The yoga way: a tool to ease menstrual pain

Many women already use yoga to prevent and alleviate menstrual pain.

Yoga is today regarded in the West as an holistic approach to health and only recently it has been classified by the National Institutes of Health as a form of Complementary and Alternative Medicine (CAM).

However, in India Yoga is not an alternative healing system but a part of main-stream medicine. [4]

Yoga combines physical exercises, mental meditation, breathing techniques and a specific lifestyle to strengthen the muscles and relieve stress. Therefore, it is a useful tool in helping mind and body to adapt with stress, anxiety and depression making the person feel relaxed and calm.

Yoga has been used to alleviate problems associated with high blood pressure, high cholesterol, migraine headaches, asthma, shallow breathing, backaches, diabetes, menopause, multiple sclerosis and attention deficit and memory loss. [1], [5], [6], [7], [8]

In addition, yogic practices have proven to be very beneficial also in the treatment of dysmenorrhoea.

A yoga teacher looking for the right alignment

Apart from increasing the circulation to the reproductive organs, they increase the flow of vital energy to these organs and establish a balance among hormones regulating menstruation. Yoga can prevent and treat diseases by using the energies inside the body, improving the circulation and waste disposal thereby cleansing the cells.

Yoga treats the individual as a whole and not just the symptoms

This is the base of an holistic approach toward a disease. Therefore, Yoga is not just a system of physical exercises but a psycho-physiological system of therapy. [9]

What is dysmenorrhea?

Dysmenorrhea can be literally translated as “difficult monthly flow”. Commonly, it is referred to as menstrual cramps and it consists in a painful menstruation. Primary dysmenorrhea occurs in 50% of female adolescents and is a common problem in women of reproductive age. [1]

Pain usually develops within hours of the start of the menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle. [2]

Symptoms often co-occurring with menstrual pain include nausea , diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue.

The release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract: these substances are thought to be a major factor in primary dysmenorrhea.
Several studies have shown that adolescents with primary dysmenorrhoea report that it affects their academic performance, social and sports activities and is a cause for school absenteeism.

It is estimated that over 600 million hours are lost from work each year due to dysmenorrhea. [3]

Results of practicing yoga for relieving menstrual pain

A study that involved 92 student girls ranging from 18 and 22 years old was carried out to assess whether three yoga postures (Cobra pose – Bhuganagasana – , Cat pose – Bidalasana – , Fish pose – Matsyasana) were able to reduce the intensity and the duration of menstrual pain. These three asanas (postures) were performed in the luteal phase of menstrual cycle for 20 minutes a day.

This practice reduced the severity and the duration of primary dysmenorrhea and the study concluded that yoga can be an effective non pharmacological alternative for adolescents affected by menstrual pain.

Yoga is believed to reduce pain by helping the brain’s pain center to regulate the gate- controlling mechanism located in the spinal cord and the secretion of natural painkillers in the body. [1]

Yoga is becoming more and more accepted in western societies as a form of alternative therapy

In another study, 60 medical students were asked to attend a 40 minute yoga class and a 10 minutes practice of meditation and pranayama (breathing control) every day over a period of 3 months.

Findings reported a significant reduction in the perceived  menstrual pain after the 3 months period. 83.33% of the study group reported complete pain relief and 11.66% reported mild pain while no reduction of pain was found in the control group. [3]

Yoga Nidra for dysmenorrhea

A study aimed to verify the efficacy of yoga Nidra for patients affected by menstrual disorders with somatoform symptoms.

Somatization disorder is a chronic condition consisting of multiple medically unexplained bodily complaints occurring over a prolonged period of time. [10]

The functional impairment associated with somatoform disorders is comparable with that seen in depressive and anxiety disorders. [11]

In Yoga Nidra the body is completely relaxed

The results of the study indicate that somatoform symptoms in patients with menstrual disorder can be decreased by learning and applying a program based on Yoga Nidra.

Yoga Nidra is a cost-effective and easy method to implement against somatoform symptoms.

The study suggests that in patients with menstrual irregularities, Yoga Nidra not only has utility as a possible therapeutic strategy, but also may be a method for improving headache, dizziness, nervousness and irritability. Yoga Nidra probably relieves pain by stimulating the pituitary gland to release its own potent pain-suppressing compounds.

Research studies have uncovered the existence of endogenous opioid-like neuropeptides (endorphins and enkephalins), the body’s natural painkillers;  These are produced by the pituitary gland under conditions of extreme stress and prolonged pain. These neuropeptides are secreted into the cerebrospinal fluid, which surrounds and supports the entire central nervous system, in order to establish a general sense of well-being. [12]

What is Yoga Nidra?

Yoga Nidra is probably one of the best-known techniques to induce complete physical, mental and emotional relaxation. Yoga Nidra is a state of consciousness which is, neither sleep nor awaken, neither is it concentration nor hypnotism. It can be defined as an altered state of consciousness.

In Yoga Nidra, it is not necessary to concentrate. One should just keep the mind moving from point to point and be aware of every experience. Yoga Nidra means sleep with a trace of awareness. [13]

Through Yoga Nidra, powerful stimulus can be given directly to the pituitary gland to release endorphins and enkephalin, so that synthetic painkillers are not needed anymore.

Yoga Nidra has been termed ‘sleepless sleep’ because we learn to enter the state between sleep and wakefulness without loss of awareness. [12]

The 11C-raclopride binding potential images at the level of the striatum for one participant during attention to speech (A) and meditation (B). The reduced 11C-raclopride binding potential in ventral striatum is evidence of increased endogenous dopamine release during meditation.

Increased endogenous dopamine is released in the ventral striatum during Yoga Nidra meditation, heightening sensation of pleasure, and it is suggested that being in this conscious state of meditation is caused by a suppression of cortico-striatal glutamatergic transmission, the main excitatory neurotransmitter. [14]

The Yoga Nidra study concluded that there was a significant improvement in pain, gastrointestinal, cardiovascular and urogenital symptoms after 6 months of practice of Yoga Nidra in the intervention group in comparison to the controlled one.

Therefore, Yoga Nidra has been shown to be effective not only for physical or mental relaxation but also for preparing the mind for yogic discipline. It has many applications in the management of diseases of all kinds, and promises to play a far greater role in the future as its potential becomes fully recognised by doctors, psychologists and healers. [12]

Useful asanas to relieve menstrual pain suggested by B.K.S. Iyengar

To better benefit from the asanas, we suggest to follow the instruction of a certified yoga teacher or even better a certified yoga therapist. Asanas have to be performed in the right way and preferably following a specific sequence.

Here follows a sequence directly studied by B.K.S. Iyengar for menstrual pain. For the naïve practitioners, most of these poses should be performed with the aim of some props like belts, blocks, blankets, bolsters or chairs.

B.K.S. Iyengar, founder of the homonymous yoga style

A 24 asanas sequence for menstrual pain developed by B.K.S. Iyengar: [15]

1. Baddhakonasa (fixed angle pose)

benefits: relieves menstrual pain and checks heavy menstruation, keeps the ovaries healthy, corrects irregular menstruation, helps open blocked fallopian tubes and reduces vaginal irritation

cautions: don’t practice this asana if you have a displaced or prolapsed uterus.  If you have asthma, bronchitis, breathlessness, rheumatoid arthritis, cardiac conditions or premenstrual stress, practice this asana against a wall

2.   Upavistha Konasana (seated wide-angle pose)

benefits: massages the organs of the reproductive system, stimulates the ovaries, regulates menstrual flow and relieves menstrual, corrects a prolapsed uterus or bladder

cautions: if you have asthma, practice the asana sitting on a folded blanket close to a wall

3. Supta Baddhakonasana (reclining fixed angle pose)

benefits: regulates blood pressure, relieves lower backaches and varicose veins, improves blood circulation in the ovarian region and is particularly beneficial during puberty and menopause, corrects a prolapsed uterus and alleviates menstrual pain and leukorrhea

4. Virasana (hero pose)

benefits: reduces stiffness in the hip joints and inflammation in the blood vessels of legs caused by standing for long periods, relieves gout and rheumatic pain, increase the capacity for deep breathing

cautions: avoid practising this asana if you have headache or diarrhoea

5. Supta Virasana (reclining hero stretch)

benefits: reduces menstrual pain and helps treat disorders of the ovaries, soothes acidity and stomach ulcers, corrects a prolapsed uterus and tones the pelvic organs

cautions: women should place a bolster under the back during menstruation

6. Supta Padangusthasana (reclining leg, foot and toe stretch) 

benefits: removes stiffness in the lower back, and relives backaches by helping align the pelvic area, helps relieve menstrual pain discomfort such as cramps, heavy bleeding or pain during menstruation

cautions: do not practice the asana if you have asthma, bronchitis, migraines, eye strain or diarrhoea

6. Tadasana Urdhva Hastasana (mountain pose with arms stretched up)

benefits: tones and stimulates the abdomen, pelvis, torso and back, helps treat depression and boosts self-confidence

cautions: if you have a prolapsed uterus keep the tips of the toes together and heels apart

7. Utthita Trikonasana (extended triangle pose)

benefits: tones the pelvic area and helps relieve menstrual disorders

cautions: not to be practiced during menstruation

8. Utthita Parsvakonasana (intense side stretch)

benefits: stretches and tones the abdominal and pelvic organs, helps relieve menstrual disorders

cautions: avoid this asana during menstruation, premenstrual stress or leucorrhoea (vaginal discharge). Do not practice if you have heavy or irregular periods during the rest of the month, avoiding the days of menstruation

9. Ardha Chandrasana (half moon pose)

benefits: corrects a prolapsed uterus, improves coordination , motor reflexes and enhances your span of attention

cautions: do not practice the asana if you have stress-related  headaches, migraines, eye strain, varicose veins, diarrhoea or insomnia

10. Prasarita Padottanasana (intense leg stretch) 

benefits: reduces depression and boosts confidence, tones the abdominal organs and regulates menstrual flow

cautions: do not hold this pose for more than 1 minute if you are a beginner

11. Adhomukha Svanasana (downward-facing dog stretch)

benefits: calms the brain and stimulates the nerves, checks heavy menstrual flow and prevent hot flashes during menopause

cautions: do not practice this asana in an advanced stage of pregnancy; if you have high blood pressure or frequent headaches, support your head with a bolster; beginners shouldn’t hold this pose for more than 30 seconds

12. Uttanasana (intense forward stretch) 

benefits: reduces abdominal and back pain during menstruation, helps the brain and the body recover from mental and physical exhaustion

cautions: do not practice this asana if you have osteoarthritis of the knees of diarrhoea

13. Viparita Dandasana (inverted staff pose) 

benefits: corrects a displaced bladder or prolapsed uterus and relives menstrual pain helping to treat the symptoms of menopause

cautions: do not practice this asana during an migraine

14. Salamba Sirasana (headstand)
benefits: builds stamina, brings relief from digestive and eliminatory problems when practiced in conjunction with Salamba Sarvangasana

cautions: do not practice this asana during menstruation

15. Salamba Sarvangasana (shoulderstand)

benefits: helps treat a prolapsed uterus and reduce uterine fibroids, relieves congestion and heaviness in
the ovaries and helps treat ovarian cysts, reduces menstrual cramps and helps regulate menstrual flow, if
done regularly between two menstrual periods

cautions: do not practice this asana during menstruation

16. Halasana (plough pose)

benefits: rejuvenates the abdominal organs and improves digestion

cautions: avoid this pose during menstruation

17. Adhomukha Virasana (downward-facing hero pose) 

benefits: alleviates menstrual pain and depression associated with menstruation, relieves pain in the back and neck

cautions: do not practice this asana if you are incontinent

18. Urdhvamukha Janu Sirsasana (upward-facing bent knee pose)

benefits: corrects a prolapsed uterus, regulates menstrual flow and relives menstrual disorders, massages the reproductive and pelvic organs, improving their functioning

cautions: avoid this asana if you are tired, have low blood pressure, migraines, insomnia or diarrhoea

19. Paschimottanasana (intense back stretch)

benefits: stimulates the ovaries, uterus and the entire reproductive system

cautions: do not practice this asana if you have asthma, bronchitis or diarrhoea

20. Janu Sirsasana (head-on-knee pose)

benefits: reduces menstrual cramps and relives dryness and itching in the vagina

cautions: avoid the pose if you have diarrhoea

21. Setubandha Sarvangasana (bridge pose)

benefits: strengthens the abdominal organs and the spine, relives backaches and neck strain. The pose sends a fresh supply of blood to the brain, resting and revitalising the mind and body

22. Viparita Karani (inverted pose)

benefits: regulates blood pressure, relieves nausea and prevents varicose veins and reduces depression

cautions: do not practice during menstruation

23. Savasana (corpse pose) benefits: removes fatigue and soothes the mind, speeds recuperation after an illness

cautions: do not practice this pose between other asanas, this is the asana you will finish your practice with.

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[12] Rani, K., Tiwari, S. C., Singh, U., Agrawal, G. G., & Srivastava, N. (2011). Six-month trial of yoga nidra in menstrual disorder patients: effects on somatoform symptoms. Industrial psychiatry journal, 20(2), 97.

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[15] Iyengar, B. K. S. (2007). BKS Iyengar yoga: The path to holistic health. New York, DK publishing