The Graceful Change

Menopause can be a trying time for women, but with a healthy yoga practice, stress about hormone replacement therapy doesn't have to be part of the picture.

By Trisha Gura

When Alison, 48, began experiencing intense hot flashes, they often arrived at night and interrupted her sleep. But on the whole, her perimenopausal symptoms were more annoying than unbearable. Then her menstrual cycle spun out of control. "Suddenly, my menstrual flow was really heavy and lasted twice as long as before," says Alison, who lives in Chicago and requested that her last name not be used. "My periods went on forever." Her gynecologist suggested that Alsion try hormone replacement therapy (HRT) prescription drugs used to control menopausal symptoms. "She told me not to rule it out if my symptoms were really bad, but my feeling was that I'd rather try to just get through them," Alison says.

She had good reason for wanting to avoid HRT. The treatment regimen, which artificially elevates a woman's estrogen and progesterone levels, has come under intense scrutiny in recent years. Major studies have linked it to an increased risk of breast cancer, heart disease, strokes, and other life-threatening conditions.


The Hormonal Roller Coaster



Hormonal fluctuations generally accompany women's passages into each new biological stage of life; with them often come various discomforts, such as acne and mood swings at puberty, morning sickness during pregnancy, and postpartum depression. "Menopause is no exception," says Nancy Lonsdorf, M.D., author of A Woman's Best Medicine for Menopause (Contemporary Books, 2002).


"Hormones are very powerful; they affect just about every tissue of the body," Lonsdorf says. "So it's no wonder that various conditions can arise as the body tries to adjust to these hormonal shifts. For instance, when the brain is affected by erratic hormone patterns, sleep, mood, and memory may all be influenced, and when the uterus is stimulated by sporadic hormone patterns, irregular bleeding occurs, and so on."




The Great Stabilizer

Yoga instructor Patricia Walden, 57, knows firsthand how yoga can help temper menopausal complaints. Like many other women's symptoms, hers arrived like rain: first a sprinkle, then a full-fledged storm. Hot flashes came first, and then-for the next year-she suffered through constant fatigue and insomnia. She often awoke in the night and stayed awake for up to three hours.


As Walden's symptoms diminished, her conviction that yoga could be a potent tool for easing the suffering that accompanies hormonal shifts deepened. She began to connect with other women who were experiencing similar difficulties and has since created specific yoga sequences for women with menopausal symptoms. "I was interested in women's issues before," says Walden, coauthor with Linda Sparrowe of The Woman's Book of Yoga and Health: A Lifelong Guide to Wellness (Shambhala, 2002). "But after having gone through menopause myself, I am much more sensitive to it."

A regular yoga practice can make a world of difference in a woman's experience of menopause. And a solid practice before this phase can ease the transition, says Suza Francina, author of Yoga and the Wisdom of Menopause (Health Communications, 2003). "If you practice yoga before menopause, then all the poses that are especially useful for coping with uncomfortable symptoms are already familiar, and you can reach for them like an old friend," she says. "If you are familiar with restorative poses, then you have the best menopause medicine at your disposal."

Your Personal Prescription


Hot Flashes. One of the most common (and mysterious) symptoms; nearly 80 percent of all women experience them during perimenopause. Characterized by a rise in core body temperature coupled with a rapid pulse rate, these "power surges" produce a blushing that begins in the face and spreads down the neck and arms. Hot flashes can disappear as quickly as they appear, often leaving a woman feeling chilly and clammy as her body tries to correct the temperature fluctuation.





Once the stress dissipates, the parasympathetic nervous system responds by doing just the opposite-slowing the heart rate back to normal, stimulating the smooth muscles of the digestive tract, and bringing the body's systems back into balance.



If insomnia is a problem, inversions can sometimes help, because they ground the body's energy and burn off excess anxiety. When followed by restorative postures, they encourage a deep state of rest.





Walden has found that specific poses create a mental state that positively affects the mind. "Backbends, especially if supported, allow a sense of lightness into the body," she says. "They stimulate the adrenals and massage them into action. Also, the heart and lungs open and take in more oxygen." Chest-expanding poses energize the body by improving respiration and circulation, and thus counter feelings of depression. And many yogis have discovered that inversions, such as Sarvangasana, can help improve a depressed mood. "By turning everything upside down, inversions influence your emotional being in a positive way," Walden says.



These asanas are just a sampling of the tools a woman can equip herself with as she journeys through menopause—and beyond. If you've never practiced before, yoga can be a tremendous aid when your body feels out of control. If your yoga has been a companion for years, you might find that this is a good time to modify your practice to give your body what it needs. Yoga's rewards, after all, are lifelong. As Alison puts it, "I have received so many incredible benefits from yoga, especially during this period in my life. It has physically improved my body and mentally helped me with the ups and downs."

The HRT Controversy



By the 1980s, research had suggested that the estrogen-progesterone combination could also lower the risk of heart disease, osteoporosis, and perhaps even Alzheimer's disease. The studies showing these benefits, however, also showed that estrogen-related drugs could increase the risk of breast cancer. Perhaps more important, the trials were not definitive. Some were quite small; others used an observational approach—that is, researchers interviewed women who had chosen to take hormones (or not) and followed up with them for a number of years to record any health troubles. This approach is far from the gold standard for medical research, as the results can easily be misleading. For example, women who chose to take HRT tended to have a healthier lifestyle than those who didn't. So while those taking hormones fared better at the end of the study, it wasn't clear if this was a result of the drugs or their better overall health.



Where does that leave HRT? Researchers are now focusing on whether different kinds of hormones, especially plant-based estrogen, might offer relief from symptoms without increasing the risk of disease. And they're interested in learning how HRT affects younger women. The WHI study participants were between the ages of 50 and 79. Might younger, perimenopausal women safely take hormones for shorter periods of time (less than four or five years) to combat severe hot flashes and insomnia? We won't know for certain until additional studies are completed.


Trisha Gura is a freelance science writer and yoga student in Boston. Linda Sparrowe, a Yoga Journal contributing editor, is the author of YJ's coffee table book, Yoga, and coauthor (with Patricia Walden) of the forthcoming book Yoga for Healthy Menstruation.

Article courtesy – Yoga Jounal