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Yoga Therapy for Perimenopause & Menopause.

Translated from the Greek word Meno (meaning month) and Pausa (meaning pause/end) the Menopause is a natural biological process with changes in the production of the hormone’s oestrogen, progesterone and testosterone and refers to the 12-month stage after menstrual periods have permanently stopped. Perimenopause is the time prior to that when ovulation and periods are still occurring and symptoms in particular hot flushes, night sweats and irregular menstruation may be occurring. Post Menopause is the stage following menopause and some symptoms can continue/further symptoms arise.

According to the NHS (2022) the average age for menopause is 51 but it can of course happen earlier due to unknown natural causes or surgical procedures or can occur later.

A brief overview of the most common symptoms includes: - irregular/heavy menstruation, hot flushes, changes in sexual desire, vaginal dryness/urinary problems, mood disturbances (anxiety/depression), brain fog/reduced cognition, headaches, skin/hair changes, sleep disruption, palpitations, and joint aches. In addition, the risks of heart disease, osteoporosis and alzheimers increase.

An understanding of the potential broader impact of the Menopause upon women helps to show why Yoga Therapy and its whole person approach may help.

“The sex hormones (as they are known) do not just act on the womb and the genital tissues.

There are also receptors for these hormones in other parts of the body, including the breasts, bones, skin and connective tissue and the brain. This means the hormones have a profound influence on a woman's life from puberty (when the ovaries start working) and for the next forty years or so. They are playing a major role not only in fertility, but also in physical and emotional wellbeing. It is therefore no wonder that, when the ovaries stop working, it can be a time of profound change for women.”

Information from Menopause: The Answers' - Dr Rosemary Leonard

As can be seen from above there can be some challenging symptoms to navigate at a time when women might be juggling careers, ageing parents, and teenagers. The socio- cultural impact of the menopause is not to be underestimated. It affects half the population, and it is believed that in the UK there are thirteen million women of menopausal age (Newson 2022). Despite this, it is a subject which has only recently attracted the attention and support it deserves. It is now more widely and openly talked about in part due to high profile campaigners (Meg Matthews, Lisa Snowdon, Davina McCall), a slow but steady shift in public perception, ongoing campaigns to protect the rights of women experiencing menopause symptoms in the workplace, campaigns to improve the availability and funding of HRT, the arrival of books written by health experts (Maisie Hill) and medical professionals (Dr Naomi Potter, Dr Louise Newson) and since 2019 the International Menopause Society in collaboration with the World Health Organisation has designated October as World Menopause Awareness month. The use of social media and podcasts has made it easier to access information and support groups, but I would suggest both mediums to be approached with some caution ensuring that the sources are credible and accurate.

Menopause is a period of transition and regardless of symptoms experienced which can vary considerably so too the emotional responses may vary from relief to sadness and loss, to fear of ageing. Some may choose to manage menopause symptoms with HRT, others with natural alternatives, some a mixture of both. I have met women who have found it a positive and empowering time (fully embracing a no-nonsense approach to life and embarking on new adventures!), a purposeful time to redefine who we are and others who have found it quite debilitating.

Why might Yoga Therapy help those experiencing symptoms of Menopause which are impacting their quality of life?

Yoga Therapy which can work alongside other treatments involves the application of specific asanas, breathing techniques, mindfulness, and psychotherapeutic principles backed by biomedicine and neuroscience to address a specific physical, physiological, or psychological condition or a combination of them. It takes a whole person approach and in my view is unique in that it defers to the wisdom of scientific and medical advances combined with yoga philosophy offering a multidimensional lens through which to view a person and approach a specific and unique yoga therapy treatment plan.

Regarding the menopause Yoga Therapy provides an opportunity to treat the physical (joint pains) and physiological (hot flushes/interrupted sleep) and emotional. Emotional symptoms might include mood disorders such as anxiety or depression or a broader reaction to this time such as fear of changing appearance. In addition, a philosophical approach supported by yoga texts could provide lifelong support and guidance geared towards acceptance.

As a tailored approach practices offered might focus upon anxiety and autonomic nervous system (ANS) regulation to build resilience and reduce emotional reactivity and provide tools to identify triggers and alleviate symptoms. These might include movement practices to reduce rumination, mindfulness practices to support present moment awareness and reduce fear of the future and breathing practices focusing on emotional/ANS regulation. At the same time if night sweats and disturbed sleep are concerns then Yoga Therapy offers restorative practices to improve sleep such as yoga Nidra.

There is a wealth of research on how yoga can benefit symptoms which arise during menopause, for example yoga has been identified as increasing GABA and Serotonin which lift mood and enhance wellbeing both helpful in alleviating depression/low mood in menopause (Streeter et al 2012). Yoga has been shown to help decrease insomnia during menopause (Alfonso et al 2012)

The application of Yoga Therapy

A previous blog titled “The Koshas and Yoga” provides more detail but in brief these five sheaths ( like layers of an onion) from the more tangible gross physical body, through the mind to the subtle inner layers and ultimately the core of our existence – our “self”, are instrumental in how we perceive the world around us, how we interact with others, our relationship with ourselves and our overall wellbeing. A wonderful multidimensional tool (there are others too) which Yoga Therapists can use to treat the whole person and the various menopausal symptoms arising over time. How might it work here?

. Physical body (Annamaya Kosha) and how it is impacted - diet, sleep, movement practices to help ease joint pains, strengthen, improve posture, focus, and balance. Longer holds in yoga postures, restorative yoga and cooling gentle practices to invite ease, calm and maybe alleviate hot flushes and help with interrupted sleep. Often the most tangible way in to exploring the koshas but not necessarily the first way if it is felt that breathing habits and mood disorders are causing tension holding patterns, poor diet/sleep habits in which case we might start with one of the following.

. Breath/Energy body (Pranamaya Kosha) and how fluctuating/decline in hormone levels impacts energy, exacerbating fatigue, affecting mood/mood swings/rages and mental health and focus/concentration (brain fog). Useful here are breath practices (ujjayi/brahmari/sitali/lions’ breath/breath of joy) which have different benefits from energising to calming and balancing and soothing the autonomic nervous system. Also, an exploration of lifestyle practices which deplete energy and how to change that.

. Mind/Thoughts (Manomaya Kosha) – already mentioned above (reinforcing how interlinked these layers are) mood disorders from anxiety/rumination to overwhelm and depression can be exacerbated by the hormonal and physical changes. Practices to address this might include mindfulness techniques, visualisations, and journaling. Although not Talking Therapy there are plenty of opportunities to discuss emotions, feelings, physical symptoms and be listened to in a therapeutic and supportive environment.

. Wisdom (Vijnanamaya Kosha) and joy/bliss (Anandamaya Kosha) are interesting concepts which broadly speaking govern our overall attitudes, approach to life and may impact decision making and how we look after ourselves and interact with others. As Yoga Therapist we might dive into our training in psychology as well as anatomy and physiology and consider what could be useful to help with acceptance of this transition, not being stuck in the past, surrendering and being able to identify with changes occurring and exploring practices to support this psychological shift. Practices might include time in nature, Mette practices (compassion to self), yoga Nidra, inspiring books, support groups and hobbies which bring joy.

Yoga Therapy during Perimenopause/Menopause– building awareness, inviting opportunities to reflect and work out what can really help us come to a place of peace and wellness is not to be underestimated. An unwinding, an exploring and identifying of helpful and unhelpful behaviours and habits which exacerbate symptoms and those which help alleviate symptoms. Also offering specific, practical, and manageable tools and techniques to alleviate debilitating symptoms, lift mood and improve quality of life.

Final Thoughts

What the above reveals is that the menopause can affect women in a variety of ways and yoga therapy can work alongside other treatment modalities but rather uniquely doesn’t just offer solutions to alleviating symptoms but also tools and practices to assess lifestyle and behavioural changes which may minimise some symptoms arising. As a yoga therapist who works with women navigating this time my aim is to work both holistically and pragmatically and build an understanding of how our behaviours, diet, lifestyles, connections with others/nature, physical activities, posture, way we breathe, and our thoughts are intrinsically interwoven and even finding ways to work with just a couple of the above can greatly benefit all the others.

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