Yoga Therapy and Menopause
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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