038 Derk Steinberg Iyengar Yoga Therapy AIHM2017

Iyengar Yoga Therapy for
Menstruation and
Menstrual Disorders
Gwendolyn Derk, CIYT, CIAYT, MD/PhD candidate
Lois Steinberg, CIYT, CIAYT, PhD
MDC1
Disclosure Statement
Gwendolyn Derk and Lois Steinberg have
indicated no financial relationships with
any commercial interest relevant to this
activity.
1
Slide 2
MDC1 Attention Speakers: Please include this disclosure statement and add speaker names if
no financial relationships. If there are financial relationshps, please add that on the
Faculty Disclosure slide
Megan Denhardt, CAE, 6/22/2017
Workshop Objectives
• Review current state of research
• Explain the basic physiological concepts of
menstruation as well as the most common
pathologies and connect them to body posture
• Discuss Iyengar Yoga Therapy menstruation
sequences for healthy women
• Identify poses that are contraindicated during
menstruation
Menstrual Disorders & Dysmenorrhea
Primary Dysmenorrhea
Secondary Dysmenorrhea
‐ Endometriosis
‐ Adenomyosis
‐ Fibroids
‐ Polycystic Ovarian Syndrome
Osayande, AMIMI, and Suarna Mehulic. "Diagnosis and initial management of
dysmenorrhea." Am Fam Physician 89.5 (2014): 341‐6.
2
Prevalence for Dysmenorrhea
• Range from 20 to 91%
• Surveys from the United States, Europe, &
Australia that 20% of women have
dysmenorrhea that stops them from
participating in usual activities
• A recent cross sectional study from Ethiopa
reported that 67% of female college students
reported having dysmenorrhea and 60% said it
affects their school performance
Oates, Jennifer. "The Effect of Yoga on Menstrual
Disorders: A Systematic Review." The Journal of
Alternative and Complementary Medicine (2017).
Evidence: Yoga for Dysmenorrhea
2017 Systematic Review with 15 primary studies
Year Author & Design & Age Intervention Dose Outcome Results

country Sample Measures
2011 Rakhshaee RCT, 18‐22 3 yoga 20 mins daily Menstrual Sig. Diff.

(Iran) primary asanas (cat, for 14 days questionnaire (p<0.05) in
Dys., cobra, fish) of menstrual & visual pain
50 yoga, cycle; for 3 analog scale pre/post and
42 cycles for pain (VASP) between
control control
3
Year Author Design & Age Intervention Dose Outcome Results
& Sample Measures
Country
2012 Sakuma RCT, 68 20‐64 Home based ~6 min VASP, BMI, Pain reduced
(Japan) healthy yoga DVD; asana &2 flexibility, grip in good
women asana and min test, reach adherence
(44 yoga, pranayama pranayama test, General group
24 control) every day Health pre/post
for 2 weeks Questionnaire (p<0.05) &
and 4 week compared to
follow up control, and
GHQ score
improved in
yoga group
2013 Rani RCT, 126 19‐36 Yoga Nidra 35‐40 mins TSH, FSH, LH, Decrease in

(India) women (guided per day, 5 prolactin, TSH, FSH, LH,
with relaxation) days a week heart rate and prolactin
menstrual for 3 variability, in yoga
disorders, months symptom group vs
(45 yoga, severity control; no
42 control) sig. relief
from
menstrual
Alternative and Complementary Medicine symptoms
(2017).

& Sample Measures
Country
2013 Parkhad Pre/Post; 13‐17 Asana and 45 mins questionnaire Reduction in

(India) 200 pranayama in daily for 6 dysmenorrhea,
adolescents school months backaches and
complaints,
normalization of
menstrual cycle
& blood loss,
2013 Sharma Case 18‐40 Group A Daily on Heart Rate, Heightened
(India) Control (60 Control the 7 days Blood relaxation
women before pressure, response in
with Group B menstrua galvanic skin groups B and C
menstrual Viloma tion, for 3 response, compared to A
distress and pranayama cycles respiratory
30 healthy) rate,
Group C temperature
Asana
4
Year Author & Design Age Intervention Dose Outcome Results
Country & Measures
Sample
2013 Chein Case 18+ Asana and 30 mins Menstrual Yoga group has

(Taiwan) Control relaxation biweekly Distress lower MDQ
30 for 8 Questionnaire scores and
control weeks (MDQ), serum lower
30 homocysteine homocysteine
women and nitric
primary oxide
dys.
2013 Choundhary RCT, 32 18‐30 Asana, Daily 90 questionnaire Yoga group
(India) women Pranayama, mins for reported lower
with Yoga Nidra 16 weeks negative affect,
PMS lower water
retention, lower
impaired
concentration

country Sample Measures
2013 Nag and RCT; 113 18‐23 Asana 60 min class Pain and Sig.

Kodali medical every day for Stress Rating Reduction in
(India) students 6 months pain and
with stress
primary p<0.0001
dys. (60
yoga, 53
control)
2013 Nidhi RCT, 90 15‐18 Asana, 1 hour daily AMH, LH, FSH, Yoga group
(India) students pranayama, for 7 days a score for showed
with relaxation week for 12 hyperandrogre greater
PCOS weeks nism, reduction in
Testosterone, AMH, LH,
prolactin, BMI, Testosterone
menstrual , and
frequency hyperandrog
renism score
& increasing
menstrual
frequency,
no change in
BMI, FSH,
prolactin
5
Country Sample Measures
2013 Kanojia RCT; 50 18‐20 Asana, 40 min Questionnaire Sig. decrease in

(India) healthy Pranayama, for 6 day of anxiety, body weight,
(25 yoga, Relaxation a week depression, heart rate,
25 for 3 anger and systolic and
control) menstrual well‐being; diastolic blood
cycles grip test; pressure,
blood depression,
pressure; anxiety, and
body weight increase in well
being score in
yoga group
2015 Ganesh Pre/Post; 18‐25 Group A 10 mins MDQ, Greater

(India) 90 Pranayama daily for 2 numeric pain improvement in
women (Nadi menstrual rating, quality Group A
with Shodana) cycles of life compared with
primary questionnaire Group B for pain
dys. Group B and quality of
Pranayama life
(Kapalabhati)

Country Sample Measures
2015 Wu ( RCT; 40 20‐30 Asana, 50 mins Resting EEG No effect on

women Pranayama, twice and cognitive menstrual cycle;
with Relaxation weekly functioning yoga enhanced
primary for 6 tests accuracy and
dys. (20 weeks reaction time
yoga, 20 and increased
control) alpha waves
2016 Tsai Pre/Post; 20‐45 Asana, 50 min Questionnaire Sig. decrease in

64 Kapalbhati biweekly of menstrual abdominal
healthy pranayama for 12 pain and swelling, breast
women weeks premenstrual tenderness,
symptoms, adbdominal
SF‐36, cramps, cold
sweats,
improvements
in physical
function and
pain
6
& Sample Measures
Country
2016 Rani RCT, 87 18‐45 Yoga Nidra 35‐40 min General well‐ Yoga group

(India) women with (guided for 5 days being survey, improved in
menstrual relaxation) a week TSH, FSH, LH, anxiety,
disorders for 3 prolactin, depression,
(65 yoga, 65 months progesterone, well‐being,
control) estradiol, vitality but not
testosterone control group,
sig. reduction of
all TSH, FSH, LH,
prolactin in yoga
group
Efficacy of Yoga for Dysmenorrhea
Summary: All studies suggest reduced menstrual
distress following a yoga intervention, but further
higher quality research is warranted.
Heterogeneity of Interventions (Type and Intensity) & Outcomes
• Descriptions of interventions (supplements with
pictures)
• Crystal Parks EYPQ survey
• Validated survey tools (NIH PROMIS, MDQ)
• Adequate reporting using tools from the Equator
Network (CONSORT, PRISMA, etc.)
7
Methods
• Retrospective study
• Data was collected at Iyengar Yoga Champaign‐Urbana (IYCU)
over a 17‐year study period from 1999 to 2016
• Yoga therapy participants filled out a brief survey ranking their
physical and mental health status (7‐point scale: 0 being
extremely good, 3 being neutral, 7 extremely bad) before and
after each class
• Detailed patient history form
• Normalized to values between 0 and 1
• Repeated‐measure mixed‐effect regressions were performed
to compare self‐rated health status before and after each yoga
session (n=4,126) stratified by chronic condition
Results
• Two‐hundred participants attended a total of 4,126 yoga therapy sessions
• Ages ranged from 14 to 80 years with a mean and standard deviation of 45.9 ± 15 years
• The median time span of participation was 105 days (3.5 months) and the median number of
classes attended was 9
• The ratio of length of practice to the number of classes attended was calculated for each
student: the median ratio is 9.33 days per class, while the mean is 18.0 days per class
• Participants were 77% (n=154) female and 22.5% (n=45) male
• The repeated measures mixed effect model (n=4126) showed statistically significant
improvements in both physical status and mental status after a yoga therapy session
8
Workshop Objectives
pathologies and connect them to body posture
• Discuss Iyengar Yoga Therapy menstruation
sequences for healthy women
• Identify poses that are contraindicated during
menstruation
Source: The Female Reproductive System, Junqueira's Basic Histology, 14e

Citation: Mescher AL. Junqueira's Basic Histology, 14e; 2016 Available at:
http://accessmedicine.mhmedical.com/ViewLarge.aspx?figid=109634302 Accessed: October 07, 2017
Copyright © 2017 McGraw-Hill Education. All rights reserved
9
Postural changes affect location,
morphology, and rib coverage of
the liver, spleen, and kidneys: each
organ was found to compress or
expand in the cranial‐caudal,
medial‐lateral, and anterior‐
posterior directions.
Ashley Hayes, et al. “Comparison of Organ
Location, Morphology, and Rib Coverage of a
Midsized Male in the Supine and Seated
Positions,” Computational and Mathematical
Methods in Medicine, vol. 2013.
Lafon, Yoann, et al.
"Combination of a model‐
deformation method and a
positional MRI to quantify the
effects of posture on the
anatomical structures of the
trunk." Journal of
biomechanics 43.7 (2010):
1269‐1278.
10
Postural Changes
Muscolino, Joseph E., and Simona Cipriani. "Pilates
and the “powerhouse”—I." Journal of bodywork and
movement therapies8.1 (2004): 15‐24.
Workshop Objectives
• Explain the basic physiological concepts
of menstruation as well as the most
common pathologies and connect them
to body posture
• Discuss Iyengar Yoga Therapy
menstruation sequences for healthy
women
• Identify poses that are contraindicated
during menstruation
11
Iyengar Yoga Methodology for
Menstruation
• Keep the abdomen and pelvic
region soft and open
• Avoid heating poses
• Extension of the front spine
• Relaxation of the mind
Iyengar, Geeta S. Yoga: A gem for women. Vol. 1. Allied
Publishers, 1998.
Workshop Objectives
pathologies and connect them to body
posture
• Discuss Iyengar Yoga Therapy
menstruation sequences for healthy
women
• Identify poses that are contraindicated
during menstruation
12
Contraindications for Menstruation
• Inversions
• Deep Twists
• Abdominal Gripping Poses
Iyengar, Geeta S. Yoga: A gem for women. Vol. 1. Allied
Publishers, 1998.
Adho Mukha Virasana
Steinberg, Lois. Geeta S. Iyengar's Guide to a Woman's Yoga

Practice. Vol. 1. United States: Parvati Productions, 2006. Print.
13
Parsva Supta Padangusthasana
Prasarita Padottanasana
14
Upavistha Konasana
Baddha Konasana

15
Supta Baddha Konasana
Viparita Dandasana
16
SetuBanda Sarvangasana

Treatments for Dysmenorrhea
•
17
“Words cannot convey the value
of yoga – it has to
be experienced.”
– BKS Iyengar
Questions?
Gwendolyn Derk, CIYT, CIAYT, MD/PhD candidate
University of Illinois, Urbana‐Champaign
gderk2@illinois.edu
18

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Iyengar Yoga Therapy for

Year Author & Design & Age Intervention Dose Outcome Results

2011 Rakhshaee RCT, 18‐22 3 yoga 20 mins daily Menstrual Sig. Diff.

2013 Rani RCT, 126 19‐36 Yoga Nidra 35‐40 mins TSH, FSH, LH, Decrease in

Year Author Design & Age Intervention Dose Outcome Results

2013 Parkhad Pre/Post; 13‐17 Asana and 45 mins questionnaire Reduction in

2013 Chein Case 18+ Asana and 30 mins Menstrual Yoga group has

Year Author & Design & Age Intervention Dose Outcome Results

2013 Nag and RCT; 113 18‐23 Asana 60 min class Pain and Sig.

2013 Kanojia RCT; 50 18‐20 Asana, 40 min Questionnaire Sig. decrease in

2015 Ganesh Pre/Post; 18‐25 Group A 10 mins MDQ, Greater

Year Author & Design & Age Intervention Dose Outcome Results

2015 Wu ( RCT; 40 20‐30 Asana, 50 mins Resting EEG No effect on

2016 Tsai Pre/Post; 20‐45 Asana, 50 min Questionnaire Sig. decrease in

2016 Rani RCT, 87 18‐45 Yoga Nidra 35‐40 min General well‐ Yoga group

Source: The Female Reproductive System, Junqueira's Basic Histology, 14e

Adho Mukha Virasana

Steinberg, Lois. Geeta S. Iyengar's Guide to a Woman's Yoga

Steinberg, Lois. Geeta S. Iyengar's Guide to a Woman's Yoga

Steinberg, Lois. Geeta S. Iyengar's Guide to a Woman's Yoga

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