Advertisement

Yoga for menopausal symptoms—A systematic review and meta-analysis

  • Holger Cramer
    Correspondence
    Corresponding author at: Kliniken Essen-Mitte, Klinik für Naturheilkunde und Integrative Medizin, Am Deimelsberg 34a, 45276 Essen, Germany.
    Affiliations
    Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany

    Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
    Search for articles by this author
  • Wenbo Peng
    Affiliations
    Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
    Search for articles by this author
  • Romy Lauche
    Affiliations
    Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Sydney, Australia
    Search for articles by this author

      Highlights

      • The effects of yoga on menopausal symptoms have been investigated in 13 randomized trials with a total of 1306 participants.
      • Yoga can reduce psychological, somatic, vasomotor, and urogenital menopausal symptoms.
      • Yoga does not seem to be associated with serious adverse events.

      Abstract

      Objectives

      To systematically review and meta-analyze the effectiveness of yoga for menopausal symptoms.

      Methods

      Medline (via PubMed), the Cochrane Central Register of Controlled Trials, and Scopus were screened through to February 21, 2017 for randomized controlled trials (RCTs) comparing the effects of yoga on menopausal symptoms to those of no treatment or active comparators. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated. Two authors independently assessed risk of bias using the Cochrane risk of bias tool.

      Results

      Thirteen RCTs with 1306 participants were included. Compared with no treatment, yoga reduced total menopausal symptoms (SMD = −1.05; 95% CI −1.57 to −0.53), psychological (SMD = −0.75; 95% CI −1.17 to −0.34), somatic (SMD = −0.65; 95% CI −1.05 to −0.25), vasomotor (SMD = −0.76; 95% CI −1.27 to −0.25), and urogenital symptoms (SMD = −0.53; 95% CI −0.81 to −0.25). Compared with exercise controls, only an effect on vasomotor symptoms was found (SMD = −0.45; 95% CI −0.87 to −0.04). Effects were robust against selection bias, but not against detection and attrition bias. No serious adverse events were reported.

      Conclusion

      Yoga seems to be effective and safe for reducing menopausal symptoms. Effects are comparable to those of other exercise interventions.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Maturitas
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sherman S.
        Defining the menopausal transition.
        Am. J. Med. 2005; 118: 3-7
        • NIH State-of-the-Science Panel
        National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms.
        Ann. Intern. Med. 2005; 142: 1003-1013
        • Maclennan A.H.
        Evidence-based review of therapies at the menopause.
        Int. J. Evid. Based Healthc. 2009; 7: 112-123
        • Appling S.
        • Paez K.
        • Allen J.
        Ethnicity and vasomotor symptoms in postmenopausal women.
        J. Womens Health (Larchmt). 2007; 16: 1130-1138
        • Joffe H.
        • Soares C.N.
        • Cohen L.S.
        Assessment and treatment of hot flushes and menopausal mood disturbance.
        Psychiatr. Clin. North Am. 2003; 26: 563-580
        • Greene J.G.
        Constructing a standard climacteric scale.
        Maturitas. 2008; 61: 78-84
        • Warren M.P.
        Missed symptoms of menopause.
        Int. J. Clin. Pract. 2007; 61: 2041-2050
        • Politi M.C.
        • Schleinitz M.D.
        • Col N.F.
        Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis.
        J. Gen. Intern. Med. 2008; 23: 1507-1513
        • van der Sluijs C.P.
        • Bensoussan A.
        • Liyanage L.
        • Shah S.
        Women’s health during mid-life survey: the use of complementary and alternative medicine by symptomatic women transitioning through menopause in Sydney.
        Menopause. 2007; 14: 397-403
        • Lunny C.A.
        • Fraser S.N.
        The use of complementary and alternative medicines among a sample of Canadian menopausal-aged women.
        J. Midwifery Womens Health. 2010; 55: 335-343
        • Daley A.
        • MacArthur C.
        • McManus R.
        • Stokes-Lampard H.
        • Wilson S.
        • Roalfe A.
        • et al.
        Factors associated with the use of complementary medicine and non-pharmacological interventions in symptomatic menopausal women.
        Climacteric. 2006; 9: 336-346
        • Bair Y.A.
        • Gold E.B.
        • Zhang G.
        • Rasor N.
        • Utts J.
        • Upchurch D.M.
        • et al.
        Use of complementary and alternative medicine during the menopause transition: longitudinal results from the Study of Women’s Health Across the Nation.
        Menopause. 2008; 15: 32-43
        • Newton K.M.
        • Buist D.S.
        • Keenan N.L.
        • Anderson L.A.
        • LaCroix A.Z.
        Use of alternative therapies for menopause symptoms: results of a population-based survey.
        Obstet. Gynecol. 2002; 100: 18-25
        • Cardini F.
        • Lesi G.
        • Lombardo F.
        • van der Sluijs C.
        The use of Complementary and Alternative Medicine by women experiencing menopausal symptoms in Bologna.
        BMC Womens Health. 2010; 10: 7
        • Feuerstein G.
        The Yoga Tradition.
        Hohm Press, Prescott, Arizona, USA2001
        • Clarke T.C.
        • Black L.I.
        • Stussman B.J.
        • Barnes P.M.
        • Nahin R.L.
        Trends in the use of complementary health approaches among adults: United States, 2002–2012.
        Natl. Health Stat. Rep. 2015; : 1-16
        • Cramer H.
        • Ward L.
        • Saper R.
        • Fishbein D.
        • Dobos G.
        • Lauche R.
        The safety of yoga: a systematic review and meta-analysis of randomized controlled trials.
        Am. J. Epidemiol. 2015; 182: 281-293
        • Cramer H.
        • Lauche R.
        • Langhorst J.
        • Dobos G.
        Effectiveness of yoga for menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials.
        Evid. Based Complement. Altern. Med. 2012; 2012: 863905
        • Lee M.S.
        • Kim J.I.
        • Ha J.Y.
        • Boddy K.
        • Ernst E.
        Yoga for menopausal symptoms: a systematic review.
        Menopause. 2009; 16: 602-608
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann. Intern. Med. 2009; 151 (w64): 264-269
        • Higgins J.P.T.
        • Green S.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        Wiley, West Sussex, UK2010
        • Furlan A.D.
        • Pennick V.
        • Bombardier C.
        • van Tulder M.
        2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group.
        Spine. 2009; 34: 1929-1941
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        Lawrence Erlbaum Associates, Hillsdale, NJ, USA1998
        • Egger M.
        • Davey Smith G.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple, graphical test.
        BMJ. 1997; 315: 629-634
        • Bower J.
        • Crosswell A.
        • Stanton A.
        • Crespi C.
        • Winston D.
        • Arevalo J.
        • et al.
        Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial.
        Cancer. 2015; : 1231-1240
        • Ngowsiri K.
        • Tanmahasamut P.
        • Sukonthasab S.
        Rusie Dutton traditional Thai exercise promotes health related physical fitness and quality of life in menopausal women.
        Complement. Ther. Clin. Pract. 2014; 20: 164-171
        • Crowe B.M.
        • Van Puymbroeck M.
        • Linder S.M.
        • McGuire F.A.
        • Watt P.J.
        The effects of yoga participation on women’s quality of life and symptom management during the menopausal transition: a pilot study.
        Health Care Women Int. 2015; 36: 1124-1142
        • Geetha H.
        • Chitra H.
        • Kubera N.S.
        • Pranathi M.
        Quality of life after menopause: effects of hormone replacement therapy, vitamin E and sudarhana kriya yoga practice: a comparative study.
        Biomed. Res. (India). 2014; 25: 240-242
        • Jacobsen P.B.
        • Muchnick S.
        • Marcus S.
        • Amheiser P.
        • Reiersen P.
        • Gonzalez B.
        • et al.
        Pilot study of Iyengar yoga for management of aromatase inhibitor-associated arthralgia in women with breast cancer.
        Psychooncology. 2015; 24: 1578-1580
        • Nayak G.
        • Kamath A.
        • Kumar P.N.
        • Rao A.
        Effect of yoga therapy on physical and psychological quality of life of perimenopausal women in selected coastal areas of Karnataka, India.
        J. Midlife Health. 2014; 5: 180-185
        • ShariatPanahi S.-S.
        • Hajikazemi E.
        • Nikpour S.
        • Fghanipour S.
        • Hosseini A.
        Effect of yoga exercises on quality of life of postmenopausal women.
        Health Med. 2013; 7: 1266-1273
        • Armstrong W.J.
        • Scott Smedley J.M.
        Effects of a home-based yoga exercise program on flexibility in older women.
        Clin. Kinesiol. 2003; 57: 1-6
        • Bezerra L.
        • Bottaro M.
        • Reis V.M.
        • Abdhala L.
        • Lima R.M.
        • Soares S.
        • et al.
        Effects of yoga on bone metabolism in postmenopausal women.
        J. Exerc. Physiol. Online. 2010; 13: 58-65
        • Lee J.A.
        • Kim J.W.
        • Kim D.Y.
        Effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal women.
        Menopause. 2012; 19: 296-301
        • Phoosuwan M.
        • Kritpet T.
        • Yuktanandana P.
        The effects of weight bearing yoga training on the bone resorption markers of the postmenopausal women.
        J. Med. Assoc. Thai. 2009; 92: S102-S108
        • Chaturvedi A.
        • Nayak A.
        • Nayak G.
        • Rao A.
        Comparative evaluation of the effects of yoga and exercise in perimenopausal women with metabolic syndrome.
        Clin. Chem. Lab. Med. 2015; : pS1371
        • Chaturvedi A.
        • Nayak G.
        • Nayak A.
        • Rao A.
        Comparative assessment of the effects of hatha yoga and physical exercise on biochemical functions in perimenopausal women.
        J. Clin. Diagn. Res. 2016; 10: KCO1-KCO4
        • Galantino M.L.
        • Desai K.
        • Greene L.
        • Demichele A.
        • Stricker C.T.
        • Mao J.J.
        Impact of yoga on functional outcomes in breast cancer survivors with aromatase inhibitor-associated arthralgias.
        Integr. Cancer Ther. 2012; 11: 313-320
        • Grossman J.A.
        • Payne E.K.
        A randomized comparison study regarding the impact of short-duration, high-intensity exercise and traditional exercise on anthropometric and body composition measurement changes in post-menopausal women—a pilot study.
        Post Reprod. Health. 2016; 22: 14-19
        • Innes K.E.
        • Selfe T.K.
        The effects of a gentle yoga program on sleep, mood, and blood pressure in older women with restless legs syndrome (RLS): a preliminary randomized controlled trial.
        Evid. Based Complement. Altern. Med. 2012; 2012: 294058
        • Jones S.M.
        • Guthrie K.A.
        • LaCroix A.Z.
        • Sternfeld B.
        • Landis C.A.
        • Reed S.D.
        • et al.
        Is heart rate variability associated with frequency and intensity of vasomotor symptoms among healthy perimenopausal and postmenopausal women?.
        Clin. Auton. Res. 2016; 26: 7-13
        • Kim S.
        • Bemben M.G.
        • Bemben D.A.
        Effects of an 8-month yoga intervention on arterial compliance and muscle strength in premenopausal women.
        J. Sports Sci. Med. 2012; 11: 322-330
        • Kim S.
        • Bemben M.G.
        • Knehans A.W.
        • Bemben D.A.
        Effects of an 8-month Ashtanga-based yoga intervention on bone metabolism in middle-aged premenopausal women: a randomized controlled study.
        J. Sports Sci. Med. 2015; 14: 756-768
        • Sprod L.K.
        • Fernandez I.D.
        • Janelsins M.C.
        • Peppone L.J.
        • Atkins J.N.
        • Giguere J.
        • et al.
        Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors.
        J. Geriatr. Oncol. 2015; 6: 8-14
        • Stachenfeld N.S.
        • Mack C.W.
        • DiPietro L.
        • Morocco T.S.
        • Jozsi A.C.
        • Nadel E.R.
        Regulation of blood volume during training in post-menopausal women.
        Med. Sci. Sports Exerc. 1998; 30: 92-98
        • Versoza M.L.
        Influence of Yoga on Hormonal Changes, Quality of Life, and Musculoskeletal Fitness in Menopausal Women/ML Sophia Verzosa.
        University of Lethbridge, Dept. of Kinesiology, Lethbridge, Alta2010 (c2010)
        • Chattha R.
        • Nagarathna R.
        • Padmalatha V.
        • Nagendra H.R.
        Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study.
        BJOG. 2008; 115: 991-1000
        • Elavsky S.
        • McAuley E.
        Exercise and self-esteem in menopausal women: a randomized controlled trial involving walking and yoga.
        Am. J. Health Promot. 2007; 22: 83-92
        • Elavsky S.
        • McAuley E.
        Physical activity and mental health outcomes during menopause: a randomized controlled trial.
        Ann. Behav. Med. 2007; 33: 132-142
        • Buchanan D.T.
        • Landis C.A.
        • Hohensee C.
        • Guthrie K.A.
        • Otte J.L.
        • Paudel M.
        • et al.
        Effects of yoga and aerobic exercise on actigraphic sleep parameters in menopausal women with hot flashes.
        J. Clin. Sleep Med. 2017; 13: 11-18
        • Cohen L.S.
        • Joffe H.
        • Guthrie K.A.
        • Ensrud K.E.
        • Freeman M.
        • Carpenter J.S.
        • et al.
        Efficacy of omega-3 for vasomotor symptoms treatment: a randomized controlled trial.
        Menopause. 2014; 21: 347-354
        • Jones S.M.
        • Guthrie K.A.
        • Reed S.D.
        • Landis C.A.
        • Sternfeld B.
        • LaCroix A.Z.
        • et al.
        A yoga & exercise randomized controlled trial for vasomotor symptoms: effects on heart rate variability.
        Complement. Ther. Med. 2016; 26: 66-71
        • Reed S.D.
        • Guthrie K.A.
        • Newton K.M.
        • Anderson G.L.
        • Booth-LaForce C.
        • Caan B.
        • et al.
        Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.
        Am. J. Obstet. Gynecol. 2014; 210: e1-e11
        • Elavsky S.
        • McAuleyy E.
        Personality, menopausal symptoms, and physical activity outcomes in middle-aged women.
        Personal. Individ. Differ. 2009; 46: 123-128
        • Joshi S.
        • Khandwe R.
        • Bapat D.
        • Deshmukh U.
        Effect of yoga on menopausal symptoms.
        Menopause Int. 2011; 17: 78-81
        • Elavsky S.
        • McAuley E.
        Lack of perceived sleep improvement after 4-month structured exercise programs.
        Menopause. 2007; 14: 535-540
        • Chattha R.
        • Raghuram N.
        • Venkatram P.
        • Hongasandra N.R.
        Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study.
        Menopause. 2008; 15: 862-870
        • Carson J.W.
        • Carson K.M.
        • Porter L.S.
        • Keefe F.J.
        • Seewaldt V.L.
        Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial.
        Support. Care Cancer. 2009; 17: 1301-1309
        • Afonso R.F.
        • Hachul H.
        • Kozasa E.H.
        • De Souza Oliveira D.
        • Goto V.
        • Rodrigues D.
        • et al.
        Yoga decreases insomnia in postmenopausal women: a randomized clinical trial.
        Menopause. 2012; 19: 186-193
        • Choi S.Y.
        • Oh H.S.
        • Kang Y.S.
        The effects of health promotion program on stress and menopausal symptoms in menopausal women.
        J. Korean Acad. Adult Nurs. 2007; 19: 353-364
        • Qiu P.
        Effect of yoga on relieving menopausal symptoms.
        Matern. Child Health Care China. 2014; 29: 3580-3583
        • Vora R.D.A.
        Effect of yoga on menopausal symptoms in the early menopausal period: a randomized controlled trial.
        Indian J. Physiother. Occup. Ther. 2014; : 49-53
        • Newton K.M.
        • Reed S.D.
        • Guthrie K.A.
        • Sherman K.J.
        • Booth-Laforce C.
        • Caan B.
        • et al.
        Efficacy of yoga for vasomotor symptoms: a randomized controlled trial.
        Menopause. 2014; 21: 339-346
        • Jorge M.P.
        • Santaella D.F.
        • Pontes I.M.
        • Shiramizu V.K.
        • Nascimento E.B.
        • Cabral A.
        • et al.
        Hatha Yoga practice decreases menopause symptoms and improves quality of life: a randomized controlled trial.
        Complement. Ther. Med. 2016; 26: 128-135
        • Han Y.
        • Duan F.
        • Xu R.
        • Wang Y.
        • Zhang H.
        Functional exercise in combination with auricular plaster therapy is more conducive to rehabilitation of menopausal women patients with anxiety disorder.
        Int. J. Clin. Exp. Med. 2015; 8: 21173-21179
        • Cramer H.
        • Rabsilber S.
        • Lauche R.
        • Kummel S.
        • Dobos G.
        Yoga and meditation for menopausal symptoms in breast cancer survivors-a randomized controlled trial.
        Cancer. 2015; 121: 2175-2184
        • Avis N.E.
        • Legault C.
        • Russell G.
        • Weaver K.
        • Danhauer S.C.
        Pilot study of integral yoga for menopausal hot flashes.
        Menopause. 2014; 21: 846-854
        • Innes K.E.
        • Selfe T.K.
        • Vishnu A.
        Mind-body therapies for menopausal symptoms: a systematic review.
        Maturitas. 2010; 66: 135-149
        • Daley A.
        • Stokes-Lampard H.
        • Thomas A.
        • MacArthur C.
        Exercise for vasomotor menopausal symptoms.
        Cochrane Database Syst. Rev. 2014; : Cd006108
        • Schulz K.F.
        • Chalmers I.
        • Hayes R.J.
        • Altman D.G.
        Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials.
        JAMA. 1995; 273: 408-412
        • Cramer H.
        • Langhorst J.
        • Dobos G.
        • Lauche R.
        Associated factors and consequences of risk of bias in randomized controlled trials of yoga: a systematic review.
        PLoS One. 2015; 10: e0144125
        • Cramer H.
        • Lauche R.
        • Langhorst J.
        • Dobos G.
        Is one yoga style better than another? A systematic review of associations of yoga style and conclusions in randomized yoga trials.
        Complement. Ther. Med. 2016; 25: 178-187
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials.
        Ann. Intern. Med. 2010; 152: 726-732
        • Cramer H.
        • Krucoff C.
        • Dobos G.
        Adverse events associated with yoga: a systematic review of published case reports and case series.
        PLoS One. 2013; 8: e75515