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What Doctors Don't Tell You

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October 2020 (Vol. 5 Issue 7)

Moving with the change

About the author: 

Moving with the change image

The menopause is not an illness, but a natural transition in a woman's life cycle, where we drop away from the more frenzied activity of earlier years and into a more relaxed approach to life

The menopause is not an illness, but a natural transition in a woman's life cycle, where we drop away from the more frenzied activity of earlier years and into a more relaxed approach to life. Hormone fluctuations and the resultant symptoms accompany each female biological life stage, and changes are felt on all levels-physically, emotional and spiritually-as we take stock and prepare to move on.

Yoga is a system that asks us to be present and to meet whatever is arising with kindness and curiosity. At a time when many women may have a confused relationship with their bodies, yoga can help them to move with, rather than against, the natural physical tides.

How our changing biology feels

Menopause is defined as the time when monthly periods have stopped for more than 12 consecutive months, although changes in hormonal levels and menstrual patterns-called the 'perimenopause'-begin about six years prior to the menopause. Symptoms may begin to appear during this time, including irregular menstrual patterns, hot flushes, night sweats, mood swings, reduced libido and sleeplessness. A decrease in oestrogen is also associated with a loss of skin elasticity and skin dryness, including vaginal dryness. Symptoms often continue for up to a year or more after a woman's last period.

Before perimenopause begins, the menstrual cycle is governed by the hypothalamus, the 'control centre' for many bodily functions (including appetite and temperature) located at the base of the brain. It tells the pituitary gland to produce a range of hormones, including those for reproduction from the ovaries. In perimenopause, the pituitary gland senses reduced oestrogen and progesterone levels in the ovaries, and signals them to increase production, so there is a kind of hormonal tug of war, resulting in (often wildly) fluctuating hormones. Many symptoms result from spikes of stimulating oestrogen and waves of slowing progesterone, which can affect sleep, mood and even memory.

After the menopause, the ovaries no longer produce progesterone, and oestrogen levels dramatically decrease, signifying a new female life phase, where the body is adjusting to living with new (and normal) lower hormone levels. After a few years, oestrogen release from the ovaries stops completely, although women still have oestrogen stores in fat cells and particularly in 'female areas' like the bottom and thighs, which is why entering the menopause can be healthier when a little overweight than underweight.

As well as its role in the menstrual cycle, oestrogen plays other roles in the body. It is important for the formation of new bone, which is why yoga's weight-bearing effects play a key protective role in the postmenopausal years. Yoga can also help us to celebrate our own body shape and form as it is. Creating strength and flexibility can nurture an embodied mind and acceptance of a changing shape.

Stress and the menopause

Reducing chronic stress is a key consideration as, postmenopausally, some oestrogen may still be produced in fat cells by conversion of testosterone from the adrenal glands, which also produce the stress hormone cortisol. In cases of long-term stress and adrenal fatigue, this source of oestrogen can be affected. Protecting adrenal health is also supportive of the thyroid gland; its lowered function is common around the time of menopause and symptoms are similar. Yoga has a sound body of research showing that it can lower stress and anxiety, and offer long-term health through hormone support.1

Protecting the female heart

After the menopause, women are at as much risk of heart disease as men. As oestrogen also contributes to arterial and heart health, reduced levels lead to an increase in risk factors.

Oestrogen also helps keep skin supple and hair thick. Many of the poses in the sequence below are inversions and forward bends, where the heart gets to rest and circulation is encouraged. Full breathing, with an emphasis on the relaxing out-breath, also slows heart rate, increases oxygenation, and encourages circulation to the skin and hair follicles.
A focus on the heart is not just physical. Many women coming into the menopause bring years of looking after others before themselves through their children, family and care of others. The symptoms and lower energy at this time can force a re-evaluation and reveal the need for self-care in the face of what is often referred to as 'compassion fatigue'. An embodied and mindful yoga practice can help foster the loving kindness to self that allows us to continue to care for others.

Research on yoga and the menopause

Research reviews of yoga and menopausal symptoms remain inconclusive, with the most promising results related to improvements in the psychological issues-depression, mood swings and anxiety-associated with this life phase.2 But the problem with major reviews of the literature is that most studies are carried out for short periods of time, ranging from 8 to 12 weeks. For novices and particularly those starting the practice in later life-and most studies required the women to have no yoga experience-it requires at least six months to a year, if not longer, of practising yoga breathing and postures to see any true, long-lasting results.

Of the five randomized controlled trials (RCTs) meeting the criteria for review, only one included a longer-term follow-up of yoga compared with no treatment. In this case, the study reported significant group differences for psychological, somatic and vasomotor symptoms at the five-month follow-up.

A separate study of the effects of yoga therapy on the four domains-physical, psychological, vasomotor and sexual-of perimenopausal symptoms showed that, in 216 women after 12 weeks of yoga intervention, symptoms in all the four domains were improved by yoga therapy, "significantly improving"the overall quality of life.3 Participants in this study practised daily for 45 minutes, demonstrating that a 'little and often' approach can have the best outcomes.

Another review concluded that eight of the nine studies of yoga, tai chi and meditation-based programmes showed improvement in overall menopausal and vasomotor symptoms-those sudden blood-flow increases that cause night
sweats and hot flushes-and six of seven trials indicated improvements in mood
and sleep.4

Patricia Walden, yoga teacher and co-author with Linda Sparrowe of The Woman's Book of Yoga and Health: A Lifelong Guide to Wellness, had a vigorous physical practice until perimenopause, when the Yoga Journal reported that "unsupported inversions, strenuous poses, and backbends sometimes made her symptoms worse. When that happened, she turned to supported and restorative poses to calm her nerves". For those with established yoga routines, adjusting your practice to slower forms with more modifications may lend themselves to your new body status.

For those coming to yoga to help meet this phase of change, the specific needs of this time can help to create a sensitive, introspective and compassionate practice-fundamental philosophical aims of yoga that we can take long into old age.
Yoga practices for cooling, calm and self-care

The following sequences are designed to bring focus and circulation to the pelvic area, while cooling brain agitation and encouraging awareness of changing energy and temperature states. They can be followed as an entire routine or as portions when you need some respite from symptoms or a physical meditation to connect with bodily changes.

Several of the poses are cooling alternatives to more heating postures, and can be introduced into an existing practice or in classes where you might feel the pace or effort has become too overwhelming. They are not lesser versions of classical poses, but body-intelligent variations in which we listen and honour our needs, rather than forcing the body to adopt an idealized version of yoga postures. This can help us stay strong and flexible rather than wear out our resources, so inviting injury.

(Heart Pose)

Starting on all fours, allow movement through the hips, shoulders and spine to loosen your body. From there, walk your hands forward to bring your elbows down onto the floor, then either bring your forehead to the ground or bring the floor up to your forehead with blocks. Breathe to let gravity open your heart and lengthen your spine.

This also provides an alternative to the Child Pose for those who have knee issues, and can be practised more dynamically with elbows lifted and pressing back from the hands as a spine-lengthening alternative to the Downward-Facing Dog. And it offers a cooling forward bend and inversion combination that you can come back to (if need be) during a more dynamic or passive practice.

Strengthening with the right energy

The following sequence focuses on strengthening through the legs to support weight-bearing and also to encourage apana vayu, the energetic 'wind' or energy tide that yogis believe rises up from the pelvic region and diminishes as we get older. Many women feel weaker in the legs during menopause, and stress can exacerbate that feeling, so slower movements held with long and spacious breaths can help bring a gathering of power without the buildup of stress or strain.

Adho Mukha Svanasana

(Downward-Facing Dog Pose)

While on all fours, open the hands, tuck toes under and round the back upwards while exhaling. Start with knees bent and heels up to give you room to explore opening up the front body while drawing back the tops of the thighs to open the hamstrings. Explore 'figures-of-eight' movements through the shoulders and hips to loosen them and create a sense of playfulness.

Prasarita Padottanasana
(Spread-Out-Feet Intense Stretch Pose)

With outer edges of the feet parallel and the feet activated, feel the uplift through the inner legs; drawing the belly in helps to naturally draw up the pelvic floor and encourage circulation around the reproductive organs and adrenals. Reach up through the legs to allow soft release into the upper body as you hold the pose with full, tension-releasing out-breaths. Placing a bolster, blocks or a chair under the head can make this a more mind-and-body cooling pose.

(Intense Stretch Pose)

From Downwards-Facing Dog, walk the hands back with bent knees and feet parallel, a hip-width apart, to fold fully forward while releasing the arms and head. This softer variation may be where you need to stay-always or just on some days-if you feel lower back pain, tight hamstrings or simply the need for a restful version. From here you can explore lifting up from the feet and through the inner legs to bring the legs straighter; you can play with this up and down as feels right and as it allows you to feel the cooling effects of forward bending.

Viparita Karani
(Waterfall Pose)

Inversions help to soothe the nervous system and brain by raising the legs above the heart, so allowing blood to simply flow back to the heart via gravity. Supported versions mean we can stay longer without the heat or strain of muscle effort. Here, the added backbend opens the area between the navel and pubic bone which, with the inversion, helps raise apana energy in menopause (hence contraindicated in menstruation). Stay in each variation for a good few minutes for full benefit.

With a bolster or folded blankets placed against a wall (with a little gap for your tailbone), lift your right hip up onto the bolster and swing your legs up the wall, or shimmy them up the wall if necessary; if you have tight hamstrings, start the lift further away from the wall. Settle down into the weight of the legs and relax, breathing into the shoulders to drop them, causing the heart to rise, with your arms wherever they're most comfortable.

Utthita Trikonasana
(Extended Triangle Pose)

The triangle is a potent female or divine symbol in many cultures, and feeling the strength of its angles from the ground helps us feel and connect with the pelvic and abdominal region. With the back foot turned in and front foot parallel with the sides of the mat, lengthen out the bottom arm to come down only as far as you can go while still turning the belly and chest out and upwards. This provides the space to open up across the chest and lengthen the spine and neck.

Restorative menopause sequence

This is a simple practice you can do at the end of any sequence or whenever you need to bring down a raised temperature, heightened emotions or feeling overwhelmed. Lying on the floor creates a natural support and trust that there's nowhere to fall. Focus on drawing your breath in towards your pelvic and abdominal region as you inhale, and breathe out into your whole body and soft outer shell as you exhale. Allow the poses to unfold, staying present with each breath and offering compassion to your whole mind-body.

Supta Matsyendrasana variation
(Supine Spinal Twist Pose)

Let the floor hold you to feel the whole body and spine lengthen as you revolve around the core. As you exhale, draw both knees up to your chest, then extend the left leg along the floor, keeping the right knee to your chest. Extend the right arm out, palm facing down. On an out-breath, drop the right knee over the left side of the body, keeping your left hand resting gently on the right knee, and turn your head to the right. Hold for 10 to 25 breaths, then roll back to centre on an in-breath, bringing both knees back to your chest. Repeat on the other side.

Supta Baddha Konasana
(Supine Bound Angle Pose)

Place a lift under your back to give you enough freedom for your lower back to feel completely comfortable. Place folded towels or blankets under both thighs if you feel any pulling or pinching in the lower back or knees. Support your head as you lightly draw your chin into the throat and soften the forehead and eyes. Bend the knees and bring the soles of your feet together. Draw the heels closer to your hips, then let the knees fall apart. Inhale and bring the arms along the floor over your head, palms together, thumbs crossing. Hold for four to eight breaths, then exhale and release arms and legs.

(Corpse Pose)

This pose can be a full practice in itself and, with knees supported by a bolster, it allows softness in the lower back and full relaxation of the thighs to support kindness and restoration around the lower abdomen. With eyes closed, lie on your back, feet slightly apart and arms slightly out to the sides, palms up, fingers lightly curled. Inhale and tense every part of your body for a few seconds, then exhale and relax all the muscles at once. Hold this pose for as long as you need to. When you're done, gently wiggle your fingers and toes to come back, then bring your knees to your chest and give them a squeeze. Roll onto the right side of your body and slowly push yourself up to sitting.

1 Health Psychol Rev, 2015; 9: 1-18
2 Evid Based Complement Alternat Med, 2012; 2012: 863905, 11 pages; doi: 10.1155/2012/863905
3 J Midlife Health, 2014; 5: 180-5
4 Maturitas, 2010; 66: 135-49

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The not-so-sweet truth

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