, hot yoga or power yoga would be contraindicated—anything that is trying to increase body heat. More meditative and calming activities would be beneficial."
To date, the most successful intervention for reducing both the frequency and intensity of hot flashes and night sweats is deep breathing as paced respiration—ideally 6–8 breaths per minute in twice-daily 15-minute sessions (Sood et al. 2013). Sood et al. noted that since women reported difficulty in finding time for two practices per day, it would likely be beneficial to find a once-daily practice that would still maximize beneficial effects. More studies have replicated Sood et al.'s findings, confirming the efficacy of this deep-breathing technique (Freedman 2014).
While yoga per se has not yet been "proven" to relieve vasomotor symptoms, breathing exercises from yoga and other mind-body practices can help. As an example, see the "Sitali Cooling Breath" exercise in the Web Extra, at "Yoga Poses for Menopausal Women”.
Painful Sex and Incontinence
Strong notes that while everyone talks and jokes about hot flashes and moodiness, few women speak openly about vaginal changes, even though one-third or more of women experience them. Vaginal and urinary issues, referred to as genitourinary syndrome, come from estrogen loss, which causes the vagina to become shorter, narrower and drier, leading to irritation, itching, pain during sex, and even bleeding during exercise (Brody 2016). Estrogen loss also affects the urethra and bladder, resulting in urinary urgency, frequency and incontinence among some women (Kim et al. 2015). Unlike hot flashes, this condition does not resolve once hormone levels stabilize.
In a randomized pilot study, University of California, San Francisco, researchers found that a 6-week yoga therapy program consisting of twice-weekly group classes and once-weekly home practice decreased incontinence frequency but did not affect urge incontinence (involuntary leakage when the urge to urinate is strong). Subjects practiced Iyengar yoga with an emphasis on alignment, pelvic-floor structures and muscle awareness, prop use for support, and mindfulness—rather than cycling rapidly through postures, deep breathing and relaxation (Huang et al. 2014).
Pilates practice, with an emphasis on alignment, core conditioning, breathing and muscle awareness, particularly of pelvic-floor structures, has also been found to help some women with incontinence (Pedriali et al. 2016). For instructors working with women with genitourinary syndrome, an emphasis on these practice points may be helpful in achieving symptom relief.
For sample yoga poses helpful for menopausal women, plus research on yoga’s impact on other menopausal symptoms, please see “Menopause Symptoms: Can Yoga Help?” in the online IDEA Library or in the January 2017 print issue of IDEA Fitness Journal. If you cannot access the full article and would like to, please contact the IDEA Inspired Service Team at 800-999-4332, ext. 7.
Photograph courtesy of StrongYoga®4Women.