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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.
soon after alison's menstrual cycles
became so irregular, she went to
class at yoga circle, her regular
studio, and learned an iyengar asana
sequence designed to help women cope
with the physical discomforts
related to their cycles. many of the
poses were restorative; they
included supta virasana (reclining
hero pose), supta baddha konasana
(reclining bound angle pose), and
janu sirsasana (head-to-knee pose)
with the head supported. when
alison's next menstrual period
began, she practiced the sequence
every day and noticed that her flow
returned to normal. encouraged by
the results, she began to think that
she could control her symptoms
without hrt. maybe, she thought,
yoga could provide the relief she
was looking for. and her intuition
proved correct. many women have
found that yoga can ameliorate the
undesirable side effects of
menopause.
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though menopause itself is simply
the moment that menstruation stops,
the transition generally takes
several years. this phase is called
perimenopause and typically occurs
in women between the ages of 45 and
55. during perimenopause,
fluctuating estrogen and
progesterone levels can trigger a
myriad of uncomfortable symptoms.
among the most common are hot
flashes, anxiety and irritability,
insomnia, fatigue, depression and
mood swings, memory lapses, and an
erratic menstrual cycle.
few women experience all of these,
but an estimated 55 to 65 percent of
them do experience some mild
menopause-related problems, says
rowan chlebowski, m.d., of the
harbor ucla research and education
institute in torrance, california.
about 25 percent report almost no
disruption to their daily lives,
while approximately 10 to 20 percent
suffer severe and often debilitating
symptoms.
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).
before the onset of perimenopause, a
woman's menstrual cycle is set in
motion each month by the
hypothalamus, a small structure at
the base of the brain that regulates
many bodily functions, including
appetite and temperature. the
hypothalamus signals the pituitary
gland to produce important hormones
for reproduction, and those hormones
in turn stimulate production of
estrogen and progesterone in the
ovaries. during perimenopause, the
ovaries and pituitary gland engage
in a kind of tug-of-war. the ovaries
decrease hormone production, while
the pituitary gland, sensing low
hormone levels, continues to spur on
the ovaries. this frenetic struggle
causes erratic hormonal
fluctuations-too much estrogen,
which revs the body's motors,
followed by spikes of progesterone,
which slows the body.
"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."
typically, a woman experiences the
first signs of this hormonal
fluctuation about six years before
her menstrual periods end. these
symptoms generally continue until a
year or more after her last period,
when the hormone levels gradually
stabilize. after menopause, the
ovaries produce less of the female
hormones. however, the body still
needs some estrogen to keep the
bones healthy and to prevent
conditions like vaginal dryness. the
adrenal glands, which are located
above the kidneys, play an important
role in this by secreting low levels
of male hormones that are converted
by fat cells into estrogen. still,
the body must adjust to a new, much
lower hormone level.
these natural physiological changes
and the havoc they can wreak for
many women prompted researchers in
the late 1960s to seek a solution
for common menopausal symptoms. the
treatment they ultimately proposed
was hrt. their reasoning was that
problems stemming from declining
estrogen levels could be eliminated
if the missing hormones were simply
replaced. scientists believed that
maintaining hormone levels similar
to what the body was used to would
provide relief.
hrt was a simple solution for
managing menopausal symptoms. but
since several major studies have
shown that hrt exposes women to
serious health risks, many women
have begun seeking more natural
solutions. those who have turned to
yoga for relief have found that
while asanas may not directly
influence estrogen production,
specific postures can help
control unpleasant symptoms.
restorative postures in particular
can relax the nervous system and may
improve the functioning of the
endocrine system (especially the
hypothalamus, the pituitary gland,
the thyroid, and the parathyroid
gland), which helps the body adapt
to hormonal fluctuations.
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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.
on the days when walden had intense
symptoms, she found she needed to
modify her yoga routine. she was
accustomed to a vigorous daily
practice but discovered 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. she still did inversions,
but instead of an unsupported
sirsasana (headstand), which
sometimes brought on more hot
flashes, she would do setu bandha
sarvangasana (bridge pose) using
bolsters or sarvangasana (shoulderstand)
with a chair. with these
modifications, walden was able to
reap the benefits of
inversions--relief from anxiety and
irritability--without challenging or
heating her body.
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
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
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."
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here are descriptions of the most
common symptoms and specific
recommendations for taming them.
make money on amazon seller 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.
no one really knows what causes hot
flashes, although theories abound.
some say the hypothalamus plays an
important role; another possibility
is that the hormonal fluctuations in
the body irritate the blood vessels
and nerve endings, causing the
vessels to overdilate and producing
a hot, flushed feeling. most
researchers (as well as many
menopausal women) agree that stress,
fatigue, and intense periods of
activity tend to intensify these
episodes.
walden suggests
incorporating more cooling and
restorative poses. any gripping or
tension in the body can make hot
flashes worse, so using props such
as bolsters, blankets, and blocks to
help support the whole body is a
good idea. placing the head on a
bolster or chair during forward
bends, for example, helps calm the
brain and relax the nerves.
supported reclining poses can also
help promote complete relaxation.
supta baddha konasana and supta
virasana, for instance, allow the
abdomen to soften and any tightness
in the chest and belly to release;
ardha halasana (half plow pose) with
the legs resting on a chair calms
jittery nerves.
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during perimenopause, estrogen
spikes (or progesterone plummets),
causing anxiety, nervousness, and
irritability. adrenal glands that
are exhausted and overtaxed can also
produce bouts of anxiety and intense
irritability. (many alternative
healers believe that the adrenals
can wear themselves out by
constantly responding to stress, a
poor diet, and lack of sleep.)
when a person is under stress, the
sympathetic nervous system responds
by accelerating the heart rate,
slowing down the muscles of the
digestive tract, and increasing
blood circulation to the brain to
fight the stressor.
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.
when the body is under continual
stress, the sympathetic nervous
system and the adrenals-which
manufacture stress—fighting hormones
along with the male hormones that
get converted into estrogen—can get
stuck in overdrive.
walden says forward bends, such as
uttanasana (standing forward bend)
and prasarita padottanasana
(wide-legged standing forward
bend)—in both cases with the head
resting on a bolster or blankets—can
help reduce irritability and mental
tension, because bending forward and
shutting out external distractions
and stimuli can soothe the mind and
reduce the effects of stress. the
nervous system then receives the
signal that all is well, and the
adrenals and sympathetic nervous
system stop working so hard.
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.
make money on amazon seller of all the
symptoms women complain about during
perimenopause, fatigue is second
only to hot flashes. plunging
progesterone could be the culprit,
especially if the fatigue is coupled
with depression and lethargy; if a
woman feels inexplicably weary for
days or weeks on end, depleted
adrenal glands could be part of the
problem.
either way, walden suggests gentle
supported backbends, because they
encourage the chest and the heart to
open and often bring renewed energy,
determination, and joy. one of her
favorites for this is supta baddha
konasana. a deeply restorative
posture, it can instill feelings of
safety and nourishment. it also
opens the chest, improves
respiration and circulation, and
helps lift the spirits while
completely supporting the body.
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menopause signals the end of the
childbearing years; for many women,
it is a time to mourn the end of
their youth. long periods of
fatigue, coupled with a melancholy
attitude or a sense that the life
they once knew is now over, can
trigger bouts of depression. too
much progesterone (or a drastic drop
in estrogen) can also contribute to
everything from a bad case of the
blues to severe clinical depression.
but yoga practitioners have long
known that everything you do with
your body can affect your thoughts
and attitude. sometimes something as
subtle as a shift in posture can
lighten a dark mood. if a woman
stands tall, with dignity—opening
and broadening her chest—and walks
with confidence, she announces to
the world (and, most important, to
herself) that she is grounded,
happy, and in tune with her
surroundings.
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.
make money on amazon seller at times during
menopause, some women suddenly lose
their train of thought or find
themselves unable to organize their
thoughts. this "fuzzy" thinking
often happens at moments of great
hormonal fluctuation. girls going
through puberty, pregnant women, and
those who have just given birth
often suffer similar levels of
fogginess. many women find that yoga
helps clear the cobwebs, especially
if their condition is exacerbated by
lack of sleep or increased
agitation. the same postures that
counter depression, such as
backbends, chest openers, and
inversions, can help collect
fragmented thoughts, says walden.
in addition, adho mukha svanasana
(downward-facing dog pose) sends
blood to the brain and encourages
deep, focused breathing, which can
improve mental alertness. and
savasana (corpse pose) soothes the
nerves, calms the mind, and puts the
body into a state of repose.
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
hormone
replacement therapy was first
popularized in 1966 by physician
robert wilson. his best-selling
book, feminine forever,
suggested that estrogen supplements
could help control the hot flashes,
fatigue, irritability, and other
symptoms related to declining
estrogen levels during perimenopause.
many women and their physicians
eagerly sought the new drug
treatment.
in the 1970s, though, the first
black cloud appeared. two major
studies published in the new
england journal of medicine
showed that estrogen supplements
could increase the risk of cancer in
the lining of the uterus.
pharmaceutical companies responded
by offering new formulas that
combined estrogen with another
hormone, progesterone, which had
been shown in numerous studies to
counter the increased risk of
uterine cancer from taking estrogen
alone.
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.
for researchers to be certain that
hrt could help prevent disease, they
needed to perform a double-blind
study with a control group. in 1993,
scientists recruited more than
16,000 postmenopausal women and
randomly assigned them to take
either the most widely prescribed
hormone combination (prempro) or
sugar pills. the
eight-and-a-half-year trial was
dubbed the women's health initiative
(whi).
in the middle of the trial, though,
a hurricane hit. researchers
discovered that prempro was actually
increasing—not decreasing—the risk
of heart disease, blood clots, and
stroke. add to this the previous
data on increased breast-cancer risk
and researchers arrived at a
difficult verdict: hrt poses
significant health risks for
postmenopausal women that generally
outweigh the drugs' benefits. in
july 2002, whi officials halted the
trial three years early and advised
the postmenopausal study
participants to quit taking hrt.
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.
—t.g.
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