Yoga Therapy and Menopause
"Mit freundlicher Genehmigung von Maimu Opmann, Estonia und Lia
Lappalainen, Finland 2010"
Yoga Therapy and Menopause
1. Introduction
With today`s increased life expectancy, many women spend one-third of their life after
menopause. Yogic life style aims to improve the body, the mind and everyday life
“The Heart of Yoga” gives some definitions of Yoga:
Yoga is the movement from one point to another, higher one;
Yoga is bringing together, unifying two things;
Yoga is action with undivided, uninterrupted attention.
These definitions of yoga have one thing in common: the idea that something changes. This
change must bring us to point where we have never been before.
The most commonly performed Yoga practices are postures (asana), conscious breathing
(pranayama), and meditation (dhyana). Yoga has known as a tool to maintain good health
and prevent, deal or cure diseases.
Yoga tools were introduced in ancient texts as a system of self-empowerment and healing. In
old texts yoga is defined as a state of mind. During the menopausal period women start to
shift their interest to developing their spiritual side. It is good time to become aware of
oneself and also to support natural changes using the timeless wisdom of yoga in a practical
way.
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Yoga Therapy and Menopause
Ancient masters described human beings in a very complex way - everything is connected to
everything. Understanding that we all have higher consciousness and wisdom inside us, is a
big step towards a process of self–discovery.
In the work we would like to present yoga in a very practical way and to give wider and
deeper understanding of human system. It will help to move forward and to be more
conscious about these connections and through this to achieve higher level in spiritual
development.
This work is based on ancient knowledge of Yoga and Ayurveda. Thanks to Tirumalai
Krishnamacharya, T.K.V Desikachar and Kausthub Desikachar we have the opportunity to
use knowledge of ancient tradition in a practical way.
Whatever place, whatever time, the ancestors have framed yoga practices to suit them all.
Only the attitudes and circumstances of human beings changes.
T.K.V Desikachar and R.H. Cravens “Health, Healing and Beyond”
2. Objective of Study
We chose this topic because we observed that women at the age of 47-61 in our groups had
multiple menopausal symptoms. There where physical and psychological problems, wish to
find a new meaning to life, and spiritual development. They had not found complete relief
from modern medicine. Therefore we decided to turn to Traditional Yoga for finding
supportive tools and methods. The purpose of this study was to present yoga as a method for
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Yoga Therapy and Menopause
coping with menopausal symptoms and help women to find ways to live healthier and
happier life with deeper understanding of this natural process.
2.1. Theses
1. Explaining the process of menopause through Yoga philosophy helps to understand
this stage of life broader and deeper and to accept changes.
2. At middle age a lot of patterns from the past are already well established. How to face
and break down old patterns that are not useful anymore, and find new ones? It
requires self-awareness and stability of mind.
3. Fear is a basic feeling and belongs to our fundamental patterns. It is causing anxiety
and stress. In menopausal period a lot of fears are appearing: ageing, diseases,
loneliness, non-acceptance by society, losing job etc. Asana, pranayama and
meditation as Yoga tools help to replace these patterns and give strength and courage
to go through this process.
4. During this period of life it is very important to work with concept of faith. It helps to
find strength for personal development and to continue life journey in more positive
way, finding joy and satisfaction in a deeper level. There are certain practices in
Yoga, which help to reach the higher state of faith.
5. Women’s physical and psychological health is in process of changing, bringing
confusion and also predispositions for serious diseases. Traditional Yoga practice and
Ayrveda are giving relief in many of these cases.
6. Women are often helpless in front of emotional and hormonal instability that may
cause sleeplessness, irritability, mood swings, depression and tensions in social
relations. The suffering grows because of confusion in thoughts and feelings.
Tightness appears on a body, breath and mind level. When practicing Yoga we use
movements, pranayama, sounds, chant, meditation and teaching of yoga philosophy
as tools for finding a state of clarity of the mind
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Yoga Therapy and Menopause
7. Low self-consciousness, stressful life and illnesses decrease life energy. By
practicing Yoga concentration and self-consciousness increases, bringing inner life
force back and it appears by better life quality.
8. During menopause the focus starts to move towards the spiritual part of personal
development. The individual practice supported by group meetings gives motivation
and helps to be interested about this process.
9. Appropriate Yoga practice and trustable relationship between care-seeker and careprovider leads the care-seeker safely forward step-by-step.
3. Background and literature review
3.1. Background
Menopause is a normal process in a woman´s life. Explaining it through yoga philosophy will
help us to accept and find out effective ways to go through this process. Women need support
and instruction to accept the changes at different levels.
There are many women who would use natural support, but it is difficult to find in today´s
scientific medicine. Teaching a new lifestyle and food habits, supported by individual yoga
practice, gives a good base for the natural changes. Because of many side effects, there is fear
and insecurity of Hormone Replacement Therapy (HRT)1, in this case different kinds of
alternative perspectives as Yoga and are helpful. Even if a woman uses HRT and wants to
stop medication, it must be done slowly and replaced by something else that gives support. In
this situation yoga therapy has many tools. Woman´s body will find its own resources when
using natural way of coping with problems.
Medical help is not enough to overcome the fear of aging that many women have. The
process of changes is very deep and not manageable only with medication. Fear is a
fundamental feeling. Yoga system works with patterns, beliefs and deep feelings. When the
HRT – Hormone Replacement Therapy - it supplies with hormones when woman`s own
hormone production slows down
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person is ready, the change can take place step by step, supported by yoga teacher or yoga
therapist.
There are many psychological problems in this period of life, and one of main questions is
how to find courage and joy of living in this new situation. The spiritual part of one´s
development becomes important.
The physical condition is going through dramatic changes. Very often women experience
heaviness, weight gain, dryness of tissues, weakness, pain and other symptoms. Changes in
body appearance and function decrease self-confidence and bring fear of diseases, depression
and fatigue. Many women will start to fight against these changes with extreme diet, plastic
surgery and excessive physical exercising. It creates a lot of stress and tension on both body
and mind level. Yoga will help to accept changes in a gentle, suitable way through using
wisdom of yoga philosophy, individual asana, pranayama and meditation practice. A good
contact with yoga teacher or therapist will support the individual practice. This allows a
woman to get deeper experience and understand herself, to go through these changes and to
grow as a person.
Women are very often helpless in front of emotional instability during this period. It causes a
lot of changes in sleeping patterns and difficulties in coping with everyday life. They need
help to reduce irritability, mood swings and depression. Yoga as a holistic, self-empowering
system, has methods of teaching how to achieve the state of clarity, how to get higher level of
self-consciousness, how to take responsibility of emotions, and through this how to be more
calm and better prepared for daily life.
Women experience feelings of loneliness very often during this period of life. Many women
are alone, children have grown up, the partnership is not lasting anymore and low selfconfidence keeps them alone at home. Joining with a peer support group (sanga) is an option
in this situation. Women have a possibility to share their thoughts and experiences in a group.
Menstruation has stopped and because of that the very important cleaning system does not
work anymore and it influences general health status: cardio-vascular diseases, joint aches,
skin problems etc. Ancient knowledge of Yoga gives possibility to use a holistic way of
helping women.
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Yoga Therapy and Menopause
Woman´s physical and also psychological health is changing and because of that there are
many predispositions for serious diseases. Reason for illnesses might be very different and
healing has to be individual. Modern medicine interferes in an invasive way and healing
process is not complete. In Yoga Therapy as a holistic approach, there is possibility to look at
things from other side and to reach the cause of the problem.
During life every woman has lot of things that she needs to “digest” and solve. There is no
possibility to postpone undigested and unsolved things beyond the time. In relationship with
family, partner, friends, society, there are a lot of accumulated unsettled situations,
misunderstandings and tensions needing to be completed. All these might cause many mental
and physical illnesses in this period of life.
Since we live in a society where menopausal issues are rarely discussed openly (at least until
fairly recently), many women are unaware of the symptoms that may occur during this time
of their lives and in fact often find themselves bewildered by the changes they experience.
This is important time of life and it helps to speak openly about it.
Every woman is unique and ultimately responsible for her own health and well-being. The
action of every remedy is unique. The result of any treatment suggested herein cannot always
be anticipated and never guaranteed.
Menopause is an opportunity for conscious change, not a disease to be treated. One idea of
this work is to educate women and to give different options to solve menopausal symptoms.
3.2. Literature Review
3.2.1 Menopause - Stages, Symptoms
Menopause usually begins in a woman's early 50s and signals the end of her reproductive
years. Just as pregnancy and childbirth, each woman experiences menopause differently.
Some women sail through this time without much trouble, others are debilitated by the list of
symptoms that accompany it.
Menopause has three stages, each presenting varying degrees of challenges. Perimenopause is
the first phase and usually begins a few years before full-onset menopause begins. Menstrual
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Yoga Therapy and Menopause
cycles change and become erratic, while hormone production begins to diminish. Hot flashes
and some of the other more intense symptoms can start during perimenopause, although they
usually occur in the second stage, known simply as menopause.
During this second phase, all the symptoms the woman is going to have will make their
arrival, hormones take an even greater nosedive, and menstruation stops. Symptoms can last
from one year to a decade or more. Most women hover around the five-year mark.
The final stage of menopause is postmenopause.
Hormons. What Happens During Perimenopause and Menopause
As we have seen, the key to the flawless rotation of menstrual cycle during the child bearing
age in women is the hormonal balance among estrogen, progesterone, follicle-stimulating
hormone (FSH), and luteinizing hormone (LH). As estrogen rises, FSH falls. As estrogen
falls, FSH rises.
During perimenopause, the hormone balance starts to go slightly out of balance.
 Estrogen and/or progesterone are at lower than usual levels, and
 FSH and/or LH are somewhat higher than before, while still cycling.
After menopause, the typical pattern of the hormones is:
 Continually high levels of FSH and
 Continually low levels of estrogen and progesterone.
The follicles remaining in the ovaries of a perimenopausal woman are generally less sensitive
to stimulation by FSH than the ones that are present during the child bearing age. There will
be occasionally a cycle in which the follicle do not develop fully. We will call these cycles
abnormal cycles. The number of such abnormal cycles without a mature follicle increases as
we approach menopause and finally there will be cycles in which no follicle develops at all.
For most of the perimenopause, normal and abnormal cycles tend to be intermixed. One
month a follicle will develop normally, and other months, with increasing frequency, it will
not.
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Yoga Therapy and Menopause
When a follicle fails to develop properly, it secretes less estrogen. The low level of estrogen
cannot fully suppress the secretion of FSH by the pituitary gland. So, as estrogen levels fall,
FSH levels rise. If estrogen levels are sufficiently low, they may fail to trigger the LH surge
that's supposed to rupture the follicle, and the egg isn't released. This is termed an
anovulatory cycle (a cycle without ovulation).
If the follicle doesn't rupture, the corpus luteum cannot form, and consequently, progesterone
cannot be released at the appropriate time. The lack of normal amounts of estrogen gives rise
to all the familiar discomforts of estrogen deficiency, from hot flushes and insomnia to
depression and palpitations. In the long run, heart disease and osteoporosis may follow.
The decline of estrogen and progesterone, which may happen before the perimenopause,
signals the uterus to shed its endometrial lining prematurely. This results in a general
shortening of the length of the cycles, and often, the timing of estrogen and progesterone
decline varies from month to month, resulting in irregular cycles. Shorter cycles, irregular
cycles, or both are often the first signs that the perimenopause has started.
Androgens, like testosterone, also decline during this period, but at a much slower rate than
estrogen and progesterone in many women. The ovaries continue to secrete testosterone even
after menopause
An estimated 75 to 85% of women experience some or all symptoms of menopause,
including vasomotor disturbances (hot flashes/night sweats), fatigue, sleep impairment, mood
disturbances, cognitive difficulties, musculoskeletal pain, and headaches. Symptoms typically
begin at least one year prior to menstrual period cessation and persist for several years postmenopause; for example, findings from a recent meta-analysis indicate that approximately
50% of women continue to experience vasomotor symptoms 4 years after their final
menstrual period with reported average duration of vasomotor symptoms ranging from 3.8 to
over 7 years. Approximately 10–30% of postmenopausal women will continue to experience
symptoms throughout their lives; in breast cancer survivors, symptoms are often more
frequent or severe due to endocrine therapy and chemotherapy-induced menopause.
Symptoms can result in significantly reduced quality of life that for some can be debilitating,
prompting an estimated 60% of women to seek medical treatment. Given that there are over
50 million women in the US aged 50 or older, with at least 1.5 million reaching menopause
every year, the financial, social, and psychological burden of menopause is considerable.
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Hormone replacement therapy (HRT) has long been prescribed to alleviate hot flashes and
other menopausal symptoms, but HRT use has fallen dramatically in both the US and Europe
due to evidence from recent large clinical trials that HRT increases risk for breast and
endometrial cancer, coronary artery disease, stroke, and thromboembolism. An increasing
number of women are turning to complementary and alternative therapies to help manage
menopausal symptoms, with current estimates ranging from 40% to over 70% of women in
the peri- and postmenopausal period. Mind-body practices, including active disciplines such
as yoga and tai chi, as well as specific relaxation and other stress management techniques are
among the more commonly chosen therapies. Given that menopausal symptoms both
contribute to and are exacerbated by psychosocial stress, and a growing body of literature
suggests mind-body practices can reduce perceived stress and stress reactivity, enhance mood
and wellbeing, and improve sleep, mind-body therapies may have promise for the
management of menopausal complaints. Moreover, several mind-body therapies (including
yoga, meditation, qigong, tai chi, and several relaxation techniques) have been reported to
decrease indices of sympathetic activation, factors that characterize and may in part underlie
the development and exacerbation of vasomotor and other menopausal symptoms. These
factors may also play an important etiologic role in the development of insulin resistance,
dyslipidemia, hypertension, and other atherogenic changes associated with menopause.
3.2.2. Menopause medical and Ayurvedical view
There is a list of most common symptoms that occur during perimenopause and menopause
was developed from the real-life experiences of hundreds of women. All symptoms were
experienced by numerous women and were either cyclical in nature, or responded to
treatments (both traditional and alternative) known to address hormonal imbalances.
1. Emotional instability (irritability, mood swings, depression, anxiety, fear)
Medical view. All sex hormones, including progesterone, estrogens, and androgens, can affect
mood, memory, and cognition in complex and interrelated ways. Receptor sites for these
hormones are found throughout the brain and nervous system, and nerve tissue itself has been
found to produce them. Estrogen /---/ has been shown /---/ to increase mood-enchanting betaendorphins in menopausal women as well as in menstruating women.
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Yoga Therapy and Menopause
Ayurvedic wiev. Mood swings, depression, mental fogginess are the characteristic of
disturbed vata. (Ayurveda for women) Because of specific etiological factors, vata from the
colon, pitta from the intestine, or kapha from the stomach enters the general circulation and
lodges in the nervous system, interferes with normal functioning of the mind and nervous
system, and causes depression. The resulting of depression may be vata, pitta, or kapha. Vatatype depression is generally associated with fear, anxiety, nervousness, loneliness, extreme
behaviour, feeling of insecurity and insomnia. Pitta-type depression is generally associated
with anger, with fear of failure, losing control, of making mistakes, judgemental thinking and
acting, jealousy; it often involves thoughts of committing suicide. Kapha depression creates
excessive attachment, greediness, a sense of mental heaviness and is associated with excess
sleep, weight gain, drowsiness, and lousiness. Depression is a serious medical condition that
requires the supervision of a medical doctor.
2. Inability to concentrate
Medical view. The base for the inability to concentrate is imbalances between the sympathetic
and parasympathetic nervous systems, combined with the changing hormonal milieu of
menopause. It creates emotional instability and all conditions of this are the base for lowered
concentration ability.
Ayurvedic view. Inability to concentrate is the problem of mind. Illness may begin in the
mind and emotions and then affect the body, mental imbalance creates physical imbalance.
Worry weakens the heart. Fear, nervousness and excessive talking dissipate energy and
aggravates vata. Possessiveness, greed and attachment enhance kapha. Hate and anger create
toxins in the body and aggravate pitta. Mind and body are never considered separately.
3. Stress
Medical view. Cortisol provides a much-needed boost in the short term, helping to get
through an occasional crisis. Living in the ‘fast line’ for a long time, prolonged elevation of
cortisol can cause a number of problems. Persisting in the perception that events and
demands in life are stressful and uncontrolable, one adopting the mind-set that continually
whips adrenals into producing more and more cortisol. Over time, adrenals may become
exhausted, losing their ability to keep up with the demand for increasing amounts of this
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hormone. This is often coupled with suboptimal nutrition, impaired digestion, and poor
assimilation of nutrients, all of which go hand in hand with a stressful life.
Ayurveda view: ayurveda considers stress less as a result or condition than a causal factor in
disease. A regular daily routine, nourishing diet, positive emotions, and loving relationships
result in strength and health. But keeping late hours, eating food that is aggravating to one’s
constitution, travelling a lot, using the mind or stimulating the senses too much, repressing
negative emotions such as anger or fear, and maintaining problematic relationships all put
stress on the body and mind. In addition, toxins in food, water, air pollution, excessive noise,
and many other environmental factors are also stressful.
Stress is a major factor in many diseases. /---/ Stress disturbs the doshas and can create
disequilibrium of vata, pitta, or kapha, depending on the individual’s constitution. Vata
individuals may develop vata conditions such as anxiety or fearfulness. Pitta individuals may
react to stress in the form of anger, or they may suffer from hypertension, peptic ulcer,
ulceractive colitis, and other pitta disorders. Kapha individuals under stress tend to eat and eat
and eat.
4. Memory problems (loss and weakness of memory)
Medical view. Dementia of all types, including Alzheimer’s, is associated with free-radical
damage to brain tissue, which results from the overproduction of inflammatory chemicals at
the cellular level, eventually leading to the damage or death of brain cells. Free-radical
damage and the resulting tissue inflammations are the final common pathway by which
emotional, physical and environmental stressors of all kinds adversely affect every tissue in
our bodies, including our brains.
Ayurvedic view: Memory is recorded on the sensitive film of the nerve cells within the brain,
which are of a kapha nature; memory is enlivened and brought back at a proper time by
means of vata. Most memory problems are due either to stagnation of kapha or to aggravation
of vata dosha, with its light, airy, even spicy qualities.
2. Lack of energy, tiredness ( chronic fatigue )
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Medical view. Sympathic nervous system keeps people alert. Sleep is an indispensable bodily
function, as important as breathing and eating. It is critical for bodily rest, for consolidation
of learning and memory and also as a way to help sort out in minds and bodies the things one
have learned and experienced during the day. Lack of energy can be as a consequence of
some chronical disease. It may lead to chronic fatigue syndrome.
Ayurvedic view. Fatigue is physical and mental stress. It is not always due to overwork.
Fatigue can be due to boredom or lack of motivation. Fatigue may be due to low gastric fire,
weakness of the liver, low adrenal energy, or anaemia. It may be caused by Epstein-Barr
virus, a form of chronic fatigue syndrome related to high stagnant pitta in the liver. People
having a history of infectious mononucleosis can feel very tired.
3. Sleeping problems
Medical view. Insomnia makes the entire midlife transition harder. Insufficient sleep
increases our levels of corticosteroids and catecholamines, stress hormones that can, over
time, throw off hormonal balance and depress immune system. Sleep restores both physical
and mental energy. Women also suffer from decreased concentration, lowered efficiency,
decreased work motivation and a higher rate of errors in judgement.
Ayurvedic view. Staying up all night long increases vata and decreases kapha. During
perimenopause, hot flashes and night sweats, as well as worry, anxiety and palpitations, can
result in difficulty sleeping. Lack of sleep then results in difficulty concentrating, irritability
and mood swings. In Ayurveda, sleep is considered “one of The Three Pillars (Supports) of
Life” (the other two being intake of food and sexual restraint), making adequate, restful sleep
an extremely important part of ensuring our health and well-being. As it says in the Caraka
Samhita, “Being supported by these three well regulated factors of life, the body is endowed
with strength, complexion and growth, and continues up till the full span of life, provided a
person does not indulge in such regimen as are detrimental to health”.
4. Hot flashes
Medical view. Hot flashes are due to the hypothalamic response to declining ovarian
oestrogen production. The declining oestrogen state induces hypophysiotropic neurons in the
arcuate nucleas of the hypothalamus to release gonadotropin-releasing hormone (GnRH) in a
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pulsatile fashion, which in turn stimulates release of luteinizing hormone (LH). Extremely
high pulses of LH occur during the period of declining estrogen production. The LH has
vasodilatory effects, which leads to flushing.
Ayurvedic view: hot flashes although they are hot, are primarily manifestations of this quality
of disparity that becomes prominent due to the vata imbalance. If pitta has accumulated over
many years the hot flashes are likely to be more frequent, more intense, and more irritating,
and your mood is likely to be more irritable.
5. Heart palpitation
Medical view. This cardiovascular phenomenon is often prompted by changes in estrogen
levels. Irregular heartbeat, also known as tachycardia occurs when the heart beats faster or
more forcefully than normal. It can occur at any time of day or night, with episodes lasting
from a few seconds to several minutes. The symptoms are fluttering feeling; the heart has
skipped a beat, pounding the chest, throat or neck and increased pulse rate. Dimished
estrogen levels can result in the overstimulation of sympathic autonomic nervous system,
which can cause irregular heartbeat and heart palpations.
Ayurvedic view. The accumulation of ama (as elevated cholesterol, triglycerides, and other
artery-harming toxins) is the root physical cause of heart disease. At menopause, toxic ama
build up can lead to any number of heart health risks, making it imperative that this be
addressed through dietary and lifestyle changes.
In Ayurveda, the heart is considered the “seat of consciousness” and the dwelling place of the
superior form of ojas. There are “two hearts”; the physical heart, which pumps our blood, and
our emotional heart, which experiences love, fear, anger, and all human emotion.
6. Decrease of libido
Medical view. Sexual function is a complex, integrated phenomenon that reflects the health
and balance not only of the ovaries and hormones, but also cardiovascular system, the brain,
the spinal cord and the peripheral nerves. In addition every factor that affects sexual function
has underlying psychological, socio-cultural, interpersonal and biological influences of its
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own. Woman’s overall mental and physical health is more important to sexual functioning
than menopausal status. Vaginal dryness, insomnia, high level of stress, depression and
anxiety can have an effect in decreased libido.
Ayurvedic view. Desire derives from artava dhatu, the female reproductive tissue. When
there is a weakness or debility, libido is low. In addition to weakness in the reproductive
tissue, emotional factors and high stress are the primary causes of a reduced sex drive.
7. Osteoporosis
Medical view. Osteoporosis, or porous bone is a disease characterized by low bone mass and
structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility
to fractures, especially of the hip, spine, and wrist, although any bone can be affected.
The symptoms of osteoporosis don’t appear suddenly, but develop during years. Bones are
our foundation, out link to earth and help us moving on in our life.
Osteoporosis is bone loss that starts slowly. Bones become porous, brittle and easily subject
for fracture, because bone density lessens.
Ayurvedic view. Osteoporosis is a thinning and increasing porosity of the bone due to
increased vata. Women lose bone rapidly after menopause. This is because the
postmenopausal body produces little or no estrogen, which is necessary for maintaining bone
metabolism utilizing calcium, magnesium, zinc, and other materials for building the bone.
8. Irregular menstruations
Medical view. When woman is going through the hormonal changes of perimenopause, just
about any kind of uterine bleeding is possible. Periods are erratic. This symptom appears
because hypothalamic – pituitary – ovarian axis is not producing enough progesterone and
also because oestrogen level is decreasing.
Ayurvedic view. This is a problem of apana region and occurs in perimenopause period . Also
emotional causes may be a reason for irregular menstruation (grief, fear, anger, shame )
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9. Heavy bleeding
Medical view. When oestrogen levels are high or even normal but progesterone levels are too
low, from lack of ovulation, the monthly oestrogen build – up of the uterine lining (the
endometrium) continues unopposed. When it finally breaks down, the result can be erratic,
heavy bleeding that can go on for days at a time. Fibroid tumours are the most common
physical reason for excessing bleeding. Whether or not a fibroid causes bleeding depends
upon its location in the uterine wall. /---/ Adenomyosis is another condition that can cause
heavy bleeding. Adenomyosis results when the endometrial glands that line the uterus grow
into the uterine muscle (the myometrium). When this happens, little lakes of blood form in
the uterine wall that do not drain during menstruation. Over time, the uterus enlarges and
becomes boggy, spongy, and engorged with blood, disrupting the normal uterine contraction
patterns.
Ayurvedic view. Excess pitta in the blood makes the blood hot, sharp and penetrating and
does not allow natural coagulation and clotting to occur. Pitta people bruise more easily, their
blood vessels are thin and are more easily interrupted.
10. Breathing difficulties
Medical view. In menopaus period there might be many reasons for breathing difficulties.
There is no only one ethiology. Hypothyreoidea, heart problems, high blood pressure, heavy
bleeding, depression, anxiety, etc are the base for breathlessness. There are no evidence that
instability of hormones are the reason for the breathing difficulties.
Ayurvedic view. When apana, which is supported to move downward, heads
upward instead, it will pervert progressively, whatever previously unperverted subdoshas of
vata happen to lie in its path. All sorts of illnesses can result from apanas abnormal upward
march, ranging from /...../ asthma and other breathing difficulties.
11.Weight gain
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Medical view.
Menopausal years can lead to weight gain. The underlying reason for this weight gain is that
midlife women experience a slowdown in metabolic rate of about 10-15 percent compared to
earlier in life. Woman bodies also become more efficient at taking energy into our cells and
storing it in the form of fat. In addition, as estrogen levels fall, our appetite increases. Nature
designed this for two reasons: to allow us to survive on less food as we get older and, in some
cases, less able to fend for ourselves; and to assist us in putting on a supply of body fat that
can produce the estrogen and androgens our ovaries are no longer producing at the same rate.
It is as if body is trying to “grow a little ovary made of fat”, since fat produces estrogen.
Midlife weight gain (within limits) is not necessarily a health risk. In fact, those extra pounds
we gain at perimenopause often go away once we get past menopause and our metabolism
restabilizes. Central obesity (excess belly fat) is a problem. Abdominal fat cells are more
metabolically active - and potentially more dangerous - than the fat cells on your hips and
thighs. They can contribute to insulin resistance and can pump out too much androgens and
estrogen. The classic apple-shaped figure is associated with an increased risk for heart
disease.
Ayurvedic view. Obesity is a kapha disorder. In obese individuals the gastric fire is strong, but
the cellular fire in the tissue is relatively low. Whatever excess food or calories a person
consumes are not burned and instead turn into adipose tissue, leading to overweight and
obesity. Stress may induce repeated emotional eating, leading to significant weight gain.
The extra weight gain is a disturbance in medas dhatu. As stated by Dr. Lansdorf, “Since all
your hormones interact on the level of medas dhatu, it is not surprising that as key hormones
begin to fluctuate and then drop off sharply, your fat and carbohydrate metabolism may go a
bit haywire also.” At the same time, weak muscles do not “cook” well for fat tissue (since
muscle (mamsa) is created before fat (medas), the production of medas is affected by the
health of the mamsa). This results in an accumulation of ama in fat tissue and a weakened
ability to metabolize fat. In addition, ama blocks delivery of food to cells, causing them to
send out hungry signals. This can lead to a viscous cycle of cravings, overeating, and more
ama, and potentially can result in elevated cholesterol levels, diabetes, and thyroid problems,
all of which are common during menopause.
11. Dryness (skin, mucous tissues etc)
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Medical view. Loss of estrogen is the main cause skin and vaginal dryness. The tissues
become drier, thinner and less elastic. Drying can cause burning and itching and increase risk
of infections of skin, vagina and the urinary tract.
Women’s skin secretes less oil from the fat layer and more prone to the effects of aging.
The flow of blood to skin decreases as age, bringing less nutrition to the skin. Decreased
estrogen results in thinning and drying of the vaginal tissue.
Ayurvedic view. Dry skin can have several causes. It may be due to a lack of sebaceous (oily)
secretions; insufficient sweating; an excess of hot, sharp pitta; or too much vata. External
causes of dry skin include sun, wind, hot dry air, excess washing, and excess use of soap or
dishwashing soap.
Although vata skin problems are most common during menopause, the other doshas can also
play a part. Vata skin conditions include skin that is dry, thin, fine-pored, delicate, cool to the
touch, rough, flaky. Pitta skin conditions include rashes, warmth, redness, rosacea, liver
spots, or pigment disorders. Kapha skin conditions tend to be oily, soft, cool, enlarged pores,
moist types of eczema, blackheads, pimples, water retention and fungal infections.
12. Incontinence
Medical view. Incontinence is a result from loss of hormonal support in the vagina and lower
urinary tract and loss of muscle tone in the pelvic floor. There are two main types of urinary
incontinence: stress and urge incontinence. Weak pelvic floor muscles and loss of estrogen
cause stress incontinence. Sneezing, laughing, jumping, running dancing or just standing up
quickly may provoke a leakage of urine, the intra-abdominal pressure is increased and thus
overrides the ability of the urethral sphincter to stay closed.
In urge incontinence, the detrusor muscle around the bladder is overactive and tight, with
involuntary contractions causing a sudden urge to urinate and often loosing a small or large
amount of urine. This creates stress. Often these two types of incontinence are mixed.
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Yoga Therapy and Menopause
Ayurvedic view. Urinary incontinence is primary a vata disorder, caused by weakness of the
muscles of the bladder, especially the bladder sphincter. If that becomes weak and
uncontrolled, a person may lose voluntary control of urination to a greater or lesser extent.
13. Joint problems
Medical view. Joint pain often occurs in joints of high impact, such as knees, hips and hands
become stiffer and more painful with age. Joint pain can be extremely discomforting, with
other symptoms like stiffness and swelling. As a menopausal syndrome joint pain is caused
by hormonal imbalance. Inflammation is the leading cause for joint pain and estrogen affects
joints by keeping inflammation down, as it drops during menopause, the joints get less and
less estrogen. Overweight, lack of exercise, muscle loss, stress and metabolic disorders are
other reasons for joint pain in menopause. May also include such problems as carpal canal
syndrome.
Ayurvedic view. Depending on the person’s lifestyle, diet, and emotional pattern, either vata,
pitta, or kapha goes out of balance. Then that particular dosha slows down agni (digestive
fire), resulting in the toxic, sticky by-product of inadequate digestion known as ama. Vata,
the main active dosha, brings the ama into the colon, and from there it travels through the
system and lodges in the asthi dhatu (bone tissue) and in the joints, giving rise to the stiffness
and pain characteristic of arthritis. Ayurveda distinguishes tree categories of arthritis,
corresponding to vata, pitta, and kapha.
Some of the symptoms may also be signs of the following:
 hypothyroidism

diabetes

depression with another etiology

allergy

asthma

myoms and cysts

kidney problems
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Yoga Therapy and Menopause

constipation

back pain, hip pain, knee pain

brest and uteri cancer

high blood pressure

polyartrithes

cardiovascular diseases

some other medial conditions
3.3. Yoga Philosophy and Ayurveda as base for Yoga therapy
To deal with menopause symptoms with Yoga Therapy tools we need to understand the Yoga
and Ayrveda view of human structure.
Nathamuni`s “Yoga Rahasya“ describes stages of human life.
Yoga practice is different for people in different age.
2
1
4:2:1
3
2:4:1
1:2:4
Figure 1. The evolution of yoga practice is described on this drawing.
1. SRSTI KRAMA – period of active learning and growing. Girls were prepared for the future
life. Asana part is the most important here (4:2:1)
19
Yoga Therapy and Menopause
2. STHITI KRAMA – period of stability – yoga is for good health and also for therapy if
needed. Asana part is less and the main tool is pranayama (2:4:1). Prana stores our energy.
In this period women have a lot of responsibility, a lot of things to do and not so much time
for themselves. It is period of fertility and also menopause starts. Practice must give more
energy and to maintain good health. Pranayama as a main tool helps to calm down very
quickly giving stability instead of agitation.
3. LAYA KRAMA / ADHYATMIKA KRAMA – last stage of life, free of responsibilities, time
for yourself, to observe what is inside of your heart, also preparation for leaving from this
life. Yoga practice is more meditative. Asana and pranayama must be done in smaller parts
(1:2:4)
Focus is different for every stage, but every stage prepares the next one. During the period of
menopause most women still lead active lives, Stithi krama, with many responsibilities at
work and many still have youngsters living at home. Teenage life and menopause in the same
family may be a challenging situation. There could be possibility that there are small children
in a family because nowadays women getting birth in middle age. They need to take care of
their physical and psychological health.
Five elements
There are five elements (forms of matter) and three doshas as a base for human structure in
Yoga and Ayrveda.
Earth (prthvi) – the solid state of matter, who`s characteristic attribute is stability, fixity or
rigidity. Earth is stabile substances.
Water (apa) – the liquid state of matter, who`s characteristics attributes is flux. Water is
substance without stability.
Fire (agni) – the power that can convert a substance from solid to liquid to gas or vice versa.
Increasing or decreasing the substance`s relative order. Fire is form without substance; it`s
characteristic attribute is transformation.
20
Yoga Therapy and Menopause
Air (vayu) – the gaseous state of matter who`s characteristic attribute is mobility or
dynamism. Air is existence without form.
Space (akasa) – the field from which everything is manifested and into which everything
returns; the space in which events occur. Space has no physical existence; it exists only as the
distances that separate matter.
These 5 elements condense to the Three Doshas: vata, pitta and kapha. (see table 1.)
Table 1. The five elememets and the three doshas
The five elements
Qualities
and
functions
in the
world
The three Doshas
->
Space
->
Air
>---Vata
->
Fire
----- Pitta
->
Water
->
Earth
>---Kapha
___________________________________



VATA
(Air)
PITTA
(Fire)
Dry
Light
Cold
Clear
Mobile
Subtle
Rough
Irregular
Oily
Sharp
Hot
Light
Liquid
Intense
Fluid
KAPHA
(Water, Earth)
Oily
Heavy
Cold
Smooth
Static
Slow
Soft
Slimy
Figure 2. The important qualities of the three doshas
3.3.1. Health, disease and Three Doshas
Ayrveda’s seers isolated three forces which are particularly important, because they permit us
to understand associations that exist between seemingly unconnected casual pathways and
21
Yoga Therapy and Menopause
manifested symptoms within an organism. These forces are called the three doshas. The word
dosha means “fault,” “mistake,” “imperfection,” although the doshas are paradoxically forces
that both preserve an organism`s balance and rhythm when they are themselves balanced, yet
will disturb its harmony when they are disturbed. Like prana, these three doshas are invisible
forces which can’t be directly perceived. Only their actions can be demonstrated, through the
bodily substances, which are their vehicles. These include (but are not limited to) nervous
impulses for vata, bile for pitta, and mucus for kapha.
These three doshas are condensations of the five mahabhutas - the five “great elements”
 Vata, the body`s principle of kinetic energy, is in change of all motion in the body and
mind.
 Kapha, the principle of potential energy, is the stabilizing influence in the living
being; it also lubricates and maintains.
 Pitta, which is in charge of all transformation in the organism, controls the balance of
its kinetic and potential energies.
The three doshas pervade the body, working in every cell at every instant, but they
concentrate themselves in those tissues in which they are particularly required:
 Vata is particularly active in the brain, nervous system, the heart, colon, bones, bone
marrow, lungs, bladder.
 Pitta concentrates in the brain, liver, spleen, small intestine, endocrine glands, skin,
eyes, blood.
 Kapha is most prevalent in the brain, joints, mouth, head and neck, stomach, lymph,
pleural cavity, pericardial cavity and fat.
Each of the doshas has five varieties, or subdoshas. Although these subdoshas tend to act as if
they were distinct entities, they are merely specializations of the three doshas, created by
Nature to perform specific tasks.
 The five kaphas are manifest in body lubricants, including stomach mucus, pleural
and pericardial fluid, saliva, synovial fluid, and cerebrospinal fluid.
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Yoga Therapy and Menopause
 The five pitas appear in transformative substances, including the digestive juices,
haemoglobin, melanin, rhodopsin, and various neurotransmitters.
 The five vatas divide the body into spheres of influence according to the direction of
their motion: forward and back in the chest, upward in the head, circular in the
digestive tract, outward and inward in the periphery, and downward in pelvis.
Even though they are imperceptible to our senses, the three doshas are still forms of matter.
They are more conscious matter than is the matter that makes up the body, which allows them
to influence the body efficiently, and they are less conscious than prana, the thinking mind,
and the emotions. These higher structures can therefore efficiently control the doshas – but
only in those people who have carefully aligned their prana, thinking mind, and emotions
with the higher consciousness of the soul and the spirit. Others tend to align their awareness’s
with what is going on their bodies – which allows them to fall prey to imbalance of the dosha
forces.
Vata, pitta, and kapha are “waste products” created during the subtle metabolism of the
higher forces that are prana and its associates, tejas (the universal fire that discriminates and
digests, also called agni) and ojas (the subtle glue that integrates body, mind, and spirit
together into a functioning individual). Proper elimination of these physical wastes helps to
maintain healthy levels of the doshas within the body: urine is vehicle for removing the kapha
force, sweat carries away excess pitta force, and defecation expels excess vata force. When
an organism is healthy, little waste is produced; when it is poor health, waste will accumulate.
This is one of the main reasons why those who possess good health tend to amass more of it,
and those who are sick will usually get sicker until they change their ways.
Like all other substances, the three doshas also possess qualities, and their increase or
decrease in your system depends upon the similar or antagonistic qualities of everything you
ingest – physically, energetically, mentally, emotionally, and spiritually.
All substances and all activities increase and decrease the three doshas according to their
qualities. In particular, it is almost always the case that anything dry increases vata, anything
hot increases pita, and anything heavy increases kapha, for vata is the only dry dosha, pitta
the only hot dosha, and kapha the only heavy dosha. If we wished to express this reality in
23
Yoga Therapy and Menopause
awareness terms, we might say that vata communicates dryness to the organism, that pitta`s
message to a person is heat, and finally, that kapha proclaims heaviness throughout the being.
Panca Maya Model
We are not just a physical, physiological body, but we have different kind of energy levels,
different components that make us human beings. We all are unique individuals, changing
dynamically all the time, which is an important fact to accept. During menopause changes
occur on all levels. Understanding these layers through Yoga philosophy may clarify
situation in life to many women.
As human beings we all have five important domains, levels, layers, structures in yoga
philosophy called Panca Maya. Panca = five, Maya = domain, that spreads and moves
everywhere. The layers are interconnected, what happens in one level influences the others.
The five layers are: Annamaya, Pranamaya, Manomaya, Vijanamaya and Anandamaya.
(Taitrya Upanishades chapter two).
Annamaya is the physical, physiological part of us. It has weight, shape and texture, it is
gross and definable. Annamaya is nourished with food. It has seven dhatus, which are
fundamental support structures for our body. The whole system of dhatu is to produce the
best seed in order to sustain life. Matter has a time limit, consciousness has not, body has a
time limit and consciousness knows it.
Annamaya is the container of all the other mayas and needs some warmth to work. It does not
need to be perfect in shape, but good in function; it’s more important how it works than how
it looks. In one maya exist the others.
Evolution of the human system:
According to modern science, nerves start from the brain and spinal cord. According to yoga,
nadis are similar to nerves, but they start from the base of spine, the muladhara. The nadis
carry prana to every part of the human body. Brain comes later than the mula. Our first
feelings and sensations come from there; our fundamental feelings are older than our brain.
Mula is the source; it’s a single cell having all the layers in it. The most predominant layer is
prana; it is energy and sensations.
24
Yoga Therapy and Menopause
Our energy is depending on what is in the mula, in the earth that we came from. How our
early sensations were, challenging or easy, give an impact on how our system evolves. But
we are not fixed - we are changing. Energy depends also on the space that we have, space in
our heart. We have to give importance to our past, but always remember that the past is not
fixed, we can work to change it by changing our attitude.
We all have a similar amount of energy, but we have clouds that are on the way, this happens
in every cell of our body. The space is different, it’s significant how much space you feel you
have inside you, and do you feel free or tight. Mula is partly energy and matter. This
combination of matter and space determine mula, it’s always changing.
Annamaya leads to Pranamaya, our energy level. Food we eat gives us energy. Pranamaya is
changing according to many things like seasons or depending on the task we are going to do:
we can have a lot of energy for one job, and none for another one. In the Pranayama level we
have five fundamental pranas: Prana, Apana, Vyana, Samana and Udana.
Prana is responsible of breathing, how we get energy. It is the chest area, lungs. Prana is that
which is distributed to every layer of the body, it’s the nourishment we have after digesting.
Apana is lower abdominal region, responsible for elimination and also for pregnancy. Energy
depends on how our physical and emotional elimination works. Often we are stuck with
emotions, we cannot let go.
Sometimes we hold our emotions, we don’t want to let go, and we reject elimination.
Sometimes we don’t want to receive compliments, we reject prana.
Vyana is the distribution channel that has to work well. If something is blocking it is affecting
prana and apana, depending on where the knot is.
Sometimes we don’t have control of what we get, but we can influence what we do with it.
It is important to have Prana and Apana in balance:
Elimination
Apana
Exhale
Nourishment
Prana
IN BALANCE
Inhale
25
Yoga Therapy and Menopause
Prithvi
Akasa
Samana is responsible for digesting physiological and psychological elements; it is situated in
the navel area. Udana in throat area is responsible for communication.
We cannot increase prana, but we can let it flow more smoothly, by taking away obstacles
we can regulate its flow. That will give us more space, take away the tightness, the
constriction = dukha, and give balanced flow to prana, more space = sukha.
When we get more space in the heart we have sukha, nothing is an obstacle. If we enjoy what
we are doing there are no obstacles. The obstacles are not outside, but inside us. Our knots
can be anywhere in our body. There are certain places in the body that hold energies. If knots
are in the navel area, the energy is not flowing smoothly, it gets suppressed, and we feel very
tired, the distribution of prana is prevented.
The Prthvi and Akasa of our ancestors influence our Mula. Prana is defined by the space
Prthvi allows, if its structure becomes tight flow of prana is narrower. Nadis take prana
through the channels to every level of the body. When we get older we become drier, Vata
starts to dominate and the passage gets drier, matter limits space. We need to maintain the
liquidness of our body. We get loss of prana if the structure is rigid. In burn out the whole
system dries out. Importance of what structure brings us, what it does to the space inside us.
Prana brings lightness to every part of our body. That light is already within us. Prana
switches on the light. When something is light it feels warm. When there is warmth, prana
flows. Warmth is also at the emotional level, it’s happy, relaxed, alive, pleasant feeling,
which makes our potential manifest, and our creativity and memory will improve. The
movement of prana is fine when you feel warm, not only by temperature.
Follow the breath, concentrate on prana, doing the movement with the flow of prana. Quality
of prana is revealed through quality of breathing.
Prana is life force. The subtlest element it manifests in is space. The element of space has a
function, expansion and contraction. Breath is in every cell, expanding and contracting.
Prana is conscious breathing.
Manomaya is our intellectual level, mental faculty, learning and remembering things, for us
to behave in the world. In this philosophy, the mind is a function, present in every part of our
26
Yoga Therapy and Menopause
body; it’s not an organ. We remember because of our memory (smrti). Smrti is related with
patterns (samskara). We all have our own mind, mental faculty, our patterns are established
in our memory. Some issues we learn consciously and some come unconsciously, much
cultural behaviour is received unconsciously, and sometimes we realise it when we are
abroad in a different culture. Smrti and samskaras are strongly connected. Memories are
linked with associated feelings and habits. In Manomaya we observe and develop habits.
Asana is a new pattern for body where function is more important than form. With yoga we
try to replace one samskara with other and smrti can be replaced with other.
Vijnanamaya is our fundamental behaviour, our personality, our deeper patterns form
fundamental base for our behaviour. This level includes our samskaras, our habits. It has also
our vasanas - impressions from our past that influence us. Some impressions leave a big mark
inside us; others pass quickly, depending on the incident and our sensibility. What the act is
not as important as how we take it. Vasanas influence our samskaras, our deep behaviours
and our strong patterns. With yoga we can find tools for change; to change our attitude, to
grow out of our difficult experiences, to let them become lighter. Our predispositions svabhavas for situations are different and they are very difficult to change.
Mahat influences vijanamaya. Mahat has Vasana and Svabhava in it. To balance our mahat,
we need faith, Sraddha, conviction and support that hold us. Sraddha is something valuable,
which is lifting us.
In vijanamaya we have our conviction to life. The more positive Sraddha we have, the easier
it makes our life. Intense sraddha leads us to confidence and not to fear. Every person in this
world has access to Sraddha. It is a gift of survival, individual and collective. Sraddha is the
sunlight in us that we have to follow.
Anandamaya is the deeper domain of emotions. We have to resolve Vijanamaya to reach
Anandamaya. Sraddha generates fire, Agni. Changing samskaras from negative to positive
requires heat, unless we have heat, we cannot transform. In Anandamaya we have our
fundamental feelings, we don’t know it in its full capacity. It is impossible to repeat in any
form, or to remember or to put in words. It is experience. It is beyond senses.
27
Yoga Therapy and Menopause
All of this Panca Maya is a matter of manifest but we are not only manifest beings. We also
have the unmanifest in us, the self, purusa, which is the sixth layer, Cinmaya, our life force.
In that we are all the same, it is unmanifest and it is not changing.
Evolution of the human system
According to modern science, nerves start from the brain and spinal cord. According to yoga,
nadis are similar to nerves, but they start from the base of spine, the muladhara. The nadis
carry prana to every part of the human body. Brain comes later than the mula. Our first
feelings and sensations come from there; our fundamental feelings are older than our brain.
Mula is the source, it´s a single cell having all the layers in it. The most predominant layer is
prana; it is energy and sensations.
Our energy is depending on what is in the mula, in the earth that we came from. Were the
early sensations challenging or free gives an impact on how our system evolves. But we are
not fixed we are changing. Energy depends also on the space that we have, space in our heart.
We have to give importance to our past, but always remember that it is not fixed, we can
work to change it by changing our attitude.
We all have similar amount of energy, but we have clouds that are on the way, this happens
in every cell of our body. The space is different, it´s significant how much space you feel you
have inside you, do you feel free or tight. Mula is partly energy and matter. This combination
of matter and space determine mula, it´s always changing.
In the Pranayama level we have five fundamental pranas: Prana, Apana, Vyana, Samana and
Udana.
Prana is responsible of breathing, how we get energy. It is the chest area, lungs. Prana is that
which is distributed to every layer of the body, it´s the nourishment we have after digesting.
Apana is lower abdominal region, responsible for elimination and also for pregnancy. Energy
depends on how our physical and emotional elimination works. Often we are stuck with
emotions, we cannot let go.
28
Yoga Therapy and Menopause
Sometimes we hold our emotions, we don’t want to let go, and we reject elimination.
Sometimes we don’t want to receive compliments, we reject prana.
Vyana is the distribution channel that has to work well. If something is blocking it is
affecting prana and apana, depending on where the knot is.
Sometimes we don’t have control of what we get, but we can influence what we do with it.
Elimination
Nourishment
Apana
Prana
Exhale
Inhale
Prithvi
Akasa
IN BALANCE
Samana is responsible for digesting physiological and psychological elements; it is situated in
the navel area. Udana in throat area is responsible for communication.
We cannot increase prana, but we can let it flow more smoothly, by taking away obstacles
we can regulate its flow. That will give us more space, take away the tightness, the
constriction = dukha, and give balanced flow to prana, more space = sukha.
When we get more space in the heart we have sukha, nothing is an obstacle. If we enjoy what
we are doing there are no obstacles. The obstacles are not outside, but inside us. Our knots
can be anywhere in our body. There are certain places in the body that hold energies. If knots
are in the navel area, the energy is not flowing smoothly, it gets suppressed, and we feel very
tired, the distribution of prana is prevented.
The heart area is also very important, and specially the connection between heart and navel,
Akasa and Prthvi. Prthvi is the structure and Akasa is the space. Quality of space is
determining the quality of prana.
What is in our Prthvi and Akasa is influenced by the Mula we come with. The Prthvi and
Akasa of our ancesters influence our Mula.
Prana is defined by the space Prthvi allows, if its structure becomes tight flow of prana is
narrower. Nadis take prana through the channels to every level of the body. When we get
older we become drier, Vata starts to dominate and the passage gets drier. We need to
29
Yoga Therapy and Menopause
maintain the liquidness of our body. We get loss of prana if the structure is rigid. In burn out
the whole system dries out. Importance of what structure brings us, what it does to the space
inside us.
Prana is bringing lightness to every part of our body. That light is already within us. Prana
switches on the light. When something is light it feels warm. When there is warmth, prana
flows. Warmth is also in the emotional level, it`s happy, relaxed, alive, pleasent feeling which
makes our potential manifest, our creativity and memory will improve. The movement of
prana is fine when you feel warm, not only by temperature.
Follow the breath, consentrate on prana, doing the movement with the flow of prana. Quality
of prana is revealed through quality of breathing.
Prana is life force. The most settle element, it manifests in its space. The element of space has
a function, expansion and contraction. Breath is in every cell, it is expanding and contracting.
Pranayama is conscious breathing.
Manomaya is the intellectual level, including our education and learning. We remember
because of our memory= smrti. Smrti is related with patterns= samskara. We all have our
own mind, mental faculty, our patterns are established in our memory. Some issues we learn
consciously and some come unconsciously, much cultural behaviour is received
unconsciously, and sometimes we realise them when we are abroad in a different culture.
Smrti and samskara are strongly connected. Memories are linked with associated feelings and
habits. In Manomaya we observe and develop habits.
Asana is a new pattern for body where function is more important than form. With yoga we
try to replace one samskara with other and smrti can be replaced with other.
Vijanamaya is containing what is deeper inside us. It has our vasanas = impressions from our
past that influence us. Some impressions leave a big mark inside us; others pass quickly,
depending on the incident and our sensibility. What the act is is not as important as how we
We are not just a physical, physiological body, but we have different kind of energy levels,
different components that make us human beings. We all are unique individuals, changing
dynamically all the time, which is an important fact to accept. During menopause changes
30
Yoga Therapy and Menopause
occur at all levels. Understanding these layers through Yoga philosophy may clarify situation
in life to many women.
As human beings we all have five important domains, levels, layers, structures in yoga
philosophy called Panca Maya. Panca = five, Maya = domain, that spreads and moves
everywhere. The layers are interconnected, what happens in one level influences the others.
The five layers are: Annamaya, Pranamaya, Manomaya, Vijanamaya and Anandamaya.
(Taitrya Upanishades chapter two).
Annamaya is the physical, physiological part of us. It has weight, shape and texture, it is
gross and definable. Annamaya is nourished with food. It has seven dhatus, which are
fundamental support structures for our body. The whole system of dhatu is to produce the
best seed in order to sustain life. Matter has a time limit, consciousness has not, body has a
time limit and consciousness knows it.
Annamaya is the container of all the other mayas and needs some warmth to work. It does not
need to be perfect in shape, but good in function; it’s more important how it works than how
it looks. In one maya exist the others.
Evolution of the human system:
According to modern science, nerves start from the brain and spinal cord. According to yoga,
nadis are similar to nerves, but they start from the base of spine, the muladhara. The nadis
carry prana to every part of the human body. Brain comes later than the mula. Our first
feelings and sensations come from there; our fundamental feelings are older than our brain.
Mula is the source; it’s a single cell having all the layers in it. The most predominant layer is
prana; it is energy and sensations.
Our energy is depending on what is in the mula, in the earth that we came from. How our
early sensations were, challenging or easy, give an impact on how our system evolves. But
we are not fixed - we are changing. Energy depends also on the space that we have, space in
our heart. We have to give importance to our past, but always remember that the past is not
fixed, we can work to change it by changing our attitude.
We all have a similar amount of energy, but we have clouds that are on the way, this happens
in every cell of our body. The space is different, it’s significant how much space you feel you
31
Yoga Therapy and Menopause
have inside you, and do you feel free or tight. Mula is partly energy and matter. This
combination of matter and space determine mula, it’s always changing.
Annamaya leads to Pranamaya, our energy level. Food we eat gives us energy. Pranamaya is
changing according to many things like seasons or depending on the task we are going to do:
we can have a lot of energy for one job, and none for another one. In the Pranayama level we
have five fundamental pranas: Prana, Apana, Vyana, Samana and Udana.
Prana is responsible of breathing, how we get energy. It is the chest area, lungs. Prana is that
which is distributed to every layer of the body, it’s the nourishment we have after digesting.
Apana is lower abdominal region, responsible for elimination and also for pregnancy. Energy
depends on how our physical and emotional elimination works. Often we are stuck with
emotions, we cannot let go.
Sometimes we hold our emotions, we don’t want to let go, and we reject elimination.
Sometimes we don’t want to receive compliments, we reject prana.
Vyana is the distribution channel that has to work well. If something is blocking it is
affecting prana and apana, depending on where the knot is.
Sometimes we don’t have control of what we get, but we can influence what we do with it.
It is important to have Prana and Apana in balance:
Elimination
Apana
Exhale
Prithvi
Nourishment
Prana
IN BALANCE
Inhale
Akasa
Samana is responsible for digesting physiological and psychological elements; it is situated in
the navel area. Udana in throat area is responsible for communication.
We cannot increase prana, but we can let it flow more smoothly, by taking away obstacles we
can regulate its flow. That will give us more space, take away the tightness, the constriction =
dukha, and give balanced flow to prana, more space = sukha.
32
Yoga Therapy and Menopause
When we get more space in the heart we have sukha, nothing is an obstacle. If we enjoy what
we are doing there are no obstacles. The obstacles are not outside, but inside us. Our knots
can be anywhere in our body. There are certain places in the body that hold energies. If knots
are in the navel area, the energy is not flowing smoothly, it gets suppressed, and we feel very
tired, the distribution of prana is prevented.
The Prthvi and Akasa of our ancestors influence our Mula. Prana is defined by the space
Prthvi allows, if its structure becomes tight flow of prana is narrower. Nadis take prana
through the channels to every level of the body. When we get older we become drier, Vata
starts to dominate and the passage gets drier, matter limits space. We need to maintain the
liquidness of our body. We get loss of prana if the structure is rigid. In burn out the whole
system dries out. Importance of what structure brings us, what it does to the space inside us.
Prana brings lightness to every part of our body. That light is already within us. Prana
switches on the light. When something is light it feels warm. When there is warmth, prana
flows. Warmth is also at the emotional level, it’s happy, relaxed, alive, pleasant feeling,
which makes our potential manifest, and our creativity and memory will improve. The
movement of prana is fine when you feel warm, not only by temperature.
Follow the breath, concentrate on prana, doing the movement with the flow of prana. Quality
of prana is revealed through quality of breathing.
Prana is life force. The subtlest element it manifests in is space. The element of space has a
function, expansion and contraction. Breath is in every cell, expanding and contracting.
Prana is conscious breathing.
Manomaya is our intellectual level, mental faculty, learning and remembering things, for us
to behave in the world. In this philosophy, the mind is a function, present in every part of our
body; it’s not an organ. We remember because of our memory= smrti. Smrti is related with
patterns= samskara. We all have our own mind, mental faculty, our patterns are established
in our memory. Some issues we learn consciously and some come unconsciously, much
cultural behaviour is received unconsciously, and sometimes we realise it when we are
abroad in a different culture. Smrti and samskaras are strongly connected. Memories are
linked with associated feelings and habits. In Manomaya we observe and develop habits.
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Yoga Therapy and Menopause
Asana is a new pattern for body where function is more important than form. With yoga we
try to replace one samskara with other and smrti can be replaced with other.
Vijnanamaya is our fundamental behaviour, our personality, our deeper patterns form
fundamental base for our behaviour. This level includes our samskaras, our habits. It has also
our vasanas - impressions from our past that influence us. Some impressions leave a big mark
inside us; others pass quickly, depending on the incident and our sensibility. What the act is
not as important as how we take it. Vasanas influence our samskaras, our deep behaviours
and our strong patterns. With yoga we can find tools for change; to change our attitude, to
grow out of our difficult experiences, to let them become lighter. Our predispositions svabhavas for situations are different and they are very difficult to change.
Mahat influences Vijanamaya. Mahat has Vasana and Svabhava in it. To balance our mahat,
we need faith, Sraddha, conviction and support that hold us. Sraddha is something valuable,
which is lifting us.
In Vijanamaya we have our conviction to life. The more positive Sraddha we have, the easier
it makes our life. Intense sraddha leads us to confidence and not to fear. Every person in this
world has access to Sraddha. It is a gift of survival, individual and collective. Sraddha is the
sunlight in us that we have to follow.
Anandamaya is the deeper domain of emotions. We have to resolve Vijanamaya to reach
Anandamaya. Sraddha generates fire, Agni. Changing samskaras from negative to positive
requires heat, unless we have heat, we cannot transform. In Anandamaya we have our
fundamental feelings, we don’t know it in its full capacity. It is impossible to repeat in any
form, or to remember or to put in words. It is experience. It is beyond senses.
All of this Panca Maya is a matter of manifest but we are not only manifest beings. We also
have the unmanifest in us, the self, Purusa, which is the sixth layer, Cinmaya, our life force.
In that we are all the same, it is unmanifest and it is not changing.
take it. Vasanas influence our Samskaras, our deep behaviours and our strong patterns. With
yoga we can find tools for change; change our attitude, grow out of our difficult experiences,
let them become lighter. Our predispositions = svabhavas for situations are different and they
are very difficult to change.
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Yoga Therapy and Menopause
Mahat influences Vijanamaya. Mahat has Vasana and Svabhava in it. To balance our Mahat,
we need faith, Sraddha, conviction and support that hold us. Sraddha is something valuable,
which is lifting us.
In Vijanamaya we have our conviction to life. The more positive Sraddha we have, the easier
it makes our life. Intense Sraddha leads us to confidence and not to fear. Every person in this
world has access to Sraddha. It is a gift of survival, individual and collective. Sraddha is the
sunlight in us that we have to follow.
We have to resolve Vijanamaya to reach Anandamaya. Sraddha generates fire, Agni.
Changing samskaras from negative to positive requires heat, unless we have heat, we cannot
transform. In Anandamaya we have our fundamental feelings, we don’t know it in its full
capacity. It is impossible to repeat in any form, or to remember or to put in words. It is
beyond senses.
4. Methodology
In this chapter there is first an explanation of Yoga therapy solutions to the most common
symptoms of menopausal period followed by the methodological issues in this study.
4.1. Yoga therapy view
Menopause is a natural process and acceptance is important. By focusing all attention to the
problems, symptoms are amplified. It is important to find right tools for individual problems:
movement, breathing, sound, mantra and meditation, and to find out the person’s potential.
We always start to clear and deal with main problem.
All yoga tools work in all layers, although the starting point is different.
Table 3. This table describes the starting points of yoga tools.
Layer
Tool
1
2
3
4
5
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Yoga Therapy and Menopause
Yama
X
behaving
Niyama
X
contentment
X
X
Asana
X
combined
with
pranayama
X
Pranayama
combined
X
with
bandhas
Mantra
X
Mudra
X
X
Bhavana
visualization
Pratyahara
control of senses
Meditation
X
X
X
X
X
X
1. Emotional instability (Mood swings, depression) The most important is focusing
mind to other direction. Studying yoga philosophy gives a lot of help. Focus on
moving towards release and spiritual life.
In depression tamasic guna dominates. Depending on state of illness, medical help is
needed in some cases. After that, yoga practice is possible to start.
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Yoga Therapy and Menopause
In asana practice brmhana quality is needed . Work on prana region in the morning
to give sattvic quality: opening for the chest region with focus on inhale and hold after
inhale; neck movements and straightening the back are giving strength and stability.
Strong and active movements with different numbers of sequences and positive
bhavana gives for the mind a good concentration. All dynamic postures
recommended, mostly standing with opened eyes
Chanting loudly. Langhana practice in the evening.
Pranayama: Nadi sodhana. Viloma ujjayi in the morning. Sitali or nadi sodhana in the
evening.
Meditation: visualisation on different qualities of the Sun as light, life force and energy in the
morning and cooling practice on the evening. Using faith (sraddha) as main supportive force.
Generally for depression: relaxing the mind but brmhana practice for the body. Physical body
is warming up and mind calms down.
Ahara-vihara: focus on positive aspects of the life (relationship with friends and family, new
hobbies, activities that bring joy, etc). Food must be sattvic (balanced).
2. Inability to concentrate. Practice has to be active and changed quite often. Different
numbers of repetitions. Later static postures. Using nyasam. Chanting .
Pranayama: ratios,ujjayi (in asana practice also ) anuloma ujjayi, viloma ujjayi,
pratiloma ujjayi, sitali, nadi sodhana.
Meditation: focus on what gives mental stability (mountains, stones, trees etc).
Ahara-vihara: Long walks. Sattvic ( balanced )food is good.
3. Stress. Practice evolves movements for relaxing, and strengthening all systems over
long time. It must give support, to help cleansing process and also to remove
obstacles. Relief from stress comes through continuing yoga practice and changing
life style.
Pranayama: sitali, nadisodhana, anuloma ujjayi.
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Yoga Therapy and Menopause
Sounds and chant for relaxation and calming. But in some cases - sounds or chant with strong
voice.
Meditation: Working on concept of faith what gives strength and support and with positive
focus (sunrise, happy feelings, good memories etc.)
Ahara – vihara: Finding positive emotions through movies, singing, reading, meeting good
friends and discussion with them. To avoid stressful situations. Structure in life helps reduce
the effects of stress. Regular day routine with good eating habits and sleeping patterns are the
base for changing patterns. Learning of yoga philosophy for deeper understanding of life
gives lot of support. Every time surrounding changes it is important to learn to change along
with them without stress and to develop a new equilibrium.
4. Memory problems. The reason for loose of memory might be some illnesses
(Alzhaimer, high cholesterol, stroke etc ), medication, trauma etc. In menopause
women mind becomes restless, not focused ( vata disorder or stagnation of kapha
quality ) and this is the main reason for memory problems. In every case we are
working differently.
For some cases is useful to start with simple asana practice adding nyasam and
touching the different body parts ( to remember what place and how many times ).
Different numbers of movements. Later - longer vinyasas. Practice must be changed
quite often.
Using sound, chanting and bhavana. Good to learn longer texts as Gayatri mantra,
Surya mantra, Patanjali Yoga Sutra etc., and to create rituals.
Meditation focus depending on, which kind of disorder is the reason of memory loose.
When vata disorder - stability ( stone, mountain, tree etc ) and if kapha disorder to
concentrate, what brings clarity (sun, flowing water, light etc ) .
In some cases ( if memory problems comes from high stress level and tension ) relaxation is
needed: postures done on exhale, prolongation of exhale and hold after, soft sound (mmm,
maa, laa ) or chant ( santih, somaya namah, namah etc ). Working on better sleeping patterns
through langhana evening practice.
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Yoga Therapy and Menopause
Using sound, chanting and bhavana. Good to learn longer texts as Gayatri mantra,
Surya mantra, Patanjali Yoga Sutra etc. and to create rituals.
Ratios and different pranayama technics are useful to teach.
Ahara – Vihara: Organising daily routine and stable structure for work and rest.
Active walk every day. If to forget something just sit quietly and to stay with this and
breath calmly. Using notebook to release stress level. Recommended by ayurveda:
carrots-, beets juice (enhance pitta ), sweet potatoes, spinach, ghee and other sattvic
food. Ginko tea.
5. Lack of energy. (Chronicle fatigue)
The reason for this symptom is different and according to this , there are used different
practices. To find the reason is most important. Very often there is luck of sleep or over
working and not enough fire. In this case we need to improve good sleep and rest.
Langhana practice in the evening . Prolongation of exhale with soft movements, hold
after exhale. Focus more on apana region. Sound or chant softly or mentally. Not long
practice.
Pranayama: sitali/ sitkari
Meditation on breath (longer exhale ), still water, moon, calming feelings, directing mind
on different body parts with using bhavana( giving away tiredness, heaviness, releasing
all what is not useful)
Later: morning practice should be for strengthening inner fire. Vinyasas with hold after
inhale, more opening up in the beginning and calming part in the end. Practicing
Mahamudra, Bhujangasana, Dvipadapitham etc. In starting point it should be shorter
practice.
Sitali, nadi sodhana,ujjayi, anuloma ujjayi pranayama
Meditation on positive force - morning sunlight, moving water (river, sea) or something
personal, what gives joy and feeling of space ; filling the body parts with lightness and
energy. Sound or chant, what supports this process ( hram, hrim...,Om, Suryaya Namah,
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Yoga Therapy and Menopause
Namah, Om Namo Narayanaya etc.). Work on faith (sraddha) what gives the base for the
spiritual development for the future.
Ahara – vihara: Resting in daytime, short walks. Appropriate bed time and enough sleep.
Sattva food. Warm drinks. No animal fats.
If there are specific illnesses, consultation with doctor is needed.
6. Sleeping problems.
In the morning recommended practice is from lying to standing postures. Morning practice
should be strong ( if mind is restless in the morning ).
Relaxing practice in the evening: langhana movements done on exhale; exercise is mild with
prolongation of exhale or with soft or mental chanting.
Visualisation
of full moon, still water, sunset etc, chant (santhi, somaya namah) and
relaxing sounds (ma, om) for calming mind must be done only softly or mentally.
Sitali pranayama, ujjayi on exhale
Evening practice can be done in bed before falling asleep.
If waking up in the middle of the night – concentration in different parts of the body with
prolongation of exhale, nyasam, keeping hands on the belly to feel the breath, chant
(mentally), reading numbers (from 60 to 1)– to keep mind busy.
Every tool must be used according to student capacity and needs.
Ahara-vihara: Changes in life style and eating habits are necessary. Walk in the evening. Not
to eat late in the evening, not to go to sleep too late, not to excite the mind – movies, books,
events, not to solve problems before sleeping time and not to work too late. Not to sleep on
daytime. Remove the causes of stress.
Recommended herbal teas are chamomile, peppermint and lavender.
7. Hot flashes. The body has to be done hotter. Heat is fighting against heat. Asana practice
is vinyasa krama, staying in postures (bramhana) and a langhana pranayama at the end of
asana practice (prolongation of exhalation with holding after exhale).
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Yoga Therapy and Menopause
Pranayama: sitali/sitkari, ujjayi, anuloma ujjayi, in some cases pratiloma ujjayi with short
hold after exhale.
Meditation: Chanting with low voice, calming visualisation (phases of the moon – full moon
or waning moon, calm water or flowing water) in the evening.
Chanting ( suryaya namah, chandraya namah) , what brings activity or some active sounds (
ram, hram,hrim...). - in the morning. Visualisation of the space in the heart, light and clarity.
Ahara – vihara: To have enough air in room. Walk in fresh air. Herbs: strong sage tea in the
morning and in the evening. No spicy food.
7. Palpitation. In menopause, very often it is a symptom of panic and not organic
illness.
Langhana practice, relaxing all levels. Calm, soft low sounds and extending exhale.
Sitali pranayama, ujjayi on exhale
Meditation: visualisation of the space in chest area supported by mental chant.
Usually palpitation is psycho – somathycal symptom and happens outside of the
home or in night time. Practice need to be done immediately and this is why there are
“silent tools “. In some cases good to use chant with voice and hand movements.
Learning, how to accept some symptoms and to keep mind relaxed.
Good to have consultation with doctor to be sure about other conditions what might
be reason for such symptoms.
Ahara – vihara: Relaxation during daily activities. Not spicy food. Not to eat too
much in one meal.
8. Decreased libido
This happens because of psychological changes and also physiological changes in
woman s body. Focus shifts in spiritual part.
Dryness of vagina is one symptom what decreases libido.
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Yoga Therapy and Menopause
Working on apana region is important. Hold after exhale and prolongation holds
while practicing Ashwini mudra ( contracting lower floor muscles ). Practicing
towards Mula Bandha and Uddiana Bandha ( long term goal)
Keeping whole body active, practicing vinyasas and doing all possible movements in
different directions.
Meditation: Working on mind level with positive attitudes, and what keeps joy of life.
Bhavana in apana region - filling it with energy.
Ahara – vihara: Ayurveda suggest using oil ( sesam ) tampons and oils in food.
Positive emotions are useful and good relationships.
9. Osteoporosis. Muscular activity stimulates bones to strengthen themselves much
more vigorously than weight-bearing alone, and so doing prevents bones from
inordinate thinning.
Lot of body movements and repetitive movements for joints is helping. Staying in
posture gives the bone stimulus to promote the process of strengthening. Not to use
lying postures. Using back bends because osteoporosis moves the body forward.
By feeling the connection to earth and to the centre of the body women can build up
security, and a feeling of safety that affects our bones, blood and immune system.
Ahara – vihara: Active walking every day. Calcium and vitamin D are recommended for
strengthening of bone system. Sources of calcium are milk and dairy products, some nuts,
green leafy vegetables, beans and dried fruits.
10. Irregular menstruation. In perimenopause woman may have this symptom very
often. In some cases medical help is needed.
Practice must be calming, main focus on apana region. Holding hands on the belly.
Prolongation of exhale without contracting abdomen. Keeping legs on the chair. No
strong exercising in this period.
.
Pranayama: sitali/sitkari.
Meditation: bhavana must be cooling ( full moon, water ) done with soft or mentally
chanting (santih, namah, somaya namah, Om,.).
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Yoga Therapy and Menopause
Between menstruation - strengthening whole system with active practice is important;
learning chanting and having mental strength through this. Learning yoga philosophy
to face with fear.
Ahara – vihara: more resting, not carrying heavy objects, keeping mind cool. Not
eating spicy food and drinking hot drinks.
12. Heavy bleeding. Lot of relaxation on all levels (especially evening relaxation). Legs on
chair. Focus on lower abdomen (apana region). No contraction after exhalation. Long exhale
with chanting softly or mentally. Sitali pranayama (modification). Keeping hands on
abdomen. Visualisation of Moon, calm water.
Strong practice recommended for the strengthening the whole system during the time
between bleedings.
Ahara-vihara: a lot of rest, drinking warm fluids, not food what increases fire (spices, garlic,
eggs, meat, cheese, sugar). Sattva food is recommended.
Herbs: nettle tea. Applying sesame or castor oil on lower abdomen.
13. Breathing difficulties. There are lot of reasons what creats this problem.
14. Weight gaining. The reasons of weight gain are overeating in simple carbohydrates, slow
metabolism, physical inactivity, medication, psychological factors, different diseases.
Owereating of all kind is most often the result of psychological and emotional factors, such as
low self – esteem, anxiety, grief and sadness.
Recommended practice: Vinjasas , movement on hold after exhale and kramas. Staying in
postures. Forward bends and twists. Focus on apana region. Hold after exhale.
Using sounds (hram, hrim, hrum, hraim, hraum, hrah) and Surya mantra, Chandra mantra
Pranayama: Ratios, Sitali pranayama, ujjayi, anuloma ujjayi, viloma ujjayi, pratiloma ujjayi,
nadi sodhana.
Kriyas: Kabalabathi (combined with sitali), bastrika.
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Yoga Therapy and Menopause
Meditation for supporting self confidence. Using faith (sraddha) as main supportive force.
Using chanting with visualisation to get light and energy.
Practice must be done according to the student current needs and capacity, considering all
illnesses what might be a part of overweight case ( pain, high blood pressure, constipation,
high cholesterol etc.)
Ahara-vihara: walking, cycling and swimming. Changing food habits. Not eating late in the
evening and to regulate eating schedule. Keeping right diet, eating with positive attitude
enjoying the taste of food and chewing enough. Avoid heavy, tamasic food what increases
kapha. Less salt. More spices, cinnamon, cardemon. To drink enough liquids.
14. Dryness of tissues. Dryness in mouth can be relieved by jihva bandha. Taking care of
apana regin by exercising keeps mucosa tissue in a good condition in vagina and
urethra. Ashwini mudra helps to work with this area and bandhas. In vata age is
important to keep body in balance through practicing every day.
Ahara – vihara: Drinking enough during the day and using sesame, coconut, almond
or olive (according to constitution ) in food and on skin also.
16. Urinary problems.
Being aware of pelvic floor muscles and exercising them, they get stronger for holding the
inner organs, giving them a stable floor. Practicing Aswini mudra
Strength and flexibility should be there at the same time. (Too tight muscles create pain and
strain in this area). Working these muscles also increases innervations and blood flow into
vagina, bladder and urethra, making the tissue more resilient. This problem is limiting many
women’s lives as they are afraid of going away from home, and have to plan activities always
by finding out where are the lavatories. Often these two types of incontinence are mixed.
Ahara – vihara: Avoiding caffeine and keeping constipation helps. Stressful psychological
situations make this problem worse. Avoid stress.
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Yoga Therapy and Menopause
It is important to be connected to the Apana region, to feel it from inside and to find the
upward movement exhale is giving. When finding the link between apana and prana (the
heart/chest area) the flow of prana becomes more and more free.
17. Joint problems. Joint pain often occurs in joints of high impact, such as knees, hips and
hands become stiffer and more painful with age. Joint pain can be extremely discomforting,
with other symptoms like stiffness and swelling.
If there is an acute pain, practice has to be langhana to reduce pain – soft dynamic
movements according to symptoms or static postures sitting or lying (langhana) or one part is
static, other moving. Practice must be comfortable for student. Sometimes asymmetrical
movements. Not to put weight on joints.
If pain is not acute – simple movements, laying, moving one by one legs or hands, good one
at first, on painful side – very small movements on exhale. Fixing focus – making joint work
correctly. Increasing mobility little by little using vinyasas. Using support in standing
postures.
Strengthen the joints through static postures is a long term goal.
Prolongation of exhale and hold after exhale, cooling pranayama, soft sounds, calming
visualisation (moon, water, etc).
Practice 3 times per day 20 – 30 min. Hot shower after. Rest after.
Warm oil application before practice.
Ahara – vihara: rest after work with relaxing breathing. Suitable lifestyle – not to carry heavy
objects. No jumping, running, dancing. Weight loose (in long term).
Eat vegetables (not boiled but flushed with hot water). Drink cumin water, camomile, warm
tea. Foods to be avoided are: fried foods, red meat, hydrogenated oils, dairy products from
cows, caffeine, white sugar and flour. Eat food rich sulphur: cabbage, broccoli, cauliflower,
Brussels sprouts, onions, leeks, scullions, garlic and eggs.
Pain. If the main problem is pain, then the first goal is to reduce pain.
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Yoga Therapy and Menopause
Tools: practice has to be langhana to reduce pain – soft movements according to symptoms,
prolongation of exhale and hold after exhale, cooling pranayama, soft sounds, calming
visualisation (moon, water, etc).
Back pain. In menopause women often refer to back pain. Reasons are different.
Lower back pain manifests in different ways. Relaxation is needed to reduce pain according
to the student`s condition. Sometimes forward bend works better, sometimes back bend.
Observation is needed to decide, in which direction to start. Relaxation is needed to reduce
pain according to the student`s condition.
For some people stretching gives relief
(backbend), for some forward bend type of movements. According to the student, we create a
practice. Extending exhalation and using soft or mentally sounds relives the fear of pain.
Starting position must be comfortable for student - usually laying . All movements can be
done on exhale at first.
Pranayama: ujjayi on exhale, sitali/sitkari; asymmetrical anuloma ujjayi when pain in one
side of the back (ex.:2 times exhale from left nostril, one time from right- it is one cycle for
pain in left side)
Meditation: Bhavana - directing prana, light, space, towards the painful area. Relaxing back
with chant ( Santih, Om, Namah, Somaya namah...). Working with the mind, filling it with
faith and trust using chant ( Sraddhaya namah, Hrdayam may.. ) to get rid of fear.
When the pain has passed, we have to restore body movements in all directions step by step.
At first find what are possible directions, then improve the mobility in all possible directions
and then strengthening the structure through taking care of all muscles around the lower back,
tightening apana region, staying against the gravity, staying in postures.
Ahara-vihara: sleeping on harder bed, relaxing , resting enough. Building body awareness:
working positions, sitting position. Avoiding lifting heavy objects. No vata food.
Headache. Gentle relaxation is needed in all levels. Using lying postures with focusing on
apana region, opening neck and shoulder region, neck relaxation. Main focus should be on
chanting and meditation.
In some cases, if migren, just resting in a comfortable position, wet cloth on eyes in a dark,
calm room and focusing on long exhale in apana region gives help.
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Yoga Therapy and Menopause
Pranayama: long exhalation, sitali/sitkari with soft chant or sound on exhale ( santih, Om,
namah) placing hands on eyes.
Meditation: mainly cooling and relaxing. Bhavana on flowing water, cooling and flowing
prana, space and clarity in the head region.
There has to be strong practice between headaches, building up the muscle balance between
weak and tight muscles of the whole body. Vinyasas and static postures done in all possible
directions
Ahara-vihara: to have a good rest, fresh air, slow walk, light, sattva food. The cool, wet
towel on the forehead gives relief. Awareness of sitting, standing and working postures
.
Constipation. The reason might be physiological or psychological. It is vata condition
expressing ( dry, hard ). It may cause many problems by itself (discomfort, flatulence
and pain, headache, bad breath etc.) and may lead to absorption of toxins from the colon.
Practice, what includes active vinyasas, focusing on apana region ( pascimatana- , parivrtti-,
parsva type) done on exhaile, inverted (viparita) postures. Prolongation of exhaile and hold
after ( towards uddiyana bandha ) . Postures done on inhale ( purvatana type ) and short hold
after inhale for increasing digestive fire are also useful. Using sounds( hram, hrim..) and
chanting what helps to increase fire and activates digestive process. Drinking warm water
before practice.
Pranayama: ratios ( 1.0.2.0; 1.0.1.1; 1.0.1.2; 1.1.1.0, 1.2.1.0 ) depending on capacity and
current needs ( including other symptoms of menopause ); sitali/sitkari (reliving stress level);
nadisodhana, ujjayi, anuloma ujjayi, viloma ujjayi, pratiloma ujjayi.
Meditation on cleansing process, visualisation of flowing water, movement of prana in
abdominal region; for increasing cooking process in samana region - bhavana on fire,
warmth. Using chanting
(Om hram, om hrim..., Agnaye namah, Suryaya namah,
Gayatrimantrah etc ) together with visualisation.
Ahara – vihara: Exercising every day, active walking. Dicrising stress level. Vata balancing
diet is needed: Food and drink must be warm. No dried fruits, salads, most beans. Eating well
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Yoga Therapy and Menopause
cooked vegetables and good oils. Drinking kumin tea, senna leaf tea, ghee in hot milk,
pineapple juice and eating more fiber (oatmeal). Avoid over eating.
4.2. Methods used and Yoga Therapy tools
Yoga Therapy methods and tools for reducing menopausal symptoms were:
 Individual Yoga classes (during 2 months to 3 years): data anamnesis, testing (pulse
diagnostics, color of the skin, temperature etc), observation of breathing and
movement capacity, mental capacity
 Yoga group classes (during 1 month to 4 years): feedback through discussion
 Questionnaire for Menopausal Women (see Appendix)
 Interviews (in individual classes, in group classes)
Yoga tools:










Yama, Niyama
Asana
Pranayama
Sounds
Chanting mantras
Meditation
Visualization
Rituals
Yoga philosophy
Ayurveda
The selection criteria
The selection criteria for participation were middle-aged women with menopausal symptoms
and interest in individual development by Yoga Therapy. The participants were recruited
through our general yoga groups and “mouth to mouth information”. Information about the
menopause study with an option to participate was proposed.
5. Results and Discussion
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Yoga Therapy and Menopause
Altogether 49 women were included in this study. They participated in the questionnaire, the
group sessions, individual classes and the interview. Age range was between 47 and 61 years.
Their earlier experience of Yoga was from 1month to 20 years and they practiced yoga either
in groups, individually or both. (See table 3) (Questionnaire in Appendix 1)
Table 3. Background variables of the participants (n=49)
Backround variables
Results
Age
Experience of yoga
Type of practice
1) only in group
2) only individual program
3) both, group and individual program
Practice frequency
a) once in a week in a yoga group
b) once a week in a group and individual practice
2 – 3 times a week (individually)
4 – 5 times a week (individually)
6 – 7 times a week (individually)
c ) only individual practice
2 – 3 times a week
4 – 5 times a week
6 -7 times a week
Reason for starting yoga
a) interest in philosophy
b) physical well-being
c) health problems
d) wish to change yourself
e) to learn to work with yourself
f) to keep good tonus
g) other reasons
Questionnaire
47 – 61
1 month – 20 years
1
2
3
n=8
n=14
n=26
12
n=8
n=3
n=17
n=6
n=4
n=6
n=4
4
n=21
n=24
n=30
n=23
n=28
n=18
n=9
All participants but one were going through menopause (perimenopause, menopause or
postmenopause), and had various menopausal symptoms. The most common chronicle illness
was back pain (see table 4). The women participating in the study took medication for
diabetes, asthma, allergy and high blood pressure. Two women took sleeping pills. Hormone
replacement therapy was used by eight participants, of these one stopped taking HRT during
the Yoga therapy period and two are waiting for life situation to calm down to be able to stop
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Yoga Therapy and Menopause
HRT. Most of the others are also having a long-term goal of getting rid of hormones, but felt
it was too early at this point. Homeopathy and acupuncture were used to relieve menopausal
symptoms. Also vitamins and different natural products were taken (soya, propriotes,
glucosamine, omega 3, magnesium, salvia). See table 4.
Table 4. Health situation among the participants
Menopause symptoms
Emotional unstability (sadness, irritablity, fear,
depression, anxious)
Inability to concentrate
N
Chronical diseases
n=23 diabetes
n
n=1
n=22 asthma
n=5
Stress
n=27 hypothyreoidea
n=2
Memory problems
n=16
allergy
n=2
Lack of energy, tiredness on daytime
n=23
gynecological operations (operated
myoma, cysts)
n=5
Sleeping problems (can be multiple choices)
a) inability to fall asleep
b) waking up in the middle of sleep
c) waking up too early
Hot flushes
pyelitis
n=19
n=26
n=11
n=19 insomnia
n=2
Palpitation
n=13 depression
n=1
Decreased libido
n=12 back pain (incl.disc prolaps n=4)
n=14
Osteophorosis
n=5
hip problems
n=4
Irregular menstruation
n=7
breast cancer (operated)
n=2
Heavy bleeding
n=3
polyarthritis
n=1
Breathing difficulties
n=6
knee problems
n=2
Weight gaining
n=18 Allergy
n=1
Dryness of skin
n=21 Struuma
n=1
Incontinence
n=11 high blood pressure
n=2
Problems of joints
n=22
n=2
The women participating in our study did all ask help for menopausal problems from Yoga
therapist, 7 from doctor and 9 had been discussing the problems with their friends.
Table 5. Medication and HRT among participants.
Question
Yes
No
Question
number in
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Yoga Therapy and Menopause
N
n
questionnaire
(appendix 1)
Are you going through menopause?
n=49
48
1
5
Do you take any medication?
n=42
14
28
8
Are you using hormonal replacement therapy
n=49
8
41
9
n= 49
22
27
10
(HRT) to relieve symptoms of menopause?
Do you use natural therapy?
(homeopathy, herbs etc)
The open-ended question in the questionnaire (no 14) was used as a base for the interview.
The participants mentioned relaxing trough yoga exercises as a method to survive different
situations in everyday life, both situations regarding a hectic and stressful lifestyle and
situations regarding menopausal symptoms.
“I have learned to take small pauses during the day, to stop and listen to my breath, let it
become calm, adding an image to my mind that gives me tranquility.”
Consciousness about life situation started to increase. A feeling of self-awareness, strength
and balance in body and mind were improving.
“Yoga practice helps me get closer to myself, the deep self. It clears my life and brings peace
to my soul.” “Yoga makes me alive in spiritual way. It gives me vitality and balance.”
Participants found satisfaction and happiness in their life. There were changes of attitude,
new directions in life and a feeling of being alive in a spiritual way. Someone had learnt to
change food habits trough Yoga Therapy sessions, and was feeling lighter and more energetic
with the new way of eating. Someone said Yoga gave self-inquiry and rhythm to life.
Some women told they were glad to feel the physical strength awakening and sensing better
alignment of the body. Also get conscious of the excessive tensions in the muscles and to be
able to let go.
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Yoga Therapy and Menopause
Through Yoga practice, the quality of sleep had become better. There was less anxiety when
waking up at night, and practice made it easier to fall asleep. “I try not to force myself to
sleep, but think that relaxation is also rest and sometimes that makes me fall asleep again.”
For hot flashes, incontinence and painful joints the participants had concrete solutions.
“For my incontinence problems I’ve got help by doing exhales from lover abdomen and
slightly contracting the pelvic floor muscles several times a day.”
“I have learned to change my attitude, to take some humor with my menopausal problems.”
“Sitali breathing helps against hot flashes, also the change of attitude: now I embrace the
flushes and that makes me feel better.”
“If I don’t do my practice I’m more stressed and I get pain in my joints.”
Breathing was mentioned as something the participants had learned to use in many life
situations, to get to be more focused, to find calmness and also to wake up, to get energy.
See Appendix 2 for the original answers on questionnaire question number 14.
Discussion
The results show that the women participating in this study had all the typical symptoms of
menopause as well as difficulties in coping with them. In western society we are not prepared
for the hormone driven changes that menopause brings us. Feedback from groups tells that
individual practice, supported by group classes, gave a lot of motivation and help to the
participants to be more interested about their own progress. Care-seekers commented that
they did not know where to search help or what to do to reduce symptoms. Therefore we have
found out that there is a need for both individual and group classes in which solutions for
improving life at middle age are taught by using Yoga Therapy.
The participants of this study felt that they got advice and ways to cope with menopausal
symptoms. Below we explain how we planned and realised our classes. We also discuss some
of the Yoga Therapy philosophy we used in our groups and in the individual classes.
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Yoga Therapy and Menopause
Our teaching was based on Patanjalis Yoga Sutras, Yoga Rahasya and Upanishades. We took
up one topic of Yoga philosophy in the beginning of every group class. In individual classes
we used yoga philosophy according to the student’s current needs. The wisdom of Yoga
philosophy gave a new point of view to the care-seekers problems.
Behavioural patterns (samskaras) are firmly established by the time of menopause. We are
not always aware of them and don’t dare to think about changing them although our body is
insisting on trying to tell us that there is a need for change.
What is on the mind is also in the body, and spreads to all our levels so it can be recognised
in our breath and emotions. Mind can have one pattern, one kind of behaviour at the time,
which can change. Health and disease are both patterns that can change. In case of illness, it
helps if we can create a new pattern of behaviour or attitude. We need to strengthen the new
pattern, because the old one stays always with it, getting weaker. By adding something new,
good for us, the old pattern fades. Transformation is a change, but not a permanent one, so we
cannot take it for granted. Continuation of regular practice and detachment is needed to reach
the state of clarity of the mind. It is important to let go off something to get to the goal. By
regular practicing the new habit gets stronger. Regular practice gives experience of change on
all five layers and motivates to continue practicing. “I feel more in balance within myself
after the morning practice, and I can feel if I have not done it.” It is necessary to continue
practising even when the goal is reached. Otherwise we will not be able to stay there, after
stopping regular practice problems might come back. The practice gives results when
continued over a long time without interruptions and with a positive attitude and eagerness.
The attitude to start the practice may not be filled with eagerness in the beginning, but by
taking up the habit of starting it regularly in any case, this attitude changes. Yoga Sutra gives
the advice to avoid things that are not good for us even when we are tempted, and to do
things that are good for us.
The inner fire helps to eliminate defects by practice and attitude, and motivates to keep up the
new way. It is important to notice defected patterns, deal with them, not run away and feed
the fear. For changing the patterns discipline is needed: efforts need to be strong.
Fear is with us from birth and so is faith. During the years of menopausal period women have
many fears, such as ageing, losing close people and no longer being necessary at work and in
family life. Different fears can hide the faith and trust in life. By practice of yoga there is
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Yoga Therapy and Menopause
possibility to find out a source of faith for each person. In India yoga therapists often ask:
“Who is your favourite God?” here in the North we can ask: “What gives you support in life?
What gives you faith in your life?” Many people are supported by Nature and their ancestors.
They have faith in love, compassion and other Universe’s Laws or they get strength from
believing in God. By strengthening the faith with visualisation, sound and other tools of yoga
it is possible to change old samskara. It happens step by step. Awareness of good changes
gives more confidence, courage and strength.
All people have obstacles what is not possible to change, but it is possible to change attitudes
towards them. Care-seekers experienced that the yoga practice helped them to concentrate
and to become aware of some patterns. By visualising useful qualities for every individual
(strength, light, space, love, warmth, flexibility, cleansing etc), these qualities will transfer
into the person, which influences the healing process. This experience motivated care-seekers
to go on with their practice. It gave faith and very often belief that they can change quality of
their life themselves. Women are better able to take responsibility of their health and future
life.
There are often conflicts between what we perceive and how we communicate. Kausthub
Desikachar has said: “Embrace what you are doing or don’t do it”. What we feel in our heart
is what we should speak and express in our actions. Reducing the gap between the perception
of reality and how we live by it is the base for reducing sufferings. In everyday life, people
are linking to fear or to faith, it is our personality at that time. Depending on what we link
with reality will change. To be aware of this and to learn to link with faith (Sraddha) is a long
process, for the rest of our lives.
Sraddha comes from fire and fire comes from sraddha, they are connected. The sound of
voice determines our sraddha, voice communicates a lot about a person. Using sound and
mantras in the practice has been also a step-by-step process. Some women were not confident
in using their voice and needed some time and practice to change their attitude and let the
sound come freely out. It is important to find own voice, to dare to speak about difficult
problems, to deal with them and not to hide them. Also to know when it is time to speak, or
not to speak, and reflect on how to do it. It was a process of finding the own deep sound, to
get to know it and to learn to use it in a conscious way.
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Yoga Therapy and Menopause
Many women have a lot of tensions in their whole system, especially in their body. The body
is a container for patterns. Ancient texts say that the body is our temple and there must be
clean and quiet. That means the mind has evolved in this process. One of the important goals
is to start cleansing of the container on the different layers. Exhale helps the cleansing
process and letting go, mudras and bandhas are for strengthening. We are using postures as
most gross tool, and pranayama and meditation as more subtle tools for that. Using of sound
is enhancing cleansing process.
When teaching sounds, it is necessary to turn attention to the quality of voice. Mood swings
can have an effect on the way of speaking to colleagues, family members, neighbours and
any people we meet. There is always a message not only in the words but also in the tone and
sound of voice. Verbal communication increases or reduces suffering. When suffering grows,
the space in the heart decreases. Paying attention on feeling of tightness in heart space and
hearing the voice quality, women will be more conscious and avoid suffering in the future.
The voice should come from the clear and calm place in our heart.
Women become wise step by step, and their advice can help next generations. The voice in
the belly is coming from the previous generations; our voice is also the voice of our
ancestors. Finding our voice means also being at peace with our past, not fighting to crack it
even if it would be heavy. After finding peace we can let change happen. It happens in stages
and it can be hard to cope with, because decisions with our past identity change. The seed in
us, to get to its full potential has to go through challenging steps and it is a lonely journey.
What we connect with is important, connecting with Sraddha leads us to our potential, but we
find often reasons for not to blossom. Sound inside us is sound of consciousness, sound of
light, the connection to our ancestors. Bound with parents is very strong, especially with
mother. Sraddha is coming from Sraddha of our ancestors, it is female energy and it has light
in it. Sraddha is that fire, immeasurable, but in our life we cover it.
We can remove whatever hides our light, and then choose what we do. If we allow our own
light to be there we automatically let other people have their light. We are not afraid of
success or of fear, but to find ourselves. For our psychological structure we need to have a
balanced fire. Sound is a connection to a higher force in us that comes from somewhere else.
Our voice tells if we are in contact with our consciousness.
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Yoga Therapy and Menopause
Fire and water are important elements on our journey of transformation. They are closely
connected: fire cooks and water binds, retains. We need binding energy of water to
transformation the concept of water is symbolic: water starts from a small spring and flows a
long journey of time and effort before coming to the big ocean. Any element can take over
another one, if there’s too much water it’s sticking, stubborn, taking us towards earth,
structure, and we can stay stuck with it. If fire takes over water we become very dry. Burn out
is an extreme situation of dryness. During menopausal period women’s structure starts to get
dry giving symptoms of dry itching skin, dry mucous membranes, joint pain, nadis loosing
space for prana to flow and sound getting narrower. With tools of yoga like smooth asanas
we can give “oil” to joints and mucous membranes, pranayama gives space to nadis and
sound opens and deepens our voice. Regular practice smoothens these changes and prepares
us to live with our changing self with all its layers.
After removing the structures, we can have pure feelings and sensations and reach the
Anandamaya level. Words cannot describe it, mind cannot understand it, it’s just a pure
feeling. There is only that joyful feeling, nothing else matters. Getting in touch with the deep
feeling of joy even for a short moment gives us hope and strength.
Connection with higher force happens in a way it’s meant to happen, not how we expected it
to happen. When we are not seeking a feeling it may come. Meditation is a good way to
prepare the terrain.
Faith gives the strength and will to keep practising. Also the relationship between the careseeker and care-provider gives strength. Regular practice with the group is motivating, and
some care-seekers said that it also motivates to do the individual practice at home.
Yoga Sutra talks about isvara, special being, higher force that is not affected by obstacles.
Here we come back to the question of what is giving us faith and spiritual strength in life. We
can meditate on isvara and that can help us reach the state of yoga. Isvara is the source of
wisdom and light inside of us all. Being conscious of it gives us strength and self-confidence.
We can wake up or support our inner light by reciting a sound or mantra and by adding
visualisation to it.
It’s important to understand that what we are searching is inside of us, not outside. By
practice of sound, visualisation and meditation the higher force hidden inside us will be
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Yoga Therapy and Menopause
relieved and the obstacles will be removed or they will not bother any more. The changes
were shown in different things, feeling at work became lighter, and home situation changed
for better, because women found the inside calmness.
People with agitated mind have four symptoms: physical disturbance, disturbed breathing,
negative thinking and emotional suffering. These symptoms cover all layers of the human
system and often they come in combinations. We can hide three of them, but agitated breath
is always showing, pulse is always there.
In this work with women we have used concentration and meditation on breath as a means of
moving towards the calmness that is inside. Many women experienced this helped to get
awareness of this moment, of calmness, and of a pause in life. When senses are withdrawn
from outside objects change of attitude begins: listening to the self and not just outside
happenings. Some women found it easier to have a mantra of sound, or visualisation, or both
as tools for concentration. Meditating on water or moon help finding calmness, sun is an
object for clarity and strength.
Suffering is being without space. We need space between our trouble and us. Opening
movement and breath, visualisation and meditation are tools to get the space. Letting arms
and chest open with inhale and being aware of the pause after opens up and lets life energy to
flow in. When feeling down and depressed opening movements and concentration on inhale
gave space to every level. Also building up the physical foundation, feeling the feet on the
ground, getting awareness, strength and mobility in the whole body gave physical and
psychological endurance and well-being. Practices with strong vinyasas, balance and staying
in the posture were giving heat that is necessary in the reduction of hot flushes. Strong
practices also gave confidence and stability.
It is important to reflect what we do, how we do, what is the right context. It is reflection in
our actions and communication. Discipline and self-reflection are supporting each other. This
became very obvious in our work: women did reflection on their family-situation, on
relationship with their partners and grown-up children. Every action should be done like it is
done for someone we care and respect. We should not be attached to the fruits of the action
but to the action itself. And to accept whatever happens.
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The obstacles on our way are ignorance, wrong knowledge, our ego=wrong identification,
desire, aversion and fear. Those are the things that hurt us. They are in the mind, breath and
body: all the dimensions are influenced. Ignorance is the basic obstacle; as a result of it we
don’t know what is permanent and what is temporary. Explaining this to the women in our
study helped them to get aware of the possible reasons for their suffering. At menopause all
the not solved obstacles may come out: “I’m old, nobody needs me anymore” or “I know
everything, and I know what is right.” The mind is covered with clouds.
Each person is unique. People have many identities; they don’t affect us in the same way. For
example religion can make some people big, having a lot of space, and others it’s making life
very constricted. Changing structures all the time takes too much energy. We need changes,
but not too much and not too little. It is important how this relationship between structure and
space appears inside us. Sleep is a state of very little structure, it gives us energy, it is stable,
and we identify with self. We are holding to structures, and holding too long makes us tired.
We don’t need to reject our identities, but find harmony by having a structure that gives us
stability without a feeling of suffocation. Yoga can help us find what we are meant to do, and
at least by middle age we should be ready to start changing our life towards it.
Excessive attachment is based on assumption that it will contribute to everlasting happiness.
“My husband left me, I’m no good anymore”. If we can release from this bandage of identity
we get freedom to understand different directions. To release from identity of being a mother
to an adult son can help a woman to understand him in a deeper level.
Desire and expectations bring us from light to darkness, because they give us a lot of
suffering. At this period of life women can be very attached to what they have and change of
circumstances is difficult, like changing jobs, letting children move on, accepting new life
situations over all.
A lot of things can be prevented when they are small, but usually when the obstacles are
small we don’t see them. They have potential to grow, so we should notice them early to be
able to use the tools of yoga for preventing them from growing, during period of menopause
this is important. We need to talk about our problems with our yoga therapist or somebody
else we trust, and do regular practice to get clarity.
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These obstacles can be expressed by sensual desire, anger, greed, delusion, rage and
jealousy, and can lead to faulty actions. It is an ideal time, on the way towards spirituality, to
work with these obstacles, to let them diminish with practice of visualisation, mantras and
meditation.
Intention of an action is what counts. Women need to be forgiving to themselves and do a lot
of self-reflection. We can do something to prevent future suffering and do not worry about
the past. Accept what has happened. Often it is necessary to remind menopause women to
start taking steps towards joyful future and stop being victims. It is important to learn to
forgive and to ask for help. We cannot always solve everything by ourselves.
The goal of Yoga is to reduce suffering, for that we need clarity. We need wisdom to
distinguish what is permanent and what is temporary; by self- reflection we develop ability to
do it. We need to practice all the eight limbs of Yoga to reach clarity. Yoga roots deeply in
our heart by practice, by experience, and stays there by continuing regular practice.
Asana and pranayama are concrete and easy ways to start reducing the obstacles on our way
to clarity. Asana practice involves body exercise, when it is done properly there must be
alertness without tension in the movements, and also in the attitude when practising. Breath
during Yoga practice should be long and smooth. These qualities are important also in
everyday life. To be conscious of our attitude at work and with our relationships, to listen to
our breath during the day helps us to be conscious of our life and choose to do changes if
necessary. It is time to work with happy attitude and choose leisure time that gives joy. We
learn to direct our senses in the right way, to have less suffering, make fewer mistakes and
grow our accuracy.
We have source of light inside us, with pranayama practice we can make it clearer to help us
to go through the process of changes happening during the period of menopause. Many
women told that they learned to make small pauses during the day just to listen to their breath
and be aware of the moment of now.
Menopause women have difficulties of concentration and memory. The practice that is useful
to the care-seeker helps her in everyday life to learn to focus on one thing at a time. Focusing
removes clouds. This learning of concentration leads to meditation.
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Yoga practice is developing intuition; we learn to listen to our heart, to accept truth as it is
now. Truth can change. We take small steps, so that over the time we can make big changes.
By understanding our deep mind we can understand the others. Then deep knowledge can be
realised. We need to grow wiser to use our wisdom. This is a long term goal that is
motivating the menopause women in their practice. It means to be in calm with the others and
ourselves. To reflect on happiness, “am I happy?” By practising yoga we get awareness of
our patterns and know what needs to be changed, that gives clearness and calmness, which
are developing.
We are what we eat or what we have digested. Gaining weight is one of the symptoms of
menopause. Women need support in changing their patterns of eating. Consciousness of what
I really eat is necessary, to stop and eat and to have a right attitude towards eating. To enjoy
it, taste food, see it, take time to taste it and chew it well. Ayrveda gives important knowledge
of nutrition and reasons for avoiding certain foods with certain symptoms and take some
herbs, teas or other nutrition supplements to improve health in different cases.
When we can connect with our heart we can connect with the space in the heart, we can
listen, and when we are listening we can link with: listen carefully, link strongly, then we can
experience great joy.
CONCLUSION:
In this study we discovered that Yoga Therapy is a supportive method for coping with
menopausal symptoms. The Yoga philosophy gives a new way towards approaching life,
helping to accept menopause as a natural process, and even regard it as a possibility to grow
wiser. No big changes happen unnoticed.
Many women were surprised that symptoms like sleeping problems were a caused by
menopausal changes. Understanding reasons for symptoms and being able to discuss them
made many women feel better. For some women it changed their attitude towards the
problems, and those did not occupy such a big place in the mind. Being able to share
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problems with care-provider and other group members lightened life, and gave a feeling of a
heavy weight taken off. The meanings of dukha, darkness and heaviness covering the heart
and sukha, lightness and well-being felt concrete.
Yoga therapy is a self-empowering method, encouraging women to take care of themselves,
but also the support of care-provider as well as group practice, and discussions with women
in the same period of life, showed to be very important supports. In this life situation many
women worry and take care of ageing parents, of growing up children, of work and other
responsibilities, often forgetting themselves completely. The message of getting help for pain
and other symptoms and not just suffering alone and sometimes acting like everything is fine
was very important.
Some women started to notice their deep patterns of behavior: of thinking, talking and acting.
Getting awareness of those was a beginning towards a change. Changing patters, finding a
new way of thinking and living is a long process. Sometimes there seems to be a big change
in the beginning of starting the practice, and that feeling is one thing giving support to
continue it.
In menopause years it is important to keep up and joyfully build up strength, within all our
levels, which are interconnected. Yoga is an excellent way of getting awareness of the body
in more and more subtle ways. Being connected to our Apana region we are more present in
ourselves. We create strength and flexibility in our boundaries and with our relationships.
It is a great opportunity for us to be able to continue this process with some women who
participated to this study. We have a feeling of being in the beginning of a journey of
transformation.
Letting go of fear is a long- term goal accessible step by step. Giving space for faith
diminishes fear. With Yoga practice, some women were able to let go and accept life as it is
right now, finding space for faith. Some women said they had not ”had time” to think about
faith and deeper life in the middle of everyday rush. They were just fulfilling requirements
coming from outside. Getting in touch with the calmness of mind even for a short time was
giving hope for a change in life.
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Yoga practice gave experience of focusing mind on one thing at a time and some women
found it helpful to do a short pranayama practice during the working day, which gave energy
and confidence. We find the ability of letting yoga improve quality of life was an important
goal of our study.
For some women physical practice was very necessary at this moment of life, especially to
give relief of back pain and hip pain. They were accustomed to overdo physical exercises,
with excessive speed or too heavy movements or in a stressed ambiance. The attitude in
doing the practice turned out to be essential: not to compete or compare with the others, and
to be able to practice in one’s own rhythm and with own adaptations.
Some of the women participating in this study still continue their private practices and group
classes. For us this was the beginning of an interesting journey and we hope to continue it.
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Appendix 1.
Questionnaire for Menopausal Women
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1. Age
2. Experience of yoga (how many months/years)
3. Practicing
a) only in group
b) only individual program
c) both, group and individual program
4. Why did you start practicing yoga? (can be multiple choices)
The explanations were:
a) interest in philosophy
b) physical well-being
c) health problems
d) wish to change yourself
c) to learn to work with myself
d) to keep good tonus
e) something else
5. Are you going through menopause (also premenopause and postmenopause)?
6. Do you have one or some of these symtoms:
a) emotional unstability (sadness, irritablity, fear, depression, anxious)
b) inability to concentrate
c) stress
d) memory problems
e) lack of energy, tiredness on daytime
f) sleeping problems (can be multiple choices)
- inability to fall asleep
- waking up in the middle of sleep
- waking up too early
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g) hot flashes
h) palpitation
i) decreased libido
j) osteophorosis
k) irregular menstruation
l) heavy bleeding
m) breathing difficulties
n) weight gaining
o) drying of skin
p) incontinence
q) joint problems
r) tinnitus
7. Do you have some chronical diseases?
8. Do you take any medication? (yes, no)
9. Are you using hormon replacement therapy to relieve symptoms of menopause? (yes,
no)
10. Do you use any natural therapy (homeopathy, herbs etc)? (yes, no)
11. Have you got some help from yoga practice? (yes, no)
If no, what is the reason?
Not enough time to practice
Other condition required more attention
Medicine helped more quickly
No discipline
Other options
12. How often have you practiced (or you are practicing)?
a) only once in a week in a yoga group
b) once a week in a group and individual practice
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2 – 3 times a week (individually)
4 – 5 times a week (individually)
6 – 7 times a week (individually)
c ) only individual practice
2 – 3 times a week
4 – 5 times a week
6 – 7 times a week
13. Have you asked help if you have had health problems or menopausal problems?
yoga teacher
doctor
friend
somewhere else
14. What kind of help did you get from yoga practice? (Answered individually)
Appendix 2.
The most common answers in question 14 in the questionnaire were:
Relationship with teacher has been the best support for menopause period.
More forgiveness to herself and others.
Found satisfaction and happiness in personal life while practicing meditation on opening the
space in the heart. Less mood swings.
Not so much fear when thinking about future. Understanding of ageing has developed in
better direction. No anger and feeling of helplessness.
Feeling of happiness in the heart grows and life seems more joyful.
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Found answers for many questions and practical advises for going through changes with less
of suffering
Learn to see things from other point of view and not to judge others so easily.
Found the way, how to go through the rest of the life in a more wise way. Health is better.
After practicing a while, memory became better and not so much tension and headaches.
Learn for asking help.
Less palpitation and breathlessness. Less stress and better sleep.
Group support gave good starting point and experience, that many women has similar
problems. There is no fear and desperation anymore. This group of people supports each
other in many ways.
Immunity has grown. Not so much illnesses as before.
Experience of self-healing gave faith in yoga practice.
Lot of relieve from stress doing yoga practice in working place.
There is more happiness in the heart. Blood pressure came down and no medication is
needed.
Self- confidence is higher because body posture is better. Lot of inner- strength has founded.
Night hot flashes are gone after relaxation practice and sitali pranayama in the evening and
changing eating patterns. Body weight has dropped. It motivates to practice more regular.
“Being conscious of the body helps to be more conscious of breath and that helps in trying to
have pauses in life. It’s not easy to take enough time to sleep, have to concentrate on
changing the rythm of everyday life. I’ve learned to change my attitude, take some humour
with my menopausal problems, when I give a presentation and get hot flushes I don’t get
irritated any more, also I wear loose clothes, so the sweat does not show so well.”
“Being conscious of breath and letting the exhaile get longer while doing relaxing practice
helps to sleep”
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“For my incontinence problem Iv’e got help by doing exhails from lover abdomen and
slightly contracting the pelvic floor muscles several times a day.”
“When my body is feeling well, my mind feels fine.”
“When I wake up in the middle of the night, I don’t get anxious anymore, but I relax and
listen to my breath. I don’t try to force myself to sleep but think that relaxation is also a rest,
and sometimes that makes me fall asleep again. Even if my sleep is shorter than needed I feel
quite good the next day after relaxation practice in bed.”
“Even a short practice helps to my back and hip pain.”
“I have learned to take time for myself and listen to my body and my thoughts, just to calm
down, and I feel better.”
“Yoga practice helps me to get closer to myself, the deep self; it clears my life and brings
peace to my soul.”
“For me it’s the active movement of Yoga and walking, cycling, all moving that gives me a
peaceful mind.”
I have learned to take small pauses during the day, to stop and listen to my breath, let it
become calm adding sometimes an image in my mind that gives me tranquility.
Yoga helps me in self - inquery, it brings rhythm to my life, I want to age beautifully and
avoid getting dull. Yoga is an exellent self -development for that.
When I do my everyday practice I sleep better and my joints are more flexible, with no pain.
If I don’t do my practice I’m more stressed and I get pain in my joints.
Sitali breathing helps against hot flushes, also the change of attitude, now I embrace the
flushes and that makes me feel better.
“The spirituality of yoga gives me direction; I try to let go of all the unnecessary, in my mind
and in practical life.”
Yoga makes me alive in the spiritual way. It gives me vitality and balance.
Yoga helped me to change my food habits.
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I’ve learned to get to know myself better and to calm down.
I have got better physical and psychological balance, peace of mind and awareness of my
body.
My goal is to get rid of the HRT, now I have tools for it. (Now the situation is difficult with
construction of house/ busy period at work)
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