Yoga Therapy and Menopause

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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 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.
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 post-menopause; 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.
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.

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 beta-endorphins in menopausal women as well as in menstruating women.
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. Vata-type 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 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.

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