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Yoga & Menopause

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Yoga as a Therapy for Menopausal Symptoms

For some women, perimenopause is not an easy, smooth transition. Yoga is a regulator of the sympathetic system, respiratory system and the cardiovascular system. Combined with meditation, it is a form of exercise that has the potential to alleviate symptoms in women navigating the climacteric. In my review of literature, this essay will compare information from studies relating to the effectiveness of yoga and mind-body techniques in treating the symptoms associated with menopause. The midwife can offer yoga therapy to women who do not desire hormone therapy and would like to explore a non-allopathic alternative to treat her perimenopausal symptoms. Yoga is moving meditation, the union of mind and body. The word Yoga comes from the Sanskrit word "Yuj" meaning to unite. This means integrating all aspects of the woman- body, mind and spirit. The goals of yoga therapy are to improve the physical body, expand and relax the mind, and achieve a balanced life experience. The study of yoga and mind-body complementary and alternative medicine {CAM} is a fairly recent endeavor in the United States (Bond, 2007). The use of CAM, specifically by women, is on the rise in the United States (Schuiling, 2013). Complementary and alternative medicine {including yoga} in some midwifery communities is an essential part of midwifery practice, and in others, it is utilized only as a personal healthcare or lifestyle choice. It may be applied as an adjunctive measure to support balance and normalcy, or as an alternative option to resolve disability. Women worldwide are finding CAM therapies to relieve menopause symptoms due to the perceived harms associated with hormone therapy- venous thromboembolic disease, breast/ovarian cancer, and stroke (Lunny & Fraser, 2010). In the United States, 45% of menopausal-aged women reported using some from of CAM therapy including yoga practice and meditation (Pinkerton, Stovall, & Kightlinger, 2009). Yoga is a combination of a series of postures called asanas, meditation and controlled breathing exercises called pranayama. Asanas have an extraordinary capacity to cleanse, rejuvenate and bring the entire system into a state of balance (Chattha, Nagarathna, Padmalatha, & Nagendra, 2008). Asanas are postures that can create life balance by providing a source of distraction and enhancing self-esteem (Nirmala & Sulabha, 2010). Women can focus on the simplicity of asana, reducing stress, depression and anxiety. Asanas can be considered a workout exercise. Women can build muscle and burn calories {even after completion of the practice} by focusing on the larger muscle groups; strengthening the legs, abdominals {core}, chest and shoulders. Meditation helps quiet the mind and is found to be associated with increased melatonin levels and improved sleep quality (Nirmala & Sulabha, 2010). Pranayama develops a steady mind and strong willpower. The breath strengthens the lungs, slows down mental chatter and infuses positive thinking (Nirmala & Sulabha, 2010). The climacteric is the normal life stage characterized by physiological and psyche changes that begins with perimenopause and terminates with postmenopause. According to Schuiling (2013), the perimenopausal period spans approximately 2-8 years prior to the last menses and usually occurs between the ages of 35-50, marking the reduction/end of the reproductive capacity of women. During perimenopause hormones wildly fluctuate and the transition can be challenging. Due to this falling level of estrogen, some women suffer from perimenopausal symptoms including vasomotor instability {hot flashes and sweating}, mood disturbances {irritability, depression, anxiety}, poor concentration, and sleep issues that may be severe enough to affect quality of life (Schuiling, 2013). Symptoms vary in severity and character; on average 20% of women experience severe symptoms, 60% mild symptoms, and 20% may be asymptomatic (Nirmala & Sulabha, 2010). Hormone therapy {HT} is currently the only FDA-approved treatment for menopausal symptoms and remains the gold standard for treatment (Daley, Stokes-Lampard, Mutrie, & MacArthur, 2009). Women with disabling symptoms may need HT to improve their quality of life, but the practice is not routine treatment for all women during midlife (Schuiling, 2013). After the findings of the 2002 Women’s Health Initiative, there was a marked global decline in the use of HT due to the increased risks {venous thromboembolic disease, breast/ ovarian cancer, and stroke}. Consequently many women are now seeking lifestyle alternatives. A Cochrane library review (Daley et al., 2009) examined the effectiveness of exercise in the management of vasomotor menopausal symptoms. Asanas in the Western world are commonly practiced as physical exercise, rather than a meditation skill {as it is more associated with in the East}. This review suggested that regular exercise might help relieve hot flashes. Further studies are needed to explore the impact of exercise {asana} on a perimenopausal woman’s overall quality of life. According to Chattha et al. (2008), yoga can produce changes in perception, attention and cognition. A random controlled trial of 108 perimenopausal women investigated if yoga therapy could improve hot flashes, night sweats and cognitive function. The authors determined that the benefits of yoga might decrease the cognitive dysfunction and the clinical symptoms of the climacteric. The National Institute of Health (Innes, Selfe & Vishnu, 2010) published a review of peer-reviewed literature regarding the effects of yoga and mind-body therapies on menopausal symptoms. Eight out of nine randomized controlled trial studies of yoga and meditation reported improvement in overall symptoms; six of seven yoga trials indicated improvement in mood and sleep, and four studies reported reduced musculoskeletal pain. Results suggest that yoga therapy shows promise for alleviating vasomotor and other menopausal symptoms. A review article published in the Journal of Midwifery & Women’s Health (Bond, 2007) examined nine trials looking at the effects of exercise {asana}, relaxation breathing {pranayama} and progressive muscle relaxation {meditation} on the frequency and severity of menopausal symptoms. All participants reported improvements in quality of life. Today, women spend one-third of their life after menopause, and more attention is needed towards menopausal symptoms (Shuiling, 2013). HT is recognized as the approved treatment of moderate to severe vasomotor symptoms, treatment of vaginal atrophy and prevention of osteoporosis. However for those who cannot use estrogen, women who choose not to use it, or for those with milder symptoms, yoga and meditation do show benefit in trials (Pinkerton et al., 2009). Midwives counsel women who may experience low self esteem, the feeling of having no control over their lives, while dealing with considerable hormone changes. Including yoga therapy as part of the treatment plan can empower women {by feelings of improved life situation} promote wellness by reducing stress, depression and anxiety, providing a distraction from the demands of home and work; alleviating structural, physiological, and emotional pain and suffering (Daley et al., 2009). Yoga is available to every woman and can be free-of-cost {home practice}. This non-invasive CAM therapy ideally should be practiced daily for maximum benefits. Which type or form of yoga is important to discuss with the client. Would she enjoy a “restorative” practice like Kripalu or Kundalini, or more of a “workout” such as Hatha Power or Ashtanga? The midwife should be aware of what is offered in her community and available online. As a midwife and primary care practitioner, I will be counseling my midlife clients about healthy aging. I will support the midwifery model of care by educating my clients of the risks and benefits of HT, and the CAM therapies such as yoga to help treat symptoms due to estrogen depletion. The articles reviewed support yoga as a therapy to reduce the occurrence of menopausal symptoms. The general consensus appears to be that yoga benefits women by influencing many physiological systems within the body. Larger and more rigorously randomized control trials need to be developed. I would like to see yoga emerge as a solid, evidence-based alternative to hormone therapy and other pharmaceuticals to relieve symptoms of the climacteric.

References
Bond, S. (2007). Efficacy of complementary and alternative therapies for menopausal symptoms needs further study. Journal of Midwifery and Women's Health, 52(2), 173-175.
Chattha, R., Nagarathna, R., Padmalatha, V., & Nagendra, H. (2008). Effect of yoga on cognitive functions in climacteric syndrome: a randomized control study. International Journal of Obstetrics and Gynecology, (115), 991-1000.
Daley, A., Stokes-Lampard, H., Mutrie, N., & MacArthur, C. (2009). Exercise for vasomotor menopausal symptoms. The Cochrane Library (1), 1-17.
Innes, K., Selfe, T., & Vishnu, A. (2010). Mind-body therapies for menopausal symptoms: a systemic review. Maturitas, 66(2), 135-149.
Lunny, C., & Fraser, S. (2010). The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women. Journal of Midwifery and Women's Health, 55, 335-343.
Nirmala, V., & Sulabha, J. (2010). Yoga and the menopausal transition. Journal of Mid-life Health, 1(2), 56-58.
Pinkerton, J., Stovall, D., & Kightlinger, R. (2009). Advances in the treatment of menopausal symptoms. Women's Health, 5(4), 361-384.
Schuiling, K. D. (2013). Menopause. In Women's Gynecologic Health. (2nd ed.). (pp. 285-328). Burlington, MA: JB Learning.

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