In September 2021, I graduated from the "Yoga for Stages of Menopause" course, led by Nimah Daly. The main idea behind that training for yoga teachers was to use the knowledge of yoga and all different supportive disciplines to help women recognize what is going on in their bodies, to understand the signs and symptoms of all the stages, and empower them to create some positive changes in the relationship between their bodies and their lives, and also, to be able to advocate for themselves in their community (family, work, etc.).
From my personal perspective - after a sudden surge of energy in my mid-forties, I entered perimenopause about two years ago with no clue what was going on with me, and was afraid that I was going through the early stages of dementia or something worse. My mum suffered severe depression during her menopause, in her early fifties, and I don't think that she received appropriate support from her GP or her peers. Most of my yoga students are women, in their 40s-50s. I am glad that menopause is now something we started to talk about without shame and stigma… and we can make informed choices in our lives. Knowledge is power.
Menopause (end of reproductive years), like puberty (beginning of reproductive years), is a natural phase in life. We can't avoid it or pretend that it doesn't exist. Due to hormonal changes in the body, most women are going through changes and new challenges in their bodies - some of them are very mild, even not noticeable, but in some cases, support is needed, as they might feel lost or suffer.
I will explain now, in the bullet points, the simplified biochemistry of the stages of menopause and list some symptoms and concerns. It might help you recognize what stage you are in at the moment.
premenopause (before hormonal changes start)
normal monthly cycles, where oestrogen dominates the first half of the cycle, progesterone the second;
monthly bleeding; usual fluctuation of mood, appetite, energy levels, sleep, etc.;
early perimenopause /late reproductive stage
high levels of oestrogen as the effect of ovarian hyper-stimulation, the “last bid to reproduce” there is a readiness to uptake a new project in life;
monthly bleeding, increased libido, a burst of energy;
a feeling of irritability, anxiety, might have heavy bleeding, causing iron and energy drop, forgetfulness, the liver has to work harder to excrete the higher levels of oestrogen;
irregular periods, mood swings, hot flashes, night sweats, change in libido, insomnia, vaginal dryness, changes in body odour, memory lapses, brain fog, skin problems, depression, anxiety, headaches, gum problems, digestive issues, itchy skin, urinary tract infections, osteoporosis;
20% of women experience very few symptoms, 60% have moderate symptoms, and 20 have severe (life-changing);
in fact, menopause is just one day, the last day of having periods, diagnosable only in retrospect (after one year of the last bleeding);
happens usually between 45-55 years old;
only around 3% of oestrogen and progesterone is produced;
postmenopausal oestrogen is produced in the fat tissue and adrenal glands;
no periods; it is the continuation of menopause - some symptoms might decrease and disappear, some continue for a time, and some will remain for many years.
Role of Sex Hormones
Oestrogen is responsible for the regulation of good functioning for many organs in our body (heart, brain, bones, liver, ovaries, uterus, skin) and progesterone is known from buffering the body against the effect of stress (as it has an important role in the body’s rest & repair functions). Fluctuation and definitive changes in these hormones’ levels might feel very worrying and destabilizing, and increase the everyday life stress levels. The accumulation of the physical and mental/emotional struggles adds to the production of the cortisol in the body, which keeps the body in the long-term/persistent “fight/flight/freeze mode” and might have potentially damaging, negative effects – such as lack of sleep, anxiety, carb-cravings, joint pain, etc.
Some other health concerns in the perimenopause (months or years leading up to the menopause) and beyond might be: liver and gut health, diabetes, thyroid function, brain health, cardiovascular health, bone/muscle/ joint health, mental/ emotional health, and pelvic floor health. Notice if there are any changes.
Practice Self Care
This is where the need for stress-reducing techniques that we use in yoga might help to break or limit this vicious circle of stress production - to have a balanced number of stress-response reactions, and promote “rest/digest/repair mode” to improve our wellbeing. This and slowing down can be a starting point for dealing with changes.
To be clear, yoga cannot reverse menopausal hormonal deficiencies or help to avoid them. What yoga can help with is to deal, as mentioned above, with stress reduction (mental/emotional health), as well as some practices to protect muscular-skeletal and cardiovascular health.
Yoga can help on mental/emotional levels:
stress reduction by promoting introspection, introducing body awareness, emphasizing rest, relaxation, slowing down;
pranayama - some paced breathing techniques are scientifically proven to improve the function of the parasympathetic nervous system;
meditation - production of endorphins leading to positive feelings;
emotional acceptance and resilience – allowing all emotion and sensations to be welcome and valid, promoting of acceptance, kindness, patience;
inducing “feel-good” hormones by promoting joy and pleasure – endorphins, serotonin, dopamine – help to deal with stress and reduce pain, stabilize mood, attention, and sleep;
promoting self-touch and self-massage;
improving neuroplasticity - learning new things, challenging coordination between the brain’s two hemispheres.
Yoga can help on muscular/skeletal levels:
avoid excessive, high intensity, endurance exercises - which need a long period of rest and repair;
warm-up for all joints – to promote lubrication of joints (synovial fluids are decreasing with age and lack of oestrogen), loosen stiffness and pain;
slowing down - the loss of bone mineral density, which is causing osteoporosis, and working on muscle strength - weight-bearing exercises are good for improving bone density;
strength workout to build muscle mass - using weights and resisting bands;
isometric stretching (keeping muscle contracted without movement), this helps to build up the mass much quicker;
practicing various pelvic floor exercises to target the perineum strength and stabilize the abdomen and lower back;
micro-movements and somatic movements - to increase sensory feedback and make movement more enjoyable/accessible;
balance poses - to improve brain to joint/muscle connection and promote motor control;
Yoga can help on a cardiovascular level:
research has proven that yoga can help cardiovascular health by lowering blood pressure, heart rate, and cholesterol;
asana and breathing help maintain good circulation of oxygen and nutrition-rich blood to each cell.
In addition to all the yoga practices, we simply should stay active and benefit from complimentary activities such as weight training, walking, hiking, cycling, dancing, and swimming as “motion is lotion”.
This is also the time when the importance of rich nutrition becomes urgent to support bone, brain, and heart functions. Unfortunately, it often merges with body shape changes and pressure to go on diets, usually drastically reducing food intake, and not allowing to fulfill the body’s increased mineral, protein, complex carbohydrate, and fat needs. On the contrary – being hungry might induce a stress response by creating blood sugar imbalance, leading to cravings. It also increases the cortisol level which “consumes” bone and muscle tissue and decreases metabolism, leading potentially to more weight gain. It is a very big and sensitive topic for most women, and sometimes professional help is needed (nutritional therapist).
Another common symptom of menopause is disturbed night sleep and anxiety. Anxiety is leading to difficulty getting to sleep and depression leads to non-restorative sleep and early morning wakening. Some things to consider:
limit evening light as light inhibits melatonin production;
maintain a regular bedtime schedule, including going to bed at the same time every night;
exercise regularly, but not right before sleep;
avoid excessive caffeine (coffee, tea, chocolate) and alcohol;
avoid naps during the day, which can prevent you from sleeping well at night;
avoid going to bed when you’re too hungry or too full; a light snack is OK;
get comfy! good bedding and a good mattress are essentials;
try relaxation techniques or simply do things that relax you, such as listening to music or going for walks;
make time for self-care - self-nurturing activities such as massage, a warm bath, gentle yoga, meditation, or just quiet time by yourself;
cognitive-behavioural therapy (CBT) - a talking therapy that can help you manage your problems by changing the way you think and behave, free through NHS.
“The success of Yoga does not lie in the ability to perform postures but in how it positively changes the way we live our life and our relationships.” ~ T.K.V. Desikachar
There are many period tracking apps, they can be a great way to stay in sync with your hormones, and many of them, such as Clue and My Moontime, allow you to predict everything from productivity to mood swings based on your cycle.
Even talking with friends can help – we just don’t talk about it enough. The more we share, the more we can support each other. Quite often sharing openly, but sensitively our own experience of menopause might invite other women to take part in a discussion or investigate on their own.
My main role as a yoga teacher is to inform to the best of my ability and give support within my expertise of a specially adapted asana practice, pranayama, and mindful meditation exercises to help holistically manage some of the symptoms. As often there are no quick fixes, and it is better to make small but powerful lifestyle changes in the 4 pillars of health - exercise, stress management, sleep, and nutrition – to embrace the Second Spring. I will always advocate positivity, compassion, and self-acceptance.
In our classes or in private sessions, we can encourage practices promoting gut health, better digestion, and stimulation of the vagus nerve (responsible for gut-brain connection and good production of serotonin - which affects anxiety, low mood, and depression). We can talk about the importance of the variety of nutritional intake, fibres, and hydration, or teach the abdominal massage and remember to include twists and bending knees forward folds.
We can offer some practical solutions on how to deal with hot flashes, night sweats, disturbed sleep, or anxiety, and encourage creating supportive rituals and helping to accept less nonsense from society and family.
Anything we offer (as a practice or a piece of advice) is only an invitation or guidance. Nothing can replace medical expertise, especially when someone is dealing with depression, unrelieved fatigue, pelvic floor pain, and urinary incontinence. Ultimately, the experts will know how best to help you and your symptoms, so please do see your GP or a qualified expert if you need help.
Whether you chose a natural route, HRT, or a combination of both, there is a wealth of self-care practices available to soothe your symptoms.