Treating the Climacteric Symptoms in Indian Women With an Integrated Approach to Yoga Therapy: A Randomized Control Study

Ritu Chattha, MSc; Nagarathna Raghuram, MD, FRCP; Padmalatha Venkatram, FRCOG, MRCPI; Nagendra R. Hongasandra, ME, PhD


Menopause. 2008;15(5):862-870. 

In This Article

Abstract and Introduction

Objective: To study the effect of yoga on the climacteric symptoms, perceived stress, and personality in perimenopausal women.
Design: One hundred twenty participants (ages 40-55 y) were randomly divided into two study arms, ie, yoga and control. The yoga group practiced an integrated approach to yoga therapy comprising surya namaskara (sun salutation) with 12 postures, pranayama (breathing practices), and avartan dhyan (cyclic meditation), whereas the control group practiced a set of simple physical exercises under supervision of trained teachers for 8 weeks (1 h daily, 5 days per week). The assessments were made by Greene Climacteric Scale, Perceived Stress Scale, and Eysenck's Personality Inventory before and after the intervention.
Results: Of the three factors of the Greene Climacteric Scale, the Mann-Whitney test showed a significant difference between groups (P<0.05) in the vasomotor symptoms, a marginally significant difference (P=0.06) in psychological factors but not in the somatic component. Effect sizes were higher in the yoga group for all factors. There was a significantly greater degree of decrease in Perceived Stress Scale scores (P<0.001, independent samples t test) in the yoga group compared with controls (between-group analysis) with a higher effect size in the yoga group (1.10) than the control (0.27). On the Eysenck's Personality Inventory, the decrease in neuroticism was greater (P<0.05) in the yoga group (effect size=0.43) than the control group (effect size=0.21) with no change in extroversion in either the yoga or control group.
Conclusions: Eight weeks of an integrated approach to yoga therapy decreases climacteric symptoms, perceived stress, and neuroticism in perimenopausal women better than physical exercise.

Because the average life span of women in India has approached 62 years, the problems of menopause have attained a greater significance,[1] and the study of menopause is emerging as an issue.[2] The Indian subcontinent is a mix of many ethnic groups and cultures where the perception of menopause varies and symptoms are different from region to region. Although the most striking feature of menopause is the cessation of menstruation, other biological and psychosocial events occur and can be classified as stressors or facilitators.[3] A study in seven Southeast Asian countries (Hong Kong, Indonesia, Korea, Malaysia, the Philippines, Singapore, and Taiwan), in which approximately 400 women in each country were questioned about a number of climacteric complaints; the prevalence of hot flashes and sweating was lower than in Western countries, but was nevertheless not negligible.[4]

At menopause, some women present a clinical picture of not only the specificity of estrogen deficiency, such as hot flashes, but also a nonspecific psychological syndrome characterized largely by anxiety and depression.[5] A cohort of 16,065 women ages 40 to 55 years examined the association between psychological distress and natural menopause in a community sample of African American, white, Chinese, Hispanic, and Japanese women participating in a national women's health study. Rates of psychological distress were highest in early perimenopause (28.9%) and lowest in premenopause (20.9%) and postmenopause (22%). In a US sample of 170 menopausal women between the ages of 45 and 54, menopausal symptoms, seeking social support, and neuroticism accounted for 21% of the variance in rating menopause as stressful.[6] Perimenopausal depressed women are more likely to report both negative life events and diminished self-esteem.[7]

Hormone therapy (HT) holds a risk of breast cancer and a threefold risk of venous thromboembolism, inducing feelings of fear.[8] A randomized, controlled study of healthy postmenopausal women who were taking oral HT observed that stress coping did not change after estrogen therapy. The women in the target group were successfully treated for vasomotor symptoms but had significantly higher neuroticism scores compared with the comparison group.[9] Stress coping is an individual propensity and not dependent on specific hormonal status during menopause. Because of the serious adverse effects of HT, there has been a gap in the management of menopausal symptoms, emphasizing the need to develop and explore the efficacy of alternative therapeutic avenues that have recently demonstrated promise in alleviating menopausal symptoms.[10]

Among nonpharmacological alternative therapies that have been studied, one study used relaxation response in 33 menopausal women who demonstrated significant decreases in hot flash intensity, tension/anxiety, and depression.[11] Yoga, developed thousands of years ago, is emerging as a form of mind-body medicine. An Indian study observed a remarkable decrease (P<0.001) in the anxiety scores within 10 days of an educational yoga program for lifestyle modification and stress management.[12] Women with emotional distress who participated in yoga training demonstrated pronounced and significant improvements in perceived stress, state and trait anxiety, well-being, vigor, fatigue, and depression.[13] A pilot trial that chose eight restorative yoga poses for 8 weekly 90-minute sessions found that the mean number of hot flashes per week decreased by 30.8% and mean hot flash score decreased by 34.2% and demonstrated the feasibility of teaching yoga to middle-aged women without previous yoga experience. The high rates of participant retention and satisfaction suggest that yoga is an acceptable intervention in the American population.[14] After a 10-week yoga program comprising breathing techniques, postures, and relaxation poses designed specifically for menopausal symptoms, significant pre-/posttreatment improvements were found for severity of questionnaire-rated total menopausal symptoms, hot-flash daily interference, and sleep efficiency, disturbances, and quality.[15] An earlier three-arm randomized, controlled study also showed yoga to be as effective as walking in reducing the vasomotor symptoms of menopause.[16]

There are no randomized, controlled studies on yoga or meditation in perimenopause in Indian women. The present study was designed to examine the efficacy of an integrated approach to yoga therapy (IAYT), a nonpharmacological therapy that offers techniques to promote positive health at the physical, mental, social, and spiritual levels in alleviating perimenopausal symptoms.


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