If you are currently going through the perimenopause or menopause and you have back pain, this blog is for you. I’ll explain briefly how changing hormone levels can affect your joints and muscles, and suggest yoga therapy practices to keep you supple and strong. Far from just being a sign of old age, spine and peripheral joint pain can be the result of fluctuating hormone levels. Moreover, slower production of estrogen can lead to bone loss and the risk of osteoporosis later in life. If you are perimenopausal or menopausal, read here what you can do to support your spine and back health. Of course, it wouldn’t be yoga therapy without attention to the mind as well. The last paragraphs explain how the breath can help you navigate mood swings and feel more peaceful.
More than ever before, the menopause has left the sphere of taboos and become discussable. The current mayor of London, Sadiq Khan, even announced an unprecedented menopause policy for City Hall on 8 March 2022. He said he wanted to tackle discrimination and stigma around menopausal symptoms at the workplace. Sadiq Khan was really talking to the Zeitgeist in which women don’t want to suffer in silence any longer. Women demand support and information, proper medical attention and understanding, so this transitory time can be empowering and positively transformational.
The menopause starts when a woman hasn’t had a period for a year. However, the symptoms can be felt up to 10 years before that, in what is called the perimenopause, and last for many years after this time. The symptoms are unique to each woman, and they can include the notorious hot flashes, sleep disturbance, depression, anxiety, brain fog, joint pains, mood swings, and more. There are now a multitude of resources for information and support, a few of which I added at the end of this blog. As is often done, I will use the word menopause to signify menopause as well as perimenopause.
What causes menopausal symptoms?
Menopausal symptoms are caused by fluctuating hormone levels when a woman reaches the end of her fertile years. Three hormones in particular are important: estrogen, progesterone and testosterone. According to menopause expert and GP Louise Newsom, estrogen “protects the arteries in the heart, helps to keep your bones healthy and strong, regulates your mood, helps your brainpower and memory, and keeps any area that needs moisture well-lubricated. Testosterone helps to keep the bulk in your muscles, it regulates your sex drive, helps your mental focus and concentration, and your energy levels. Progesterone’s role is to regulate the menstrual cycle and is important during pregnancy. It’s also used as part of HRT (hormone replacement therapy) to keep the lining of the womb thin and healthy.” (quote from ‘Balance’, menopause support app created by Louise Newsom).
Why is spine and peripheral joint pain involved?
Estrogen protects muscles and prevents inflammation, while loss of testosterone can make it hard to maintain muscle strength. So with the slower production of hormones, joints may become stiff and painful and it may also become harder to build and maintain muscle.
An online article published in 2015 (“Low back pain in women before and after menopause” PubMed Central) states that low back pain increases in women aged 45-60. The authors look at seven studies in particular and conclude that all studies “seem to unanimously suggest an increased incidence of low back pain in perimenopausal women compared to other age groups” (M. Kozinoga et al.)
According to the Menopause Charity, yoga can help prevent osteoporosis and maintain all-over body strength and suppleness. It can also tackle other symptoms of the menopause, such as sleeplessness. Whether you are taking HRT (hormone replacement therapy) or not, yoga is there to keep you stronger, calmer and more flexible. If you are suffering from spine and peripheral joint pain, here is how yoga therapy can help.
Yoga Therapy for menopause and back pain
In this general plan for the menopause, I outline broad principles and some actionable practices. However, yoga therapy really works best with personal support. One of the studies about lower back pain during the menopause concludes that “the most effective exercise therapy strategy for chronic lower back pain was supervised and individually-tailored, high-dose stretching and muscles strengthening exercise programs with home practice” (Hayden et al).
This is exactly what my yoga therapy package offers: an individual just-for-you programme with home practices. Maybe, you feel your back pain mostly in the sacrum, or mostly in the neck. Perhaps you are most concerned about your posture and lack of balance. There are different practices to target all these areas of concern. The five sessions in my back care package give you the knowledge and confidence to look after your back, improve your balance, muscle strength and mobility. Contact me here to discuss if yoga therapy would be right for you: https://beneyoga.co.uk/book-a-free-consultation-call/
The menopause is a particularly important time to listen to your body. It’s not unlikely that you feel exhausted: sleep can be disturbed but even after a good night you may wake up tired. If you feel tired, yoga or exercise requiring exertion will only deplete your energy. So instead, allow yourself the time to rest and breathe in a restorative rest position. Your body will thank you and your energy reserves will be replenished. Try either of the positions below. To feel even more rejuvenated, simply pay attention to your abdominal breathing.
1/ Legs on a chair:
This is my go-to pose for an after-lunch nap. With the alarm on 30 minutes, it gives me a deep rest that is more rejuvenating than 1 hour in bed. On top of that, this position is particularly soothing for the back muscles.
Reclined bound angle pose:
This rest position is considered the most beneficial of rest positions for balancing menopausal symptoms. It promotes blood flow into the pelvis and has a calming effect. It also stretches the chest and digestive system.
If your lower back is painful, it is better to raise the hips in this pose. I definitely prefer a block to raise my lower back, and you can also use two blocks. I also like the cushions to support my legs and sometimes add cushions for my arms as well. Often, a cushion under the head can be more comfortable.
If, and only if, this pose feels comfortable, stay for 10 minutes or longer.
When you feel more energetic, it’s important to add some strengthening to your routine. This is to keep the muscles stronger in a time when lower levels of estrogen and testosterone leave them at risk to become weaker. Strengthening is also important to prevent osteoporosis. For this, weight training is often recommended. However, as I explain in this blog: https://beneyoga.co.uk/preventing-osteoporosis/ , yoga is very helpful in maintaining or improving bone strength.
Core strength is important to support the back and keep a healthy alignment. Many of my previous blogs write about how core strengthening within movement is best. You can search for them with the blog’s search bar, or have a look at my video for abdominal strength. The latter starts very gently and the first video is suitable for low-energy days or days with back pain. The next videos, however, increase the pace and difficulty to gradually strengthen all abdominal muscles and the pelvic floor. Exercises for the pelvic floor become once again super important at this time, as low estrogen levels can contribute to urinary incontinence.
The following sequence strengthens a range of abdominal muscles:
Flower vs. seed
Start on the floor with the legs bent, soles of the feet together and arms to the side.
-Exhale and tuck the chin, then lift your head while moving the knees together and up towards the chest.
-Inhale and go back to the starting position.
-If your neck is painful, you can leave the head on the floor and just move arms and legs.
-Work up to repeating this sequence about 10 times in a row, very slowly with the breath.
Joint mobilisation and stretching
Fluctuating hormone levels can cause muscles to become stiff and achy. Your daily, gentle stretch routine will therefore become even more important. To keep my spine pain-free, I know that I have to move my spine in all directions daily: rotation, lateral stretch, flexion and extension.
You can do the following movements also on a chair or standing.
-Place your hands behind the head.
-While keeping both sitting bones on the floor, exhale and stretch one side of your spine by moving gently over to one side.
-Inhale and return to the centre.
-Exhale and move to the other side.
-Repeat 4 to 6x.
For the twist, first make sure that you sit upright. This can be on a chair. Next, avoid pulling with your arms and shoulders. Instead invite the spine to rotate while you exhale. Return to the centre with an inhalation. Repeat a few times to each side.
For flexion and extension of the spine, the ‘cat and cow’ is a lovely way of stretching the whole spine on all fours. Here, I demonstrate a variation sitting down. You can try these at a desk as well.
-With the hands behind your head, exhale and roll onto the back of your hips, rounding the back like an angry cat.
-Inhale to straighten yourself and gently lift the sternum and collarbones. Your head is held by the hands so the neck doesn’t collapse backward. If this movement hurts, just come to a straight position instead.
-Repeat 4-6x each.
It can be difficult to cope with the mood swings that accompany fluctuating hormones. There may be increased anger, which perhaps was needed to rectify some injustice in your life. But there can also be sadness, listlessness and anxiety. To navigate the mood changes and connect with yourself, mindful breathing can be one of the practices that helps you through. As suggested before, you can practise this in one of the rest positions, or in a comfortable sitting position.
When fear overwhelms you, concentrate on your breathing. Watch your abdomen gently rise with the inhalation, and fall with the exhalation. By doing that, you remove the attention for whatever was making you afraid.
In moments when you feel low, try counting with the breath: breathing in for 5 and out for 5 counts. Try this for 5 to 10 minutes a few times per day.
When you are upset and need calming, try breathing in lightly and exhaling the air with a nice, long blowing exhalation. This longer exhalation will trigger the relaxation response in your body and calm you down.
This is the time to reevaluate your lifestyle and see how you can nourish your body and your mind, to find a balance that is right for you and that allows you to be your best self.
Resources and support:
Balance app, created by Dr. Louise Newson: https://www.balance-menopause.com/balance-app/
The Future of Perimenopause Report, by Henrietta Norton, Dr. Harper and Laura Biggs. https://www.wildnutrition.com/pages/perimenopause-report
Charity for menopause: https://www.themenopausecharity.org/
Online articles about menopause and back pain:
Hayden J, et al. Exercise therapy for treatment of non-specific low back pain. Ann Intern Med. 2005; 142:765–775.
Kozinoga M, et al. Low back pain in women before and after menopause. PubMed Central 2015 Sep. 14(3): 203-207.