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Finding Freedom Through Challenges & Changes
Our Natural Cycles
Menopause has three main stages: Perimenopause, Menopause, and Postmenopause. However, some research, like Coslov et al. (2021) and Cortes et al. (2023), suggest an additional phase before Perimenopause, called the Late Reproductive Stage (LRS). This stage, often in the late 30s to early 40s, is marked by irregular cycles and early hormonal changes, with symptoms like sleep disruption, mood swings, and brain fog. This study identified prevalent symptoms during the LRS, including sleep disruption, mood fluctuations, hot flashes, and brain fog, between their late 30s and early 40s.
Between her 40’s and early 50’s, a woman can start experiencing perimenopause symptoms. Many different symptoms fall under the umbrella term of perimenopause, some common, some less common and some curious. The most common symptoms are hot flashes, fatigue, sleep disturbances, vaginal dryness, headache, irregular periods, and anxiety, just to name a few.
Menopause occurs 12 consecutive months (or, if you have a fairly regular period, 13 consecutive missed bleedings) after your last menstrual cycle. So, if we think about it, menopause it’s just one day. Perimenopause is your threshold; Menopause is the step you take through that doorway into Post-Menopause or the rest of your life.
Generally, according to the British Menopause Society, the typical ages for different stages of menopause are as follows:
· Perimenopause - often begins in the 40s, though it can start earlier.
· Menopause- typically occurs between ages 45-55.
· Post-Menopause - this stage follows menopause and lasts for the remainder of life
· There is also induced menopause that happens after a severe illness, medical treatments, and surgery.
· In young adults, before the age of 40, it is defined as premature menopause or premature ovarian insufficiency (POI). According to the British Menopause Society, POI can begin as early as the teens or twenties in rare cases, and symptoms can include irregular periods, hot flashes, and other menopausal symptoms.
How and Why does menopause happen?
From a biochemistry perspective, menopause happens when women start to experience a decline in hormone levels.
· During the LRS, we can still bleed regularly but have fewer ovulations. Because we ovulate less than usual, the progesterone levels gradually fall. This happens because progesterone is produced mainly in the ovaries by the corpus luteum, which is the substance that develops after ovulation occurs and the follicle around the egg collapses.
· During perimenopause, the ovaries gradually produce less oestrogen and progesterone, leading to hormonal fluctuations. Ovulation becomes irregular, but it’s still possible to get pregnant. At this stage, there is an increase in FSH follicle-stimulating hormones in an attempt to stimulate the ovaries by the anterior pituitary gland (feedback loop mechanism).
· Prioritising gut and liver health during perimenopause is essential because these organs play crucial roles in managing the hormonal changes and metabolic shifts that occur during this stage of life, as they help break down and release hormones from the body.
· Menopause to Post-Menopause is officially diagnosed after 12 consecutive months without a menstrual period. The average age of menopause is around 51. During this phase, the FSH level can still be high initially but gradually reduces and returns to a more stable level. Perimenopausal symptoms become less intense over time.
Picture from https://menopausesupport.co.uk/wp-content/uploads/2023/06/MEN0921351544-005_Menopause-Support-Booklet-5-3.pdf
This graphic shows the fluctuations of hormones from pre- to post-menopause. As the store of eggs in the ovaries depletes, the levels of oestrogen and progesterone can become more erratic. Women have hormone receptors all over their bodies, so when hormone levels fluctuate and fall, the body will have to adjust, bringing in all the symptoms we experience physically, psychologically, and cognitively. While progesterone levels continue to fall, oestrogen levels fluctuate until post-menopause.
Important Note
Menopause symptoms are not a health risk per se. We are not broken or damaged; we are simply changing. But because of the fall in hormones, this is a good time, if we haven’t done that yet, to check with our healthcare provider and asses our physical, emotional and mental well-being, as these changes can lead to three main areas of concern: Osteoporosis, Cardiovascular diseases, and Cognitive decline.
Symptoms
According to the HSE, the most common symptoms of menopause are:
1. hot flushes
2. night sweats
3. difficulty sleeping
4. fatigue
5. lack of energy
6. low mood or anxiety
7. problems with memory or concentration
8. vaginal dryness and pain, itching or discomfort
9. reduced sex drive (libido)
10. discomfort during sex
11. irregular periods
12. headaches
13. heart palpitations (a fast-beating, fluttering or pounding heart)
14. recurring UTIs
15. loss of muscle
16. weight gain
17. joint aches and pains
Some of the less and curious symptoms are:
· Burning Mouth Syndrome
· Electric Shock Sensations
· Itchy Skin
· Body Odor Changes
· Increased Anxiety and Depression
· Hair Loss
· Tinnitus
· Cold flushes
· Rage
· Formication
· Dry mouth
· Numbness in your limbs
· Dry or itchy eyes
Women’s struggles through change
Although the transition from Perimenopause to Postmenopause is as natural as breathing, it can bring up many challenges. This is not a “one size fits all” kind of journey. There are many symptoms and different ways of experiencing it depending on our environment and personal history. When we talk about the struggles we experienced during this rite of passage, we can never speak for every woman on this earth. It’s crucial to understand that each woman’s experience is unique, and assuming that Menopause is hard or easy (depending on whom we are talking to) will separate us from other women’s experiences and stories. By doing so, we’ll fail to address one of the most critical issues in Menopause (at least for me): that many women are unhappy about moving through this transition (for different reasons) and listening to their stories is not just important; it’s essential. It will help us understand this passage even more and create a sense of engagement, community and connection.
However, the scientific world notes that there are three main areas of concern when it comes to physical and mental health that can happen due to the drop in hormone levels.
1. Osteoporosis—Oestrogen plays a crucial role in maintaining bone density by helping to regulate bone remodelling and calcium absorption. With the drop in oestrogen during menopause, bone breakdown outpaces bone formation.
2. Cardiovascular diseases—Oestrogen has protective effects on the cardiovascular system. It helps maintain healthy blood vessel function, regulate cholesterol levels, and reduce inflammation.
3. Cognitive decline—Oestrogen has neuroprotective properties; it supports neurotransmitter function, blood flow to the brain, and neural health, all contributing to cognitive function.
Something important to keep in mind is that we are just in the early years of research and studies on Menopause, and we can never assume that a woman's symptoms are connected to any of these phases. If a client or a student comes to us with typical symptoms of this passage, we should always refer them to a GP or Healthcare Provider and refrain from diagnosing them. In the case of fibromyalgia, for example, if pain presents itself around the time we should be in the LRS or Perimenopause, we cannot assume that the pain is due to the fluctuation of hormones that happens in Perimenopause.
Menopause is experienced differently worldwide, shaped by personal, family, and sociocultural factors. Cross-cultural studies reveal geographical and ethnic variations. Some research and findings suggest that menopause experiences vary widely and are influenced by cultural context, challenging the idea that menopause is equal for all.
When I asked the women in my life about their struggles during this rite of passage, I wasn’t surprised to hear many different answers. As I mentioned earlier, menopause is not a one-size-fits-all kind of passage. It varies from woman to woman, which is why this journey is deeply fascinating.
These are some of the most common struggles of daily life for a woman during perimenopause:
On a physical level, beyond the most common symptoms of hot flashes, night sweats, sleep disturbances, and weight gain, which can still disrupt daily life and lead to fatigue, some women also struggle with physical pain. Some women develop severe issues like pelvic floor dysfunctions. All of this can be physically, mentally and emotionally painful, leading us towards more profound emotional changes like anxiety, depression, feeling unworthy, useless and invisible. Mood swings, anxiety, rage and depression can occur due to hormonal fluctuations, but also because moving through all these changes can honestly try the patience of a saint. And even though we live in a modern society, sometimes women see that supportive healthcare providers and effective treatments can be challenging, especially if symptoms are not taken seriously.
Many women also experience a sense of loss or anxiety about ageing. Grief is one of the most profound experiences we allow to surface during perimenopause, and Grief is such an important piece of the puzzle on our healing journey.
Decreased libido, vaginal dryness, and discomfort during intercourse can affect sexual relationships. Pleasure and Joy can be difficult to reach in everyday life as the feel-good hormones like oxytocin are at a new low because oestrogen is known to influence the production and regulation of oxytocin, which is often associated with bonding, emotional responses and reproductive functions.
Some studies suggest that changes in oxytocin can also influence mood and may contribute to feelings of anxiety or depression that some women experience during menopause. However, the exact relationship can vary among individuals, and more research is needed to understand these dynamics fully.
Evolution
From an evolutionary perspective, we don’t currently know why menopause happens. Several theories have not been proven to be right or wrong. They attempt to explain menopause as follows:
· The "Grandmother Hypothesis": This theory suggests menopause evolved to allow older women to shift their focus from childbearing to helping raise their grandchildren.
· The "Mother Hypothesis": According to this theory, menopause protects women by stopping childbirth at an age when the risks of complications for both mother and child increase significantly.
· The "Reproductive Conflict Hypothesis": This theory posits that menopause arose to reduce reproductive competition between older women and their daughters-in-law.
· The "Embodied Capital Theory": This theory suggests that menopause is a life-history strategy focusing on reallocating resources.
· The "Patriarch Hypothesis": This hypothesis is primarily centred on men’s evolutionary patterns but indirectly impacts female reproductive strategy.
Yoga in Menopause
I want to stress that I am not a yoga teacher who avoids yoga poses. If a woman comes to my class and is in menopause, before saying no to specific asanas, I look at modifications that can suit menopausal women. My classes are designed to be inclusive and supportive. I encourage the use of different props, modifications and slow transitions.
The symptoms of menopause and their impact on women’s health and well-being can range from mild to detrimental. The drastic hormonal shifts during menopause can bring about various health issues that require thoughtful and effective interventions.
These symptoms don’t only affect physical health but also impact mental and emotional well-being, often creating significant burdens in day-to-day life. Today, the population of women (people born with a female reproductive system) is estimated at around 4,058,360,359, representing approximately 49.72% of the global population. Given the vast number of women affected, there is an urgent need for holistic support systems to address the challenges menopause brings.
“While increasing evidence demonstrates that yoga interventions benefit menopausal symptoms, there is still a need for a comprehensive meta-analysis that reviews and synthesises research findings on yoga’s effectiveness for menopausal women. Some promising preliminary findings suggest that yoga can significantly improve menopausal symptoms, such as sleep quality, anxiety, depressive symptoms, body mass index, and blood pressure (both systolic and diastolic) in women experiencing menopause. This indicates that integrating yoga into clinical practice may offer a viable approach to addressing the significant burden of menopause-related symptoms. Nevertheless, further research is necessary to determine the optimal dosage, long-term benefits, cost-effectiveness, safety, and precise mechanisms by which yoga can alleviate menopausal symptoms. Large-scale studies with robust design and diverse samples would be precious to confirm these early insights.” foot note
Despite the need for more evidence, yoga’s potential in managing menopausal symptoms is already encouraging. However, it is prudent not to make broad claims about the benefits of specific asanas and pranayama techniques for menopause management.
Still, the ancient practices of yoga, meditation, and pranayama have stood the test of time, continuously being revered for their positive effects on health and well-being. These disciplines were developed by individuals with a profound understanding of the human body and its energy systems, and their principles continue to resonate with modern practices. I believe that ancient practitioners were aware of the body's needs and rhythms, allowing them to develop practices that aligned deeply with our natural, universal energy and the cycles of nature. By tuning into our bodies today, we can rediscover and revive these teachings, bringing forth that timeless wisdom.
For yoga teachers, awareness of menopause symptoms is crucial. It empowers them to support students more effectively, creating an environment that is safe, inclusive, and responsive to the needs of women experiencing menopause. An informed yoga teacher can adapt practices to accommodate students’ physical and emotional shifts, offering a holistic and supportive experience that respects the unique needs of each individual.
Adapting to Physical Changes: Menopausal symptoms such as joint pain, hot flashes, fatigue, and mood swings can significantly affect a student's ability to participate in class. Teachers with a thorough understanding of these symptoms can adjust sequences, suggest modifications, and avoid poses that may aggravate discomfort, ensuring a more comfortable experience.
Promoting Rest and Self-Compassion: Yoga can serve as a powerful reminder to honour one’s body, and some students may need extra encouragement in this area, especially if they’re frustrated by changes in energy levels or flexibility. A compassionate teacher can foster self-acceptance, helping students avoid pushing themselves too hard while allowing them to embrace where they are in their journey.
Nervous System Assistance: Although specific asanas cannot be prescribed universally, we know that yoga positively impacts the nervous system. Particular poses and breathing techniques can aid symptoms like anxiety and mood swings. Yoga teachers can support mental well-being and help students find balance by focusing on stress-reducing poses.
Integrating Meditation, Pranayama, and Joyful Movement: In addition to poses, practices like meditation and pranayama techniques can bring joy and pleasure to menopausal women, helping them stay connected to their bodies. Moving the fascia through varied movements, particularly with an eye toward bone and joint health, can be soothing, pleasurable and strengthening.
Tantra & Sacred Sexuality: I like to intertwine my yoga classes with teachings from Tantra to help women through this transition. Tantra helps us bring forth our inner wisdom, sensuality, and feminine power. It also allows us to reconnect with pleasure, joy, and the wisdom of the body and its energy while helping us through emotional release and healing.
Promoting Bone Strength and Stability: Since menopause raises the risk of osteoporosis, incorporating weight-bearing and strength-building exercises is key. Standing poses, gentle weight-bearing exercises, and movements that promote stability all contribute to bone health and overall resilience.
Building a Supportive Community: Yoga classes can serve as a sanctuary for women navigating similar experiences, fostering a shared sense of empathy and understanding. A teacher who acknowledges menopause and encourages open discussion helps create an inclusive space, reducing stigma and normalising conversations about this natural life stage. By staying informed about menopause, yoga teachers can make their classes more accessible and supportive for students at this stage of life. This holistic approach ensures that women feel seen, understood, and respected, allowing them to benefit fully from yoga during this transformative Rite of Passage.
Something important to always keep in mind
Yoga, while highly beneficial, can also carry risks for women going through menopause if not approached mindfully. Menopause brings about unique physiological changes, including joint sensitivity, hormonal shifts, increased susceptibility to bone density loss, and pelvic floor problems, all of which may influence a woman’s ability to engage in certain yoga practices safely. Menopause may lead to lower bone density and osteoporosis, making certain high-impact or weight-bearing poses risky for some women (unless they are modified). Postures that involve significant pressure on the wrists or require extreme bending, such as headstands, arm balances, or deep forward folds, may increase the risk of fractures or strain (Modiy). As oestrogen levels drop, women can be susceptible to joint pain and joint instability. Deep hip openers, intense twists, and other extreme poses can stress the joints and exacerbate pain or cause injury, particularly in the knees, hips, and shoulders (Modiy). Many women experience hot flashes and increased sensitivity to heat during menopause, which can make heated yoga classes or intense physical sequences uncomfortable or even unsafe (Modiy). Pushing through a class while overheating may lead to dehydration, dizziness, or fatigue (as if we don’t experience that enough in the day-to-day life…Modiy). Menopause is sometimes associated with an increased risk of cardiovascular issues, and certain poses or vigorous sequences might elevate blood pressure or strain the heart. High-intensity flows, inversions, or rapid sequences should be approached carefully, especially by those with pre-existing blood pressure or heart concerns (Modiy). Yoga can sometimes bring up emotional releases, which can be powerful but also overwhelming, particularly for women experiencing mood swings, anxiety, or depression. Intense practices or those that emphasise introspection may sometimes amplify these feelings rather than soothe them, especially if not guided by a teacher sensitive to the emotional shifts that accompany menopause. Having the eyes open, looking around the space, resting and breathing through poses and sequences can be beneficial (Modiy).
Menopause can weaken the pelvic floor muscles, and certain poses, especially those that involve core work or inversions, can strain these muscles further. This may exacerbate issues like urinary incontinence, leading to discomfort or further weakening (Modiy). It is essential to refer students to pelvic floor specialists, health care providers or gynaecologists if they come to yoga class with symptoms like UTIs, lower back pain, hip joint pain while moving, a sense of pressure in the pelvis… etc.
Assuming that Mula Bandha and Uddiyana Bandha can cure pelvic floor dysfunction is reckless, especially because we cannot diagnose the exact dysfunction happening in the pelvis. Although these can help the pelvic floor, we need to be cautious and know what we are dealing with, as well as Modiy poses and breathing techniques. When the pelvic floor muscles are too tight or constantly contracted, applying Mula Bandha can increase tension, leading to pain, discomfort, or even exacerbation of issues like pelvic pain, painful intercourse, and chronic pelvic floor tension. People with this condition should focus on relaxing and lengthening exercises for the pelvic floor instead. Mula bandha may sometimes be beneficial for pelvic organ prolapse by strengthening muscles. Still, in the acute phase, after surgery, or when the prolapse is severe, mula bandha can worsen the prolapse or strain healing tissues. Consulting with a pelvic floor physical therapist or healthcare provider before engaging in this practice would be advisable.
There are many interesting techniques nowadays that can be helpful with pelvic floor dysfunctions, like Hypopressive. In my classes, I find it very useful to mix my practice with cognitive load exercises. After my yoga for menopause course, I started to add small brain snacks like vestibular system challenges and eye exercises to challenge the brain through minor stressors. During menopause, many women experience cognitive changes often referred to as "brain fog," which can include forgetfulness, difficulty concentrating, and challenges in problem-solving. Hormonal shifts, particularly decreases in oestrogen, impact the brain’s cognitive functions. Cognitive load exercises can be especially beneficial during this time by helping manage these effects and improving mental clarity.
I know nutrition can help us immensely from perimenopause onwards, but I am not a nutritionist, so I cannot say what people should or shouldn’t eat. I would suggest, however, names of nutritionists I know can help menopausal women. I do share the basics but always with the disclaimer that I am not a qualified nutritionist: collagen and vitamins are essential; what is bad for the liver, like alcohol, should be avoided; the effect of histamines, the role of hormones in our gut and the importance of keeping gut and liver health on top of my priority list, the production of melatonin and how it happens….
Although nowadays, there seems to be more awareness of menopause, I feel we need to do more or be more careful with what is passed as usual information. I know this is a difficult time for women, but the gloomy pictures we are given on social media are just a tiny part of the equation.
Menopause can be a tough threshold to cross, but it can also have some surprisingly positive aspects! Many women experience a newfound sense of freedom and self-acceptance after menopause. Hormonal fluctuations that once fuelled emotional ups and downs stabilise, often bringing a sense of peace and clarity. There’s also freedom from menstrual cycles, which can relieve the physical discomfort and planning required each month. The focus can shift to personal growth, creativity, and exploring interests or goals that may have been put on hold. It’s a chance to redefine life on our own terms, with the wisdom gained from experience guiding us forward.
Michela Sborchia
© 2024 Michela Sborchia. All rights reserved
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