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Yoga Therapy for Perimenopause / Menopause

by Uma Dinsmore-Tuli PhD CIAYT(more info)

listed in yoga, originally published in issue 256 - August 2019

Many women discover that appropriate yoga practice is a natural support for a healthy menstrual cycle, including the experience of turning points in a woman’s life such as perimenopause and menopause. After twenty years of supporting women’s life cycles with yoga therapy, it’s clear to me that there are some key practices that help re-connect women with the rhythms of their cycles, and it is this reconnection that can nourish us. Womb yoga is my term for yoga to nourish every aspect of our lives as women, whether we have a womb, or not, whether we menstruate, or not.

Womb yoga offers feminine practices that help us to dance in tune with our cycles, and support women in developing the courage to practice self-kindness and self-acceptance. They also help to foster the states of mind and heart that enable us to make the most of the opportunities for self-evaluation and choice offered in the perimenopause and menopause period of life.

Yoga for Menopause Anxiety – a Breathing Trick to help you Calm Down


Just as the term ‘peri’ simply means ‘around the edge’, so perimenopause is the leading up to the edge of menopause: the permanent ending of menstrual cycles. It is characterized by changes in the menstrual cycle and many other aspects of woman’s experience. Without a clear starting point, and potentially lasting for many years,  perimenopause and menopause are times of uncertainty and ‘unknowing in a woman’s life, because they are experiences whose beginnings and endings can only be identified in retrospect.

Perimenopause is often a time of confusion and sometimes anger or dismay, a time when the forward dash of the younger years and the outward focus of mothering or minding businesses and professional or creative projects may reach an impasse, calling for us to enter into stillness and reconsider everything we think we know. At the level of our bodies, this is often a time when we are called to notice changes or pauses in the menstrual cycles, or to become aware of the signs of incipient ageing and the effects of having lived in our bodies for over forty-five years or so. All of these signs direct us to turn our attention inwards, to stop the outward activities at least temporarily in order to evaluate and consider the inner life: to ‘grow or die’. It is a time when regrets and anger about things we have not done, or energies we may have misplaced in activities we no longer value, need to be faced.

Yoga Perspectives on Breathing, Moving, Being

Perimenopause can be understood as a positive, expansive opportunity for self-evaluation and reflection. However, cultural and social pressures and expectations around perimenopause are profoundly limiting and do not necessarily nourish the perimenopausal woman, nor support us in the inner work we need to do to find our way through the times of challenge and change at this time of life. Hence the yoga practice of satsang (loosely translated from Sanskrit as being together with like-minded women; the healing power of community) has huge importance here, and the support, sharing and wisdom of older women is absolutely crucial to the positive experience of perimenopause.

The experiences of perimenopause are all about change. The intensity of the experiences can force us to let go of habits and ideas that have been central to our sense of who we are, which can be painful. The heart of a positive yogic response to the experience of menopause is to acknowledge the challenges this pain may bring, whilst we embrace the experience as a fabulous opportunity for re-evaluation, reflection and change at every level of being. It is helpful also to see the full circle of women’s life experience at this time as a cyclic progression from bud, through flower, fruit and returning to the deep wisdom of the seed. In terms of attending to the needs of the perimenopausal time of life, it is especially valuable to recognise that the process of transformation from flower to seed is a powerful rite of passage that constitutes a life stage all of its own, a time of letting go and acceptance. This is the focus of the yoga nidrā for which you’ll find a link below.

At the heart of yoga philosophy is the concept of saṇtośa, which means the happy acceptance of what is, as it is, and ahimsa, which is often translated literally as non-harming, but can also be understood as kindness. These two concepts from the philosophical bedrock of yoga take on a particular value during perimenopausal years of our lives. To practice yoga with attention to this philosophical framework invites the opportunity to practice inner saṇtośa and ahimsa, in terms of offering kindly tenderness to oneself to help with the process of acceptance of change.

One of the most difficult aspects of the perimenopause to deal with is the experience of uncertainty, irregularity and lack of rhythm in terms of monthly cycles at a physical level, but mental and emotional life generally. This is where yoga has a deep and powerfully healing role to play, together with prāṇāyāma and meditation to promote acceptance of change in preparation for a safe journey through the passage to power that is the menopause.

Perimenopause can be a time when menstrual cycles may be very erratic, very heavy, or sometimes continuous, yoga practice needs to be responsive to changing, sometimes rapidly changing, needs. While some practices should be approached with caution - eg. inversions and some pumping breaths, these can certainly be beneficial outside of bleeding times, it is important to understand that responses to menopause are highly individualised. For example fast and heating practices may be superbly helpful for some women, but deeply depleting for others. The key is responding with attention and kindness to the cycles of each body.


Cover uma-yoni shakti


Common experiences during perimenopause with suggested yogic responses and remedies, as described in Yoni Shakti: A woman’s guide to power and freedom through yoga and tantra  (to buy copies please visit )


Many peri-menopausal women encounter alarming levels of anger during this time, and can discover untapped depths of rage and resentment surfacing, often very rapidly and unexpectedly. Yoga nidrā is a deeply effective way to develop some distance and objectivity in relation to these experiences, and to promote levels of deep rest that act as a preventive for mood swings, which worsen under conditions of stress and exhaustion.


Often related to the experiences of unexpressed anger or fear, there are so many different manifestations of depression that it is difficult to offer a single set of remedies to suit all women. However, in general it can be extremely helpful to use gentle flowing movements such as Being in the cycles (Yoni Shakti p.517)


Being in a state of exhaustion exacerbates all of the other experiences of menopause. Deep relaxation such as yoga nidrā, especially when practiced in restorative poses builds energy and promotes very deep quality rest.  

Erratic Periods / Bleeding

Many women suffer for years with almost constant bleedings, or are utterly confused and bewildered by erratic and surprising start-stop bleeds. The best help yoga can offer is to maximise opportunities to rest and recover energy (see Exhaustion above), and to promote a sense of rhythm and pattern in life by establish regularity (little and often is best) of practice to create some sense of order at a chaotic time. During bleeds, avoid inversions and pumping breaths.

Forgetfulness / Absent Mindedness and Confusion

Any practice that promotes the direction of focus into a single point of awareness is helpful in managing peri-menopausal mind-wipe. For example, balancing practices both require and promote mental focus, whilst triangle breathing in alternate nostrils trains mental attention.

Hot Flushes and Night Sweats

The cooling breaths practice (see below) are evidently first port of call for management of dramatic shifts in temperature.

Cooling breaths (sithali and sitkari)

These practices require two types of tongue rolling.  If you are able to roll your tongue lengthwise by bringing the long sides into the middle to make a tube, than you can practise the first breath (sitali).  If your tongue doesn’t roll this way, then practice the second breath instead (sitkari), which can be done by tucking the tip of the tongue under the back of the front teeth and rolling it backwards and widthways, so that the ends of the tube are on the right and left side instead of at the tip of the tongue.

Cooling breath (sitali)

  1. Sit comfortably, and establish an easy rhythm of breath. Close the eyes and watch the rhythm of the breath.
  2. Stick out your tongue and roll it lengthwise.
  3. On the next inhale, draw the breath slowly in through the end of the ‘straw’ of the tongue.  
  4. t the end of the inhale, relax the tongue, bring it inside the mouth and close the lips.
  5. Exhale through the nose.

Hissing breath (sitkari)

  1. Sit comfortably, and establish an easy rhythm of breath. Close the eyes and watch the rhythm of the breath.
  2. Roll back the tip of your tongue and tuck it under the back of the top teeth.  If it’s comfortable, you can work the tip of the tongue further back into the roof of the mouth.
  3. Pull the corners of the mouth back slightly so that air can get in through both ends of the tongue roll.
  4. On the next inhale, draw the breath slowly in through both open ends of the ‘straw’ of the tongue, making a hissing noise
  5. At the end of the inhale, bring the tongue inside the mouth and close the lips.
  6. Exhale through the nose.

For these practices, it is best to repeat for only three to five cycles of breath before taking a pause and returning to an ordinary breath.  Keeping the tongue rolled for any longer than this can make it cramp or ache, especially if the action is unfamiliar.

Top Tip: Ensure Yoga Practice is Attuned to your Cycle and Time of Life: daily Yoga Nidrā

This is a deep process of total relaxation that doesn’t require any physical movement, just the capacity to rest still and to listen – so the easiest way to access the practice is to download Total Yoga Nidrā practices from the Yoga Nidrā Network (see links below). Any of the recordings produced by well-trained teachers will be helpful, but it can be especially nourishing to choose practices with a focus on the experience of menopause and reconnection to earth’s nourishment. For example, these free Yoga Nidrā are specifically created to provide support as we encounter the inevitability of change and to dignify and honour the experiences of menopause as a powerful spiritual initiation:

Yoni Shakti: Bhairavi Self Anointing Ritual:


Yoni Shakti: Being with Not Knowing:

All you need to do is to lie down comfortably and listen!

Further Information

Next retreat with Uma will be Circle of Womanhood Retreat on the 24th July 2019 in Ballydehob, Ireland.


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About Uma Dinsmore-Tuli PhD CIAYT

Dr Uma Dinsmore-Tuli, Yoga Therapist and Co-Founder of the Yoga Nidra Network, is a leading UK expert in the lesser known practice of Yoga Nidra, to bring about profound rest and healing.  A deeply restorative practice, Yoga Nidra is often referred to as 'Yogic Sleep', where you’re neither purposely asleep nor trying to stay awake. It is deeply restorative, nourishing and rejuvenating practice and has been known to drastically improve sleep. 

Uma has written four books on Yoga for women, including Yoni Shakti ( A woman's guide to power and freedom through yoga and tantra) now in its 5th printing. She offers free Yoga Nidra practices online for people to experience in the comfort of their own homes.  Uma may be contacted via


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