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Yoga increased serum estrogen levels in postmenopausal women—a case report

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Abstract

Objective: This case report aimed to evaluate 4 months of yoga practice on the quality of life (QOL) and estradiol levels of two postmenopausal women. Methods: Participants were clinically healthy postmenopausal women, with follicle-stimulating hormone levels greater than or equal to 30 mIU/mL and a body mass index lower than 30 kg/m. The participants practiced yoga for 4 months in two 1-hour sessions per week. Results: The participants exhibited an abnormal estrogen-level increase after 4 months of yoga practice and showed QOL improvements. Conclusions: In some cases, yoga practice can affect the female neuroendocrine system, increasing estrogen and improving QOL.

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... Yoga decreased the score of the Insomnia Severity Index in perimenopausal women with chronic insomnia after 4 months [77]. Women who practiced yoga had changes in their neuroendocrine system, increasing estrogen levels and improving quality of life [78]. ...
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... Estrogen reduction can lead to nocturia and sleep fragmentation, as the number of times the individual wakes up is related to a worse quality of sleep 48 . The practice of yoga has been proven to have positive effects on reducing insomnia 54,55 . Therefore, physiotherapy can help to ameliorate the symptoms of the peri-and postmenopause periods. ...
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Mind-body medical interventions are commonly used to cope with depression and yoga is one of the most commonly used mind-body interventions. The aim of this review was to systematically assess and meta-analyze the effectiveness of yoga for depression. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through January 2013. Randomized controlled trials (RCTs) of yoga for patients with depressive disorders and individuals with elevated levels of depression were included. Main outcomes were severity of depression and remission rates, secondary outcomes were anxiety, quality of life, and safety. Twelve RCTs with 619 participants were included. Three RCTs had low risk of bias. Regarding severity of depression, there was moderate evidence for short-term effects of yoga compared to usual care (standardized mean difference (SMD) = -0.69; 95% confidence interval (CI) -0.99, -0.39; P < .001), and limited evidence compared to relaxation (SMD = -0.62; 95%CI -1.03, -0.22; P = .003), and aerobic exercise (SMD = -0.59; 95% CI -0.99, -0.18; P = .004). Limited evidence was found for short-term effects of yoga on anxiety compared to relaxation (SMD = -0.79; 95% CI -1.3, -0.26; P = .004). Subgroup analyses revealed evidence for effects in patients with depressive disorders and in individuals with elevated levels of depression. Due to the paucity and heterogeneity of the RCTs, no meta-analyses on long-term effects were possible. No RCT reported safety data. Despite methodological drawbacks of the included studies, yoga could be considered an ancillary treatment option for patients with depressive disorders and individuals with elevated levels of depression.
Article
Objective: The measurement of heart rate variability (HRV) is often applied as an index of autonomic nervous system (ANS) balance and, therefore, myocardial stability. Previous studies have suggested that relaxation or mind-body exercise can influence ANS balance positively as measured by HRV but may act via different mechanisms. No studies, to the authors' knowledge, have examined the acute response in HRV to interventions combining relaxation and mind-body exercise. The objective of this study was to compare the acute HRV responses to Yoga Nidra relaxation alone versus Yoga Nidra relaxation preceded by Hatha yoga. Design: This was a randomized counter-balanced trial. Setting: The trial was conducted in a university exercise physiology laboratory. Subjects: Subjects included 20 women and men (29.15±6.98 years of age, with a range of 18-47 years). Interventions: Participants completed a yoga plus relaxation (YR) session and a relaxation only (R) session. Results: The YR condition produced significant changes from baseline in heart rate (HR; beats per minute [bpm], p<0.001) and indices of HRV: R-R (ms, p<0.001), pNN50 (%, p=0.009), low frequency (LF; %, p=0.008) and high frequency (HF; %, p=0.035). The R condition produced significant changes from baseline in heart rate (bpm, p<0.001) as well as indices of HRV: R-R (ms, p<0.001), HF (ms(2), p=0.004), LF (%, p=0.005), HF (%, p=0.008) and LF:HF ratio (%, p=0.008). There were no significant differences between conditions at baseline nor for the changes from baseline for any of the variables. Conclusions: These changes demonstrate a favorable shift in autonomic balance to the parasympathetic branch of the ANS for both conditions, and that Yoga Nidra relaxation produces favorable changes in measures of HRV whether alone or preceded by a bout of Hatha yoga.
Article
Objectives: The objectives of this trial were to compare the effects of a holistic yoga program with the conventional exercise program in adolescent polycystic ovarian syndrome (PCOS). Design: This was a prospective, randomized, active controlled trial. Setting: Ninety (90) adolescent (15-18 years) girls from a residential college in Andhra Pradesh who satisfied the Rotterdam criteria were randomized into two groups. Intervention: The yoga group practiced a holistic yoga module, while the control group practiced a matching set of physical exercises (1 hour/day, for 12 weeks). Outcome measures: Anti-müllerian hormone (AMH-primary outcome), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, prolactin, body-mass index (BMI), hirsutism, and menstrual frequency were measured at inclusion and after 12 weeks. Results: Mann-Whitney test on difference score shows that changes in AMH (Y=-2.51, C=-0.49, p=0.006), LH, and LH/FSH ratio (LH: Y=-4.09, C=3.00, p=0.005; LH/FSH: Y=-1.17, C=0.49, p=0.015) were significantly different between the two intervention groups. Also, changes in testosterone (Y=-6.01, C=2.61, p=0.014) and Modified Ferriman and Gallway (mFG) score (Y=-1.14, C=+0.06, p=0.002) were significantly different between the two groups. On the other hand, changes in FSH and prolactin postintervention were nonsignificantly different between the two groups. Also, body weight and BMI showed nonsignificantly different changes between the two groups, while changes in menstrual frequency were significantly different between the two groups (Y=0.89, C=0.49, p=0.049). Conclusions: A holistic yoga program for 12 weeks is significantly better than physical exercise in reducing AMH, LH, and testosterone, mFG score for hirsutism, and improving menstrual frequency with nonsignificant changes in body weight, FSH, and prolactin in adolescent PCOS.
Article
The aim of this study was to assess the levels of flexibility, functional autonomy and QoL in elderly yoga practitioners. The subjects were divided into a yoga group (YG; n = 52; age = 66.79 ± 3.30 years; BMI = 24.77 ± 3.18) and control group (CG; n = 31; age = 69.33 ± 4.84 years; BMI = 24.32 ± 3.71) and submitted to flexibility tests through goniometry, the LADEG autonomy protocol and QoL, using the WHOQOL-Old questionnaire. Repeated measures ANOVA showed increases in articular range of motion in shoulder abduction (Δ%SA = 14.11%; p = 0.0001), horizontal shoulder extension (Δ%HSE = 33.90%; p = 0.0001), lumbar spine flexion (Δ%LSF = 50.74%; p = 0.0001), hip flexion (Δ%HF = 35.75%; p = 0.0001), hip extension (Δ%HE = 10.93%; p = 0.021) and knee flexion (Δ%KF = 3.90%; p = 0.001) and in the GDLAM autonomy index (Δ%AI = -13.67%; p = 0.0001) in the YG compared to the CG. The Mann-Whitney test revealed increases in QoL scores in Facet 1 (Δ%Fac1 = 9.04%; p=0.043), Facet 5 (Δ%Fac5 = 51.06%; p = 0.0001) and in overall QoL (Δ%OqoL = 8.13%; p = 0.046) in the YG compared to the CG. The remaining variables showed no significant intergroup modifications. Thus, the study suggests that the regular practice of yoga may lead to improved range of motion in the performance of activities of daily living in elderly women.
Article
Despite questionable efficacy and safety, many women use a variety of complementary and alternative medicine (CAM) therapies to relieve menopause symptoms. We examined the determinants and use of CAM therapies among a sample of menopausal-aged women in Canada by using a cross-sectional Web-based survey. Four hundred twenty-three women who were contacted through list serves, e-mail lists, and Internet advertisements provided complete data on demographics, use of CAM, therapies, and menopausal status and symptoms. Ninety-one percent of women reported trying CAM therapies for their symptoms. Women reported using an average of five kinds of CAM therapies. The most common treatments were vitamins (61.5%), relaxation techniques (57.0%), yoga/meditation (37.6%), soy products (37.4%), and prayer (35.7%). The most beneficial CAM therapies reported were prayer/spiritual healing, relaxation techniques, counseling/therapy, and therapeutic touch/Reiki. Demographic factors and menopausal symptoms contributed to 14% of the variance (P < .001) in the number of CAM therapies tried. Results support previous research showing that menopausal women have high user rates of CAM therapy and show that specific demographic factors and somatic symptomatology relate to use of CAM therapies. Health care providers can benefit from understanding the determinants and use of CAM by women during the menopause transition if they are to help and provide quality care for this population.
Article
To systematically review the peer-reviewed literature regarding the effects of self-administered mind-body therapies on menopausal symptoms. To identify qualifying studies, we searched 10 scientific databases and scanned bibliographies of relevant review papers and all identified articles. The methodological quality of all studies was assessed systematically using predefined criteria. Twenty-one papers representing 18 clinical trials from 6 countries met our inclusion criteria, including 12 randomized controlled trials (N=719), 1 non-randomized controlled trial (N=58), and 5 uncontrolled trials (N=105). Interventions included yoga and/or meditation-based programs, tai chi, and other relaxation practices, including muscle relaxation and breath-based techniques, relaxation response training, and low-frequency sound-wave therapy. Eight of the nine studies of yoga, tai chi, and meditation-based programs reported improvement in overall menopausal and vasomotor symptoms; six of seven trials indicated improvement in mood and sleep with yoga-based programs, and four studies reported reduced musculoskeletal pain. Results from the remaining nine trials suggest that breath-based and other relaxation therapies also show promise for alleviating vasomotor and other menopausal symptoms, although intergroup findings were mixed. Most studies reviewed suffered methodological or other limitations, complicating interpretation of findings. Collectively, findings of these studies suggest that yoga-based and certain other mind-body therapies may be beneficial for alleviating specific menopausal symptoms. However, the limitations characterizing most studies hinder interpretation of findings and preclude firm conclusions regarding efficacy. Additional large, methodologically sound trials are needed to determine the effects of specific mind-body therapies on menopausal symptoms, examine long-term outcomes, and investigate underlying mechanisms.
Article
Mind-body therapies (MBT) are used by 16.6% of adults in the United States. Little is known about the patterns of and reasons for use of MBT by adults with common medical conditions. We analyzed data on MBT use from the 2002 National Health Interview Survey Alternative Medicine Supplement (n=31,044). MBT included relaxation techniques (deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation), yoga, tai chi, and qigong. To identify medical conditions associated with use of MBT overall and of individual MBT, we used multivariable models adjusted for sociodemographic factors, insurance status, and health habits. Among users of MBT (n=5170), we assessed which medical conditions were most frequently treated with MBT, additional rationale for using MBT, and perceived helpfulness. We found a positive association between MBT use and several medical conditions including various pain syndromes and anxiety/depression. Among adults using MBT to treat specific medical conditions, MBT was most commonly used for anxiety/depression and musculoskeletal pain syndromes. More than 50% of respondents used MBT in conjunction with conventional medical care, and 20% used MBT for conditions they thought conventional medicine would not help. Overall, we found high rates (68-90%) of perceived helpfulness of MBT for specific medical conditions. MBT is commonly used by patients with prevalent medical conditions. Further research is needed to determine the reasons for widespread use of MBT for treatment of specific medical conditions and to evaluate the efficacy of MBT.
Article
Objective: To develop a condition-specific quality of life questionnaire for the menopause with documented psychometric properties, based on women's experience. Methods: Subjects: Women 2-7 years post-menopause with a uterus and not currently on hormone replacement therapy. Questionnaire development: A list of 106 menopause symptoms was reduced using the importance score method. Replies to the item-reduction questionnaire from 88 women resulted in a 30-item questionnaire with four domains, vasomotor, physical, psychosocial and sexual, and a global quality of life question. Psychometric properties: A separate sample of 20 women was used to determine face validity, and a panel of experts was used to confirm content validity. Reliability, responsiveness and construct validity were determined within the context of a randomized controlled trial. Construct validation involved comparison with the Neugarten and Kraines' Somatic, Psychosomatic and Psychologic subscales, the reported intensity of hot flushes, the General Well-Being Schedule, Channon and Ballinger's Vaginal Symptoms Score and Libido Index, and the Life Satisfaction Index. Results: The face validity score was 4.7 out of a possible 5. Content validity was confirmed. Test-retest reliability measures, using intraclass correlation coefficients were 0.81, 0.79, 0.70 and 0.55 for the physical, psychosocial, sexual domains and the quality of life question. The intraclass correlation coefficient for the vasomotor domain was 0.37 but there is evidence of systematic change. Discriminative construct validity showed correlation coefficients of 0.69 for the physical domain, 0.66 and 0.40 for the vasomotor domain, 0.65 and -0.71 for the psychosocial domain, 0.48 and 0.38 for the sexual domain, and 0.57 for the quality of life question. Evaluative construct validity showed correlation coefficients of 0.60 for the physical domain, 0.28 for the vasomotor domain, 0.55 and - 0.54 for the psychosocial domain, 0.54 and 0.32 for the sexual domain, and 0.12 for the quality of life question. Responsiveness scores ranged from 0.78 to 1.34. Conclusions: The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in their quality of life.
Article
In 2002 the Women's Health Initiative reported the results of a study on the effects of combined oestrogen plus progestogen on healthy postmenopausal women. They found increased rates of breast cancer, coronary heart disease, stroke, and venous thromboembolism and decreased rates of hip fracture and colorectal disease but no “global” benefit. They concluded that combined oestrogen and progestogen is not suitable for the prevention of chronic diseases.1 The subsequent extensive media coverage came at a time when the prevalence,2 3 duration,2 4 and use of hormone replacement therapy (HRT) for the prevention of chronic disease had been increasing.2 4 After the report, government regulatory authorities issued advice to health professionals and women, and guidelines relating to the postmenopausal use of hormone replacement therapy were updated.5 We examined changes in HRT use since the publication of the report. Between January 2000 and November 2002, 3500 women were screened from 23 general practices in four New Zealand centres as part of the recruitment process for the …
Article
Hormonal integration of the reproductive system is dramatically affected by reproductive aging. The progressive loss of ovarian follicles with normal aging is accompanied by an initial decrease in inhibin B and a concomitant increase in follicle-stimulating hormone. Subsequently, inhibin A and progesterone decrease, where as estradiol levels are maintained and often increase. In the late reproductive stage, cycles remain regular whereas the early and late menopausal transition are characterized by irregular cycles and often dramatic swings in estradiol and gonadotropin levels. Studies in younger and older postmenopausal women suggest that there are age-related changes in the neuroendocrine axis that are independent of the changing ovarian hormonal milieu of the menopausal transition but may contribute to the end of reproductive life.
Article
The Women's Health Initiative (WHI) Data Safety and Monitoring Board terminated the trial arm of the estrogen plus progestin combined hormone therapy early after observing an excess of harm relative to benefit of this therapy. To learn how postmenopausal hormone therapy (PMT) use in a community setting was affected by the WHI results, we resurveyed current users of PMT in August 2002 to January 2003 after publication of the WHI findings from our Minnesota Heart Survey (MHS) cohort (2000-2002), a cross-sectional epidemiological survey in the Minneapolis-St. Paul, Minnesota, area. We evaluated women's interpretation of the WHI results, reports of their physicians' recommendations, and the impact of these on PMT use in this group. We obtained an excellent response rate (97.9%, 185 of 189). Almost a third of women with an intact uterus but few women with a hysterectomy discontinued their PMT regimen within the first 6 months after the WHI research results were released. The majority of women in our study consulted their physician about whether to discontinue PMT. Women in the intact uterus group who started their PMT regimen for menopausal symptoms were less likely to discontinue PMT. Of women who continued their PMT regimen, the majority cited relief of menopausal symptoms or physician recommendation for continuation of PMT or both. Almost a third of the women interviewed reported being confused, worried, or nervous about the media reports of the WHI results. These results suggest effective dissemination of WHI information by the media and physicians and significant changes in patterns of PMT use in the community.
Article
The directly attributable effect of menopausal transition on women's quality of life (QoL) remains unclear. This study investigates the relationship between perceived change in QoL and menopausal transition status, socio-economic circumstances, lifestyle factors, and life stress. Prospective data were collected from a cohort of 1525 British women followed up since their birth in 1946 and annually from 47 to 54 years. Following factor analysis, the 10 survey items for perceived change were combined into three QoL domains: physical health (physical health, energy level, and body weight), psychosomatic status (nervous and emotional state, self-confidence, work life, ability to make decisions, and ability to concentrate), and personal life (family life and time for self, hobbies, and interests).
Article
Quality of life (QOL) is generally not precisely defined or measured. This has resulted in confusing and often misleading conclusions in multiple publications, including those coming from both the HERS and the WHI writing groups. Health-related QOL and global QOL are accurately defined, and current instruments for measuring them are available. In the continuing effort to determine the true risks and benefits of postmenopausal hormone usage, it is critical that the full spectrum of effects be measured. There is no excuse for future studies on hormone use not to include well-validated instruments for measuring QOL and for not reporting those effects as part of the rest of the study. Questionnaire instruments can often provide more information than many of the invasive tests that are part of contemporary trials. They also add little cost, yet can be invaluable in the analysis of real cost-effectiveness of interventions in contemporary women's health care. Beyond safety and efficacy evaluation of drug therapies, there is an absolute need to know about the real impact of these therapies on overall quality of life.
Article
The menopause, defined as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity, marks the end of natural female reproductive life. It is preceded by a period of menstrual cycle irregularity, the menopausal transition, which usually begins in the mid-40s and is conventionally divided into early and late phases. The endocrine changes, which underlie the transition, are predominantly the consequence of a marked decline in ovarian follicle numbers. The most significant changes include a decrease in early cycle inhibin B and in anti-Mullerian hormone (AMH) levels. The decline in inhibin B results in an increase in FSH, which appears to be an important factor in the maintenance of estradiol (E2) concentrations until late in reproductive life. In the post-menopause, FSH levels are markedly raised, E2 levels are low, whereas inhibin B and AMH are undetectable. The menopausal transition is a time of marked hormonal instability. The Melbourne Women's Midlife Health Project has been an extremely productive study in which it has been possible to describe longitudinal changes in hormone levels throughout the menopause transition and to separate the effects of hormone change from the effects of ageing on a number of endpoints. This review provides the background for an accompanying manuscript in which a novel approach to modelling the hormonal changes during the transition is described.
Article
To study the effect of yoga on the climacteric symptoms, perceived stress, and personality in perimenopausal women. 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. 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. Eight weeks of an integrated approach to yoga therapy decreases climacteric symptoms, perceived stress, and neuroticism in perimenopausal women better than physical exercise.
Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners
  • Lc Gonçalves
  • Rg Vale
  • Nj Barata
  • Rv Varejão
  • Eh Dantas
Gonçalves LC, Vale RG, Barata NJ, Varejão RV, Dantas EH. Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners. Arch Gerontol Geriatr 2011;53:158-162.
Yoga-Terapia-Hormonal Para Menopausa
  • D Rodrigues
Rodrigues D. Yoga-Terapia-Hormonal Para Menopausa. 2nd ed. São Paulo: Madras; 1999.
Perceived change in quality of life during the menopause
  • Mishra