I had a special request last week to write something about perimenopause, a topic that is in the minds of many women in my life who are in their 40s and 50s. As I, myself, am just about to cross the 40s threshold (and I can talk at length about how this is freaking me out to anyone who is interested), I was curious to see what’s out there.
First, let’s be clear. Menopause is the time in a woman’s life when periods (menses) stop. Perimenopause is the time before that, which can be as short as a year to as long as 10 years. Postmenopause is the time after menopause. Here’s a visual summary that depicts what actually happens during this time and what this means for a woman.
Why is perimenopause a big deal?
This is the time when ‘fun’ symptoms like hot flushes and irregular periods appear, probably also leading to the other manifestations like difficulty sleeping and mental health challenges (like anxiety and depression). All of this can have an impact on quality of life for the person going through perimenopause. The visual summary above has a bit more detail on this.
Can yoga help?
There are a lot of classes and courses out there these days that specifically focus on perimenopause. I have never attended one of these so I have no idea what kind of content they cover (what style of yoga do they advocate, is it asana only or does it include pranayama and meditation etc etc). Even just a quick Google search yielded a mix of things, including restorative yoga, gentle vinyasa and paced breathing exercises (and obviously, to avoid hot yoga because, well, common sense). My best guess is that yoga for perimenopause would be a balanced practice, using the same thinking and wisdom as a class I would design for stress and for immune balance. But I honestly don’t know and have no expertise here.
Surprise, surprise: the research is mixed
Studies have looked at the effectiveness of yoga in tackling the different symptoms associated with the hormonal changes of perimenopause, and have had inconsistent findings – probably because of how they were designed and how they actually defined yoga. I should also point out that I didn’t have access to most of the papers I looked at, so could only go by what was included in the abstract.
Inconclusive. One systematic review and meta-analysis found insufficient evidence that yoga helps to reduce hot flushes (ie some benefit was seen in some studies but not in others). Likewise, this study found no effect of yoga (and other non-pharmacological interventions) on hot flushes, and this study didn’t either.
I also found three relevant Cochrane systematic reviews (probably the most trusted of systematic review) on the topic, which found no evidence that relaxation (including paced breathing), exercise (although this doesn’t include yoga) or herbal supplements help with hot flushes.
Some evidence that yoga can help tackle sleep disturbances and insomnia in perimenopausal women. For instance, this study found that yoga offered mild improvements from insomnia – but note that exercise (whatever that was, they don’t say), CBT and some anti-depressants had stronger effects (CBT being the most effective). Likewise, this study reported improvements in sleep quality among peri- and postmenopausal women compared with control (ie no intervention).
Mental health and quality of life
One systematic review and meta-analysis found that yoga (and other complementary therapy interventions like acupuncture, aromatherapy and massage) offered improvements in the psychological symptoms of the menopause – although, weirdly, exercise (again, however that was defined) did not. Similar findings were reported by this systematic review and meta-analysis.
Sudashian kriya yoga (SKY, which is basically a combination of breathing exercises, including ujjayi and bhastrika) also offered improvements in quality of life (as measured using a specific menopause-related quality of life questionnaire), as reported in this study.
Where does this leave us?
Ok so there isn’t really a lot of good evidence that yoga can help with perimenopause. But that doesn’t mean it can’t and doesn’t help, especially knowing what we know about the quality of most yoga research.
Importantly, even if the only benefit you get from yoga is to help you feel a bit better about yourself and help you live life more fully, then that’s a really big benefit in itself and should not be ignored just because there is no evidence that it helps with hot flushes. Quality of life is an often overlooked outcome that I would argue is even more important that symptom alleviation itself, as it implies that the person is able to live fully with the symptoms they have.
What about HRT?
Hormone replacement therapy, or HRT (or just HT) is usually how perimenopause and postmenopause are managed, not just to alleviate symptoms (eg hot flushes) but also to help avoid health challenges later in life (eg fractures from osteoporosis and cardiovascular events).
Because long-term HRT comes with some risks, it has become a bit of a contentious subject. The recommendation (eg in this Cochrane review from 2017) is to weigh the benefits of symptom relief with the small risk of events, especially if the woman is at high risk.
But, interestingly, when you start treatment is important. This review, for instance concludes that HRT in (postmenopausal) women over 60 years of age offers no benefits and can potentially cause harm. However, younger women who are just starting to transition (eg around 50 years of age) could experience longer-term benefits, including prevention of cardiovascular and cognitive problems later in life.
In the interest of brevity, I’m going to leave it there. Ultimately, like with everything in life, it’s all about finding the right combination of treatment (in this case, the right hormone or hormone levels) and lifestyle modification to help support living well in perimenopause and beyond.