The Female cycle

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The major player in human reproduction is the Female. Unfortunately because sexual health is taboo and not openly discussed, in part due to a patriarchal society, the waters around the female reproductive system are often murky. 

Should women practice Ashtanga Yoga during their cycle? How does this yoga help with regulating the menstrual cycle?

Aside from acknowledging that some women have abdominal pain during menstruation, the topic of menstruation is not discussed in The Yoga Mala. In fact, ‘a lot of women with strong Ashtanga practices at some point lose their periods, often due to a combination of low body wight and intense exercise.’  (Alison DeMaio, MD OB/GYN) This is common for high intensity sports across the board know as athletic amenorrhea. Recent studies have highlighted that even recreational exercising women have a high prevalence of menstrual disturbances, with up to half of exercising women displaying subtle or severe menstrual disturbances. Women with athletic amenorrhea often face persistent metabolic challenges in the form of intermittent or chronic energy imbalance due to increased energy expenditure or insufficient caloric intake.***** This can lead to osteoporosis, and other metabolic disorders. An excess of any yoga practice as a from of exercise can lead to amenorrhea and a caution should be noted  to all students of yoga. 

It should be iterated here that the Ashtanga Yoga Practice is medicine. As medicine it needs to be respected. Asana is a meditation on the body and space. A meditation on the breath. If we only sit in the body and in the practice of asana we will get stuck in that layer, leading to disorders of the body. Pranayama comes from being able to use the asana to sit in comfort for extended periods of time. Meditation comes when we combine these skills.

“Some women find practice during their periods actually very helpful, and take rest the days following their cycle. After the shedding of the uterine lining, Progesterone sharply decreases and the drive, or energy is decreased causing a need for rest. Endorphans released during practice help to counteract the decline in energy and mood allowing the individual to feel better.” (Alison DeMaio, MD OB/GYN @ashtangi_ali) Days 1-4ª of menstruation a gentle and modified form of practice can be done. There are some benefits from practice that can help with uterine contractions that help to descend and remove menstrual blood. The practitioner should focus on breathing and omit any inversions. Days 5-11 energy is beginning to build and levels of estrogen rise. With the gradual increase in estrogen, willpower and self-confidence rise. This can be a a strong and dynamic time for the practice. Days 12-16 levels of estrogen drop and levels of progesterone rise. The rise in progesterone is to maintain a pregnancy if a viable egg is fertilized. Unlike estrogen which has a positive effect on the nervous system by stimulating an increase in serotonin, medium levels of progesterone have a depressing effect as they are metabolized by the liver and kidney. There is evidence that shows metabolized progesterone attaches to the GABA-A receptors preventing an uptake in serotonin and causing depressive feelings, or PMS.***** Higher levels of progesterone associated with pregnancy do not have this effect. Days 16-28 if an egg has not been fertilized there can be a gradual decrease in energy and a heightened feeling of sensitivity related to the metabolism of progesterone.

A particularly helpful asana for the regulation of menses and the symptoms of PMS is Baddha Konasana. Looking at only 3 of the many points that are stimulated during the practice of this asana:

Gōng Sūn (Sp 4) Regulates the Chong Mai, the Sea of blood 

Zhì Yīn (UB 67) Regulates pregnancy and childbirth (difficult labor)

Zú Lín Qì (GB 41) Distending pain of the breast, irregular menstruation, headaches

It is clear that practicing this asana alone can be beneficial to many women. One should be cautioned that practicing this asana alone, the blood is not warm and moving. In this case the points are stimulated but there is no direction given to them where to go. Without direction they may or may not relay the message, and healing is not guaranteed.

In the Ashtanga Yoga primary series this asana is followed by Upavishta Konasana, Supta Konasana, Supta Padangushtasana, and Ubhaya Padangushtasana, four asana that have the fingers wrapping around the big toe, the entry points to the Foot Tai Yin and Foot Jue Yin channels, points that regulate the blood and menstruation. These asana are practiced well into the series when the blood is warm and moving freely. The message that was relayed in the practice of Buddha Konasana by stimulating those points now has a map, movement, and directions.

Continually throughout his text Jois repeats that these asana and this particular formula, primary series, be learned by a ‘guru.’ There is often ‘the vague teaching of keeping the anus tight at all times which is a disservice to many women. My experience is that “anus” means a lot of things to a woman depending on the muscle use patterns and emotional conditioning. Sometimes they contract the glutes chronically. Sometimes only the urethra. Sometimes the obdurate externis.’ (Angela Jamison, Ayurvedic practitioner and Certified Ashtanga Teacher)

The cuing to ‘keep the anus tight’ and the often misunderstanding of the instruction, compounded by the surge of yoga teacher trainings in recent years due to the popularity of yoga in the west, is cause to believe that there is a link in the increase of blood clots during menses. Blood clots found in menstrual blood are usually formed in the vagina from heavy flow that collects in the vagina long enough to clot. TCM refers to this as blood stasis. 

There are no statistics at the time of writing this on how many women experience blood clots with their cycle. According to the mayo clinic, passing blood clots during a menstrual cycle is normal. Because it is ‘normal’ there are no studies done on how many women actually have this occurrence. And while passing a nominal amount of blood clots it is not dangerous and no immediate harm will arise, according to TCM it is a sign that there is something is not quite right and the body is no longer in harmony.

During days 1-4 of the cycle practicing inversions is contraindicated for women unfamiliar with how their bodies respond to the practice. The primary concern with practicing these asana during the cycle is back flow of menstrual blood. “Backflow is one of the theories of how endometriosis is formed, which is why it gets a lot of attention. When the uterus contracts as part of a normal menstural cycle, some of the blood/ endometrial tissue can travel via the tubes to the peritoneal cavity. We see this very often when we do laparoscopy on women during their period. You can see the blood down in the pelvis.” (Alison DeMaio, MD OB/GYN) Endometriosis is a condition where cells resembling the uterine lining, which is shed during menstruation, begin to grow outside the uterus. These lesions can cause excruciating pain and in some cases infertility. Typically menstrual blood is pushed out through contractions of the uterus, not via gravity. And while the blood can be reabsorbed in the peritoneal cavity, there is no benefit in forcing the body to do this with inversions and risk a serious complication. An alternative to inversions can be to lay with the legs up a wall allowing the blood that is circulated in the lower limbs during practice to return to the system.

***** https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941235/#R2

****** http://www.medref.se/pms/backstrom_13.pdf

ª Days are an approximation the average length of female menstruation is 28-29 days, however it is extremely variable.

Morgan Lee