As girls enter their teen years, they can hardly wait for the signs of womanhood to transform their bodies. They anticipate their new curves and monthly period, knowing these changes signify maturity and a profound change in their physical being. But often these new developments, once so welcome, begin to cause physical and emotional distress that can continue throughout a woman's adult life, culminating in another momentous bodily change— menopause—that has a reputation for causing a whole new form of suffering. Where did that old catchphrase “the joys of womanhood” come from, anyway?
Monthly menstrual cramps, premenstrual syndrome (PMS), and troublesome menopause have come to be accepted as normal aspects of a woman's life in the Western world. For generations, women have been told that their reproductive cycles and the changes that come with aging are mysterious syndromes, often causing pain, discomfort, and eventual loss of womanhood. In the Yoga view, these negative expectations are part of the problem. The Yoga philosophy encourages women to experience true integration of mind, body, and spirit, cultivating a more positive body image and easing the stress associated with normal reproductive functions. Through a Yoga practice, women can gain a healthier view of their cycles and achieve a degree of control over their physical, emotional, and spiritual well-being.
A few words about the menstrual cycle will help in understanding the female difficulties we'll be addressing later in this chapter. (This is a general overview that applies to healthy women whose reproductive systems are working properly.)
Approximately once a month, a surge in the hormones estrogen and progesterone causes the inner lining of the uterus (the endometrium) to build up in preparation for a possible pregnancy. An egg is released by one of the ovaries, and if a sperm does not fertilize it, the lining of the uterus is no longer needed. Estrogen and progesterone levels decline, and molecular compounds called prostaglandins are released, causing the muscles of the uterus to contract. This constricts blood supply to the endometrium, blocking the delivery of oxygen to the tissue, which causes the endometrium to break down and die. The uterine contractions then squeeze the old endometrial tissue through the cervix and out of the body through the vagina (the monthly period). It will be replaced by a new lining in the next month.
Women's reproductive cycles are governed by hormones, whose levels rise and fall in a cyclical pattern throughout the month. These hormone levels have side effects and are partly responsible for many of the negative symptoms women experience related to menstruation and menopause. As women near the age of about fifty, hormone production declines and the monthly cycle slows and eventually stops, meaning they will not have periods and are no longer capable of bearing children naturally.
As a teenager, probably one of the most unpleasant aspects of coming of age is the onset of menstrual cramps along with your first period. (The medical term for menstrual cramps is dysmenorrhea.) These abdominal and pelvic pains, felt before and during menstruation, can range from mild to quite severe. The discomfort can feel like heaviness in the belly; pressure in the groin; or debilitating aches throughout the abdomen, pelvis, and lower back.
As you get older, your cramps will usually diminish, especially after a pregnancy. This is thought to be due to the fact that the uterine nerves degenerate with age and disappear late in pregnancy, with only a portion of these nerves regenerating after childbirth. Menstrual cramps are caused by uterine contractions. The pain is intensified when clots or larger pieces of tissue pass through the cervix, especially if your cervical canal is narrow.
Yogis have long believed, and studies have confirmed, that emotional stress can increase the discomfort of menstrual cramps. Doctors have also seen that lack of exercise and inadequate rest seem to make cramps worse. Since Yoga relieves stress, exercises the body, and can enhance the body's ability to rest, it can be one of the best treatments for menstrual cramps.
Most women are aware of what their “normal” cramps feel like. If you begin to experience significant changes in the severity, timing, or location of your menstrual cramps, consult your physician, since there are a number of underlying conditions that can contribute to the pain. For regular discomfort that is not caused by an underlying disorder, the most common remedy is an over-the-counter anti-inflammatory such as ibuprofen. For mild cramps, aspirin or acetaminophen may be sufficient. You can effectively combine these remedies with Yoga to provide tremendous relief from monthly menstrual pain. If you suffer from menstrual cramps, be sure to read Yoga for Menstrual Cramps and PMS.
Women's experiences of PMS vary widely and in fact, the diverse symptoms that make up PMS have been recognized and classified as a distinct syndrome only since the 1980s. Dramatic fluctuations of estrogen and progesterone throughout the month can give rise to physical challenges including headaches, abdominal bloating, swollen breasts, acne, fatigue, insomnia, joint pain, and water retention. But the emotional roller coaster can be even harder to deal with. Overwhelming feelings of anger, depression, and self-loathing can make the most basic functioning problematical. A few women get so despondent from the monthly hormonal imbalance that they contemplate suicide.1
Studies have shown that a change in diet can help alleviate some PMS symptoms. Reducing sugar, caffeine, alcohol, tobacco, and processed foods can help calm feelings of irritability and increase energy levels. As with menstrual cramps, regular exercise and control of stress can go a long way toward easing the monthly misery. Doctors often recommend a program of muscle relaxation or deep breathing exercises to help lessen headaches, anxiety, or trouble falling asleep. A practice of Yoga that encompasses daily routines as well as meditation, Breathing Breaks, and attention to overall wellness is shown to provide maximum relief for even the most miserable PMS sufferers. If you suffer from PMS, be sure to read our Yoga Routine for Menstrual Cramps and PMS.
Women survive menstruation and PMS only to confront a new hormonal challenge: menopause. Unlike a disease that needs to be cured or prevented, menopause is a natural part of aging. Yogis view menopause as a reason for celebration, a time of deepening wisdom and insight. Released from the pressure and responsibility of childbearing, women have more freedom to focus on themselves, pursue their passions, and develop their spiritual awareness. Unfortunately, the physical difficulties of menopause combined with our youth-oriented society have made it hard for some women to imagine the potential blessings of this later stage of life.2
Menopause is the medical term for the time when you stop having menstrual periods. Natural menopause occurs when your ovaries stop releasing eggs and the lining of the uterus no longer sheds every month. This process happens gradually with the estrogen and progesterone levels decreasing over as many as ten years. When it's been a year since your last period and you haven't been pregnant, you've gone through menopause. The date of your last period is considered the onset of menopause. In the United States, the average age of menopause is fifty-one, but some women go through menopause closer to sixty, and some in their forties. If you have your ovaries removed, often done at the same time as a hysterectomy, it is called surgical menopause. Chemotherapy can also accelerate the onset of menopause.
Some women float through menopause with no intense symptoms, while many others suffer from an unpleasant array of emotional and physical problems. Probably the best-known sign of menopause is the hot flash, caused by decreasing levels of estrogen, which plays a role in regulating body temperature. You could start getting hot flashes several years before your periods stop, and they can continue for up to ten years after menopause. A hot flash is exactly what it sounds like: out of the blue, you suddenly feel so hot that you are uncomfortable and begin to sweat. Hot flashes can last thirty seconds to five minutes, and if they happen when you're sleeping, they can cause night sweats.
Decreased estrogen also causes a number of other problems. Vaginal dryness is common, leading to painful sex and an increase in vaginal and urinary infections. There is also a decreased blood flow to the vagina, which inhibits sensation and can reduce orgasmic response. Studies have not confirmed the role of menopause in sexual desire. Some women lose desire while others say they gain, and some report no change at all.
Protection against heart disease and possibly Alzheimer's is the major reason doctors recommend hormone replacement therapy (HRT) for some women. HRT involves taking two types of hormones, estrogen and progestin (although women who have had hysterectomies do not need the progestin). Taking these hormones protects against osteoporosis and may protect against heart disease and Alzheimer's. These hormones also treat hot flashes and other negative symptoms of menopause. However, there are risks involved, including possible blood clots, gallbladder disease, and a small increased incidence of breast cancer. The decision to begin HRT is a very personal one between you and your doctor, and should be carefully considered in light of your own medical history and physical health.
Other possible physical symptoms of menopause include fatigue, hair changes, headaches, heart palpitations, and weight gain. Emotional symptoms can consist of stress, anxiety, depression, tearfulness, irritability, insomnia, lack of concentration, and forgetfulness. Luckily, most women do not have every possible symptom.
While in many cultures the attribute that sets women apart from men, the ability to bear children, is a cause for reverence and celebration, in our society it is rarely celebrated and sometimes viewed as a burden. The fact that many women focus for most of their lives on avoiding pregnancy makes this special capability seem more like a liability Through physical, mental, and spiritual dimensions, Yoga can help bring back some of the innate strength and joy in being a woman.
Menstrual cramps, PMS, and menopause have all been shown to be made better with exercise. As a gentle exercise that strengthens the body and increases flexibility, Yoga releases endorphins, chemicals in your body that literally make you feel good. Higher levels of endorphins help your body maintain a state of wellness and promote physical and emotional healing. Some Yoga postures can help ease uterine cramps by gently helping blood clots release from the uterine wall, move through the cervix, and pass out through the vagina. Other poses can help alleviate backaches through easy stretching.
We cannot overestimate the role that stress plays in making menstrual and menopausal discomforts worse. Demanding jobs, family responsibilities, and unprecedented busyness have filled most women's lives with record levels of stress. The menstrual cycle itself is stressful when it disrupts normal activities and becomes just one more thing you have to worry about. The well-documented stress-relieving effects of Yoga can bring almost instant relief from many negative physical and emotional symptoms. This is not to suggest that PMS, cramps, and menopausal suffering are psychosomatic; but research has shown how stress profoundly affects physical functioning and perception of pain. So if you practice Yoga for no other reason than to combat stress, you will see improvement.
But Yoga does so much more than allay stress. Yoga positions have been proven to promote circulation throughout the body. This can stimulate the endocrine system, which helps encourage a healthy, balanced release of hormones.3 Since hormone fluctuations are partly responsible for all of the female difficulties we've been discussing, using Yoga to help your body regulate hormones is an effective preventative measure.
Yoga addresses the emotional challenges as well as the physical. When you practice Yoga, you learn to slow down your mind and begin to process negative emotions rather than let them fester. Yoga promotes awareness of your inner needs and allows you to deal with them positively. Through deep breathing, stretching, and releasing bodily tension, your parasympathetic nervous system is stimulated, relaxing you and producing greater feelings of well-being. Most people emerge from a Yoga session refreshed and invigorated, without a trace of that nasty mood that might have plagued them before they started. Practicing Yoga regularly can help you control those volatile emotions and hang on to your good moods throughout the day no matter where you are in your cycle.
Women entering menopause often suffer from dwindling self-esteem related to getting older. Yoga provides positive reinforcement of the aging process by building self-awareness, increasing your energy and stamina, and improving posture, weight, and muscle tone so you can feel better about how you look.
According to Yoga wisdom, the time of the month when you are menstruating is a time of heightened awareness, when your natural insight and intuition become more prominent. This is also thought to be true during menopause. Your senses may be sharpened and you become more attuned to smells, sounds, textures, and tastes. Rather than let this increased sensitivity become a source of annoyance, you can use it to help you focus on the miraculous changes your body is experiencing and the positive aspects of simply being alive. From a spiritual perspective, these are times when meditation may be most powerful, freeing your mind from distractions and connecting you with a greater source of power, both within yourself and without. Yoga and meditation can be a natural doorway to the spiritual dimension and a means of transforming a troublesome time into a journey of self-discovery and joy.
Engage in brisk walking, swimming, or other aerobic activity for twenty to thirty minutes at least three times a week to improve your overall health and fitness.
Eat smaller, more frequent meals and limit salt to reduce bloating and fluid retention.
Reduce or eliminate caffeine to lessen irritability, tension, and breast soreness.
Avoid alcohol before your period or during menopause to minimize mood swings and depression.
Eat a generally healthy diet, choosing foods high in complex carbohydrates (fruits, vegetables, and whole grains).
Keep a journal of what you eat for a couple of weeks, to learn which foods seem to affect you negatively or exacerbate your symptoms. Make it a habit to get plenty of rest. Breathing and meditation techniques just before retiring can help you achieve more restful sleep. If you are particularly troubled by mood swings, try becoming more aware of your feelings throughout the day so you can use a breathing or relaxation technique when you need to stabilize your emotions or need to concentrate on a task.
For hot flashes, try dressing in layers so you can remove something to cool off quickly. Use sheets and clothing that allow your skin to breathe, and try having a cold drink at the beginning of a flash.
For vaginal dryness, use ointments that you can buy without a prescription such as K-Y jelly or Replens.
Consider integrating meditation into your regular schedule, particularly during your period or if you are menopausal.
Practice the appropriate Yoga therapy routine from this chapter. Start with two or three days a week, working toward five or six days a week.
Yoga for Menstrual Cramps and PMS
Practice Core Routine I and Core Routine II for general conditioning throughout the month, when you have no PMS symptoms and are not menstruating. Use Focused Breathing.
It is important not to strain or compress the abdominal area and to avoid inverted postures during your period, but aside from that you should not abandon your practice. The following is a routine I created for a client who suffered from PMS and painful cramps. Use it instead of the Core Routines when you have PMS symptoms or are having your period. This routine takes approximately twenty minutes and can be practiced up to three times per day, using Belly Breathing with long exhalation.
Thunderbolt
You can use this posture as part of the routine, or by itself if you are having menstrual cramps or back pain. It is a relaxing pose that brings relief by promoting circulation in the abdomen. Do not do the Thunderbolt if you have knee problems.
Kneel on the floor or on a padded surface, knees and feet at hip width.
Sit back on your heels, and place your hands on the tops of your knees, elbows bent, palms down. Bring your back up nice and tall, and look straight ahead. If you are uncomfortable, you can place a pillow on your calves, so that when you sit down, it is between your calves and your buttocks. Increase the lift until you can sit comfortably. If you feel pain or tightness in the fronts of your ankles, place a rolled-up towel or blanket underneath them.
Start with 2 to 3 minutes, working up to 5 to 10 minutes.
This is a very nurturing posture that relaxes and gently stretches the back. The use of sound helps calm and relax the belly (If you have knee or hip problems, replace Sitting Cat with Knees to Chest, described. Thus you will be doing Knees to Chest twice in this routine.)
Start on your hands and knees, looking forward and down, with the heels of your hands directly below your shoulders and your knees at hip width.
As you exhale, sit back slowly on your heels and bring your head toward the floor using the sound ma as you sit back. Work toward resting your torso on your thighs with your forehead on the floor, but do not force it. Sit back only as far as comfortable.
Move back to the starting position, then repeat Steps 1 and 2, alternating the sounds ma and sa for a total of 6 to 8 times.
Reclined Bound Angle (Supported)
This relaxing posture loosens your hips and relaxes your lower back. It also promotes circulation in your pelvis.
Sit on the floor with your legs extended in front of you.
Lie back on a bolster, pillows, or folded blankets with your head supported by an additional blanket or pillow. Keep your hips on the floor.
Join the soles of your feet together with the bottom edge of both feet on the floor. Spread your knees wide and support them with bolsters or rolled blankets. Place your hands comfortably out to your sides, on the floor with your palms up. Cover your eyes with a towel or eye bag if you like.
Stay in this position for 3 to 5 minutes. When you are ready to come out, place the soles of your feet on the floor, bring your knees together, and roll to one side.
Bridge
This is a good preparation for the supported Half Shoulder Stand that comes next. It promotes circulation in your back and neck, while strengthening your shoulders, hips, and thighs.
Lie on your back, bend your knees, and place your feet on the floor at hip width.
Relax your arms at your sides, palms down.
As you inhale, use your abdominal muscles to raise your hips halfway up. Pause. Then lift your hips as high as you feel comfortable. Do not go past halfway if it causes you any back pain.
As you exhale, bring your hips back to the floor.
Repeat 6 to 8 times, remembering to pause halfway up.
Half Shoulder Stand (Supported)
This inverted posture helps calm your nervous system and relaxes your lower back.
Caution:Do not use this or any inverted posture once menstruation has started.
Place a bolster or several folded blankets parallel to and about 6 inches away from a wall.
Sit sideways on the support, and then swing your legs up the wall. Rest the back of your pelvis on the support, and rest your head, neck, and shoulders on the floor.
Move your buttocks toward the wall until your sit bones are relaxed in the space between support and the wall. If you like, you may cover your eyes with a towel or eye bag.
Remain in this position for 3 to 5 minutes. When you are ready to come down, bring your knees toward your chest and slowly roll to one side.
Knees to Chest
This soothing stretch relieves stiffness and discomfort in your lower back. It is great for releasing abdominal gas and for calming menstrual cramps. (Note that Knees to Chest is different from Knee to Chest, which appears elsewhere in the book.)
Lie on your back with your knees bent, feet on the floor at hip width. Bring your bent knees toward your chest and hold on to the top of your shins, just below your knees, one hand on each knee. If you are having knee problems, hold the backs of your thighs, under your knees.
As you exhale, draw your knees toward your chest. As you inhale, move your knees a few inches away from your chest, rolling your hips to the floor.
Repeat 6 to 8 times.
This breathing exercise calms and quiets your nervous system. It is described in detail. Sit in a comfortable position with your back up nice and straight. Slowly inhale and exhale. (If your tongue does not curl, do the Crow's Beak, described.) Repeat 8 to 12 times.
Corpse with Blankets
This is the safest and most popular Yoga posture, a classic for relaxation of the body and mind. It soothes the nervous system and facilitates deep rest.
Lie on your back with your arms relaxed near your sides and palms turned up. Place a bolster, pillows, or folded blankets under your upper back. If your head tilts back or your neck is uncomfortable, place a small pillow or blanket under your head and neck. If your lower back is uncomfortable, place a pillow or rolled blanket under your knees. If the supported position doesn't feel right to you, lie flat on your back in the classic Corpse.
Cover your eyes with an eye bag or folded towel.
Use the Healing Triangles or Yoga Nidra relaxation technique. Stay in the position for 5 to 15 minutes.
Once per day, practice Alternate Nostril Breathing for three to five minutes, and Focused Breathing Part Two for an additional three to five minutes.
Practice Core Routine I and Core Routine II for general conditioning during menopause. You can alternate them if you like. Use Belly-to-Chest Breathing or Chest-to-Belly Breathing.
Breathing Break
Once per day during menopause, practice Alternate Nostril Breathing for three to ten minutes.
Meditation
It is a good idea to integrate meditation into your daily routine. Start slowly, aiming for about five minutes a couple of times a week. Gradually as you feel comfortable, work up to twenty to thirty minutes, five to seven days a week. Use any of the meditation techniques described in Chapter 5.
You may want to incorporate a mantra or affirmation into your meditation, especially if you're suffering from depression or low self-esteem. This is a positive statement to help reprogram your self-image. You can choose your own affirmation or use this one from the American Yoga Association: “I bless my body and accept its changes with grace and appreciation.” Repeat your affirmation as you begin meditation, to help you focus. You can also repeat your affirmation upon rising in the morning and retiring at night, before meals, and whenever you start to have negative thoughts throughout the day.