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Women's Health

What I Wished I Knew About Menopause—And How Yoga Can Help

We’re conditioned to think that aging slows us down, but my experience shows that we might just be revving up for the best years of our lives.

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During the pandemic, I became obsessed with my rowing machine. I figured sweating and stretching surely would help prevent a meltdown. Every day, I used an app to rank my workouts against those of others in my 50-to-59 age group. Then one morning, I opened the rankings to all ages. Shockingly, women in their 50s were putting everyone else to shame.

After reveling for a bit, I began to wonder: Why are 50-something women performing at such a high level? Could it simply be a generational thing? Or is it that when women hit 50—with child-rearing, career-climbing, and relationship-building largely behind them—fewer distractions allow us more time to focus on ourselves?

The answer is probably a little bit of both. But there’s one more phenomenon driving women in their 50s to row, sweat, and stretch like Olympic hopefuls: They’re approaching (or have already reached) The Big M. And while we’re conditioned to think that aging slows us down, my experience shows that we might just be revving up for the best years of our lives.

What we don’t talk about when we don’t talk about menopause

Forty-one million women in the United States have reached menopause. That’s more than the population of California. And yet we barely talk about it. But I wanted to learn everything I could about this period of change, including whether yoga—which has always centered me during times of stress—could ease this transition.

Our culture notoriously marginalizes women past their childbearing years. Petra Coveney, a London-based yoga instructor and founder of Menopause Yoga, leads yoga-infused menopause workshops around the world and makes a point of showing her students how society devalues older, wiser women. “I ask participants to call out the words used in their culture to define women of a certain age. I hear ‘crone,’ ‘hag,’ ‘witch,’ ‘past her sell-by date,’” Coveney says.

Women unwittingly perpetuate these stereotypes. We spend so much of our time and energy caring for others, suppressing our needs, and silencing ourselves and each other that we, in effect, endorse our own neglect.

See also: How to Be Happy at Any Age

The rage tornado

Around the mid-40s, people who menstruate begin to experience a hormonal revolution every bit as intense as puberty: perimenopause, a years-long transition leading up to the main menopausal event (you’re not officially in menopause until you haven’t had a period for an entire year). Our bodies gradually produce less and less estrogen—the hormone that initiates sexual development, regulates the menstrual cycle, and plays a significant role in mediating psychological well-being—and the effect is dramatic.

Decreases in estrogen can lead to anxiety and depression, brain fog, memory loss, and weight gain—as well as emotional shifts that can come on fast and furious.

One hot afternoon in July, I was trying, and failing, to get dressed for my 50th birthday celebration. As I gazed in the mirror, my face looked puffy and droopy at the same time. I felt like I must have gained 50 pounds overnight. Clothes went on, clothes went off. Pants were tight in weird places. I even began hating my shoes.

Internally, I tried to reconcile the usual desire to look beautiful with the self-criticisms and self-doubts, plus a new interior voice that suggested breaking every mirror in the house and living my life in cashmere sweatpants.

When my husband dared to mention that we’d be late for our dinner reservation, I hurled my eyeglasses in gorgeous, unadulterated fury at the closest mirror. It felt terrific. Then someone who sounded a lot like 15-year-old me announced that she wasn’t leaving the house. Menopause, c’est moi.

There’s a word for the simmering fury I felt that night: “menorage.” Awakening from a decades-long estrogen haze, some women approaching menopause may find themselves questioning what they’ve been doing and why they’ve been doing it at all. We may wonder why we tacitly tolerated a certain manager or an hour-long commute or poorly designed software or an uncomfortable office chair. The absurdities of modern life can jump out in sharp relief, propelling us into new careers, new intellectual pursuits, and a radically new frame of mind.

Menopause: A silent mental health risk

Despite the benefits of hormonal changes, there are also real potential dangers. There are demonstrably heightened risks of major depressive episodes in midlife menstruators—a group that has experienced a 45 percent increase in suicide rates over the past 15 years, writes Pauline Maki, a professor of psychology, psychiatry, and obstetrics and gynecology at the University of Illinois Chicago College of Medicine. In 2018, Maki was the lead author of a new set of guidelines for the evaluation and treatment of perimenopausal depression, including hormone-replacement therapy (HRT).

The purpose of the guidelines was to acknowledge that perimenopause can be “a window of vulnerability” for depressive episodes. The guidelines make it clear that perimenopause increases the risk of depression, even if there is no prior history. Maki’s guidelines include recommendations on the potential benefits and risks of estrogen therapy—the health outcomes of which have been under-researched for too long.

The 2018 suicide of designer Kate Spade at age 55, and more recently, the apparent suicide of supermodel Stella Tennant at age 50, highlight this risk. My own sister-in-law took her life at age 55. At her memorial service, her friends talked about the medley of psychiatric drugs she’d been prescribed, including selective serotonin reuptake inhibitors (SSRIs) and sleep meds. The note she left expressed all the hallmarks of under-treated menopause: unfathomable depression mixed with undefinable rage.

Menopause is often under-treated and under-addressed, as it sits at the bleak intersection of reproductive health and mental health. The symptoms of aging can’t be “seen” through most diagnostics, so they’re easily dismissed. Even more alarming, the two-decade Study of Women’s Health Across the Nation found that people of different races and ethnicities experience menopause differently. Black women had more hot flashes and night sweats than white women, and Black and Hispanic women experience poorer quality sleep, but they are less likely to be offered treatments such as HRT.

In addition to racial disparities, there is a lack of female-specific data baked into medical culture. The U.S. Office on Women’s Health, for example, reports on its website that women are less likely than men to experience the classic symptoms of a heart attack. If 51 percent of the population is female—a majority—and they are not showing the “classic” symptoms, then maybe we shouldn’t be calling those symptoms “classic.”

While hot flashes, anxiety, and insomnia may not seem as life-threatening as a heart attack, the hormonal changes and chronic nature of menopause can grind down a person’s sense of well-being—especially for those already at risk of depression. (It’s important to note that any major hormonal event can trigger depression—puberty, pregnancy, and postpartum included.)

There have been some strides: In the United States, many are now often advised to use HRT sparingly during perimenopause, in conjunction with exercise, antidepressants, and other therapies. (HRT was previously popular, until a study in the 1990s suggested a link between HRT and higher rates of cancer.)

Beyond the need for evolution by the medical community, Maki’s perimenopausal depression guidelines also give a simple nod to the curative powers of a good workout: “It is reasonable to recommend exercise in peri- and postmenopausal individuals with depression, particularly when used in combination with recommended psychotherapies and pharmacotherapies.”

That’s where Coveney’s yoga therapy (and my rowing obsession) comes in.

See also: So You Want to Try Yoga Therapy? Here’s Where to Start

Woman in green dress jumping in the air
(Illustration: Jessie Ford)

Embracing transformation through yoga

When Coveney began experiencing menopause symptoms, she embarked on a years-long odyssey to create a program to help people regain control of their lives that combined mindfulness and cognitive behavioral therapy with Ayurveda, pranayama, and meditation. She emphasizes that these tools should be part of a larger approach to managing menopause, whether including HRT or not, depending on the individual and their health care professional’s recommendations. In 2010, Coveney became the first person, as far as she knows, to offer a fully accredited yoga teacher training course designed specifically for menopause.

Coveney thinks of menopause as an opportunity for transformation, like emerging from a cocoon or molting feathers. She compares the time leading up to menopause to hibernation. Over the years leading up to the main event, digestion slows, the mind gets fuzzy, weight can creep on. But like the creatures in springtime, she says, we emerge from that sleep hungry and energized.

Once we do, we often enter a postmenopausal phase feeling unburdened by many former responsibilities and expectations, Coveney says. To get the most out of this transition, she says, “a woman needs to reconnect with her intuitive self, introspection, and decide what she needs to let go of in terms of thoughts, habits, and behaviors that no longer support her happiness and health.”

Coveney crafted her menopause yoga teacher training course to help menstruators realize all the marvels that the third act promises. She links her menopause-specific yoga sequences to the three Ayurvedic doshas which express themselves in different ways during menopause (see “Menopause Yoga for Your Dosha Type” below).

In her workshops, Coveney first shares the latest research on the physiological changes happening during menopause, reframed in an empowering light. She then ties these physiological changes to our emotional well-being.

See also: Feeling a Hot Flash? Here’s How Yoga Can Help Relieve Your Symptoms

The power of coming together

Science strongly supports Coveney’s approach. Several studies have shown that a regular practice of asana and breathing exercises can enhance menopausal women’s moods, chase away depression, and inspire a brighter outlook.

Yoga also teaches people how to control heart rate and breathe through discomfort, which helps when those panicky feelings that precede a hot flash begin to bubble up. The studies found a positive correlation between regular practice and participants’ improved quality of life.

Restorative yoga, breathwork, and meditation are critical aids on this journey. Even better, the profound effects of group yoga on symptoms of menopause may have a chemical component as well.

Coveney says that when people gather in the yoga studio or for menopause workshops and share their experiences, they’re doing more than just talking. As they begin to connect with one another, they release oxytocin—the hormone that promotes feelings of love, bonding, and well-being. Even during the pandemic, daily rowing gave me that beautiful endorphin rush—but also connected me with women my age around the world doing the same thing. In nurturing gatherings of older women, the higher levels of oxytocin suggest that they are actually healing each other with an invisible cloud of loving hormones.

All hail the sisterhood.

Menopause yoga for your dosha type

Yoga and Ayurvedic practices can help ease some menopausal symptoms, which can be viewed as an imbalance of the three doshas, or metabolic types, says Petra Coveney, founder of Menopause Yoga. We all have a dominant dosha type that affects how we respond to this major life change. A regular practice centering on nutrition, exercise, yoga, and sleep to balance those doshas can be a useful part of a larger holistic approach to manage symptoms.

Pitta (fire/body)

Excess pitta leads to hot flashes, night sweats, anger, aggression, and irritability. Try Yin Yoga—which encourages forgiveness, a sense of emotional release and a surrender to change—or Restorative yoga using props, which can help you feel supported, both physically and metaphorically.

Vata (air/mind)

A surplus of vata leads to anxiety, panic attacks, brain fog, fatigue, and the sense of being overwhelmed. Standing balance poses such as Vrksasana (Tree Pose) can help to focus your mind, while grounding breathing exercises such as box breathing can make you feel rooted to the earth.

Kapha (water/element)

An imbalance of kapha expresses itself in lethargy, low mood, and sluggish metabolism. A dynamic hatha yoga practice with poses held for 10–30 seconds can help you maintain muscle and bone strength, lift a low mood, and make you feel energized.

See also: Balance Your Moods By Understanding the Doshas