I completed a master’s degree in psychology, and while I was publishing my literature review the Women’s Health Initiative released their findings on the dangers of hormone replacement therapy (HRT). My review of the literature had revealed the studies that are largely ignored by the medical establishment as well as pharmaceutical companies. I admit that I was furious reading the existing research, some of which appeared literally suppressed; I argued with my advisor over what I could or could not say (she won) and then the WHI study was released at the same time that I completed my work which, by the way, vindicated me.
Feel free to download a copy of Yoga Therapy for the Management of Hot Flashes, Depression and Anxiety during the Perimenopause. Here is the password: paws4fish.
As a woman goes through the climacteric phase in her life, she may experience symptoms like hot flashes, anxiety, or depression, which could be associated with changes in sleep patterns, irritability, or difficulty in daytime functioning. Interestingly, the usage of the word “climacteric” was most popular before 1900, then declined, but saw a rise again in the 1950s. Even though not commonly used nowadays, the climacteric is the transitional phase in a woman’s life when she gradually moves from being reproductive to non-reproductive, and it includes perimenopause, menopause, and postmenopause. This website reflects the research conducted to explore the occurrence of hot flashes, anxiety, and depression during the climacteric, with a particular focus on perimenopause.
The word "climacteric" has an interesting origin. It comes from the French word "climacterique," which means "constituting a critical period of life," or from Latin and Greek words like "klimaktenikos" and "klimakter," which mean "critical period" or "ladder" or "climax." In medical terms, it's often used to describe the menopausal stage of a woman's life. As an adjective, it can also mean something with extreme and far-reaching implications or results, like a critical situation.
It’s timely to think about the concept of climacteric in the context of climate change. With the increasing magnitude of droughts, hurricanes, floods, and fires that the world is experiencing, it’s like Gaia, the earthly body that nourishes all life, is undergoing its own version of climacteric. The critical changes our planet is going through are having far-reaching implications, just like the climacteric stage in a woman’s life. It’s important to be aware of the changes happening around us and take action to protect our planet for future generations.
The symptoms experienced during a woman’s climacteric reflect her fluctuating hormonal system and it often results in stressful, age-related changes. Perimenopause can happen anytime between the ages of 40 to 50, and estrogen levels gradually decrease starting from around age 35, eventually leading to a decrease in fertility. According to experts, the major reduction in ovarian function occurs in the last six months before menopause. Menopause marks the cessation of menses, and postmenopause is the time after reproductive capability ends. The postmenopause is generally considered to begin approximately one year after the last menstrual event, however unexpected ovarian activity can still occur briefly following menopause.
As women age, changes in estrogen levels can be associated with conditions such as osteoporosis and heart disease, as estrogen plays a role in preserving bone mass and protecting the heart. Some medical professionals view the decrease in estrogen production by the ovaries during menopause as a disease process, and have proposed terms like “Maturity Onset Ovarian Deficiency State” or “MOODS” to describe it (Sobel, 1996). It was thought that creating menopause as a syndrome would provide a medical diagnosis of endocrine deficiency that could be treated with hormone replacement therapy. That argument implies that aging is a disease process rather than a normal part of the life cycle.
Although the decline in ovarian estrogen levels during the climacteric has been associated with age-related diseases, it does not necessarily mean that menopause itself is a disease process. It’s important to note that estrogen is produced by other glands in the body besides the ovaries. Not only that, the ovaries continue to produce other hormones such as testosterone throughout the climacteric.The experience of menopause varies greatly among women, with some viewing it as a liberating and transformative time in their lives, hardly noticing the symptoms and requiring no intervention. Other women accept menopause as a natural and normal part of the life cycle, and generally wait for symptoms to pass.
That being said, a lot of women reveal some anxiety over feeling a lack of control over hot flashes. More is said on that later because it is helpful to understand symptoms in the context of locus-of-control research. Locus-of-control is a term that describes how individuals perceive the source of control in their lives, whether it be internal or external. Some factors that may affect locus of control include not only major life stressors but simply a woman’s belief in her own ability to control symptoms.
The way a woman appraises her hot flashes and copes with them impacts her psychological state, depending on her perception of her ability to control her symptoms (Reynolds, 1999). Kroll suggests that women who perceive less internal control over their menopausal symptoms may experience more symptoms, while those who engage in preventive strategies may experience fewer symptoms (Kroll, 1989).
It is commonly observed that women who seek alternative therapies value the sense of personal control (Seidl & Stewart, 1998). When women perceive that their symptoms can be controlled and adopt strategies such as diet and lifestyle changes, they often report experiencing fewer symptoms. These preventive strategies reflect an internal locus-of-control. On the other hand, some women rely on physicians to control their symptoms and usually opt for hormone replacement therapy (HRT), which represents an external locus-of-control.
For women seeking alternatives to hormone replacement therapy (HRT), practicing yoga can be beneficial in fostering an internal locus-of-control. Yoga involves inward focus and concentration during poses and stretches which enhance flexibility. Through the use of postures, deep breathing, sensory restraint, concentration, and meditation, Vahia and colleagues found significant improvements in anxiety and depression (Vahia et al., 1972). Vahia and colleagues found significant improvements in anxiety and depression and proposed that optimal well-being can be achieved by harnessing internal mechanisms within the individual.
The aim of yoga is to cultivate detachment from the constant fluctuations of pleasure and pain in everyday life, and to reduce physiological reactivity to external or internal stimuli. This is achieved through various practices: physical postures enhance control over voluntary muscles and release accumulated stress hormones; breathing exercises improve control over the autonomic nervous system; sense withdrawal, known as pratyahara, reduces sensory stimuli; and meditation increases self-awareness and provides insight into thought patterns and habits.
The perspective that menopause is a transitional and potentially positive experience is supported by Ayurveda, a system of knowledge rooted in ancient vedic literature. Ayurveda, which translates to "knowledge of life" in Sanskrit, is a holistic approach that encompasses the body, mind, and spirit, viewing the symptoms of menopause as an imbalance of bodily humors.
Ayurveda and yoga complement each other as Ayurveda offers a perception of the climacteric as a seasonal transition. In Sanskrit, the general term for the menstrual cycle is “artarva”, derived from “rtu” meaning season, as explained by Svoboda (1999). Just like how we adapt to changes in environmental seasons, Ayurveda provides therapies to support women during the seasons of their life. Yoga, though having developed separately from Ayurveda, shares historical similarities (Feuerstein, 1998).
The breath works! Please use this information as a doorway for your own exploration!