1. Introduction
The menopausal transition is a natural and inevitable phase in a woman’s life, marking the cessation of reproductive function. It is typically characterized by a myriad of physical, psychological, and hormonal changes that can significantly impact a woman’s overall well-being and quality of life. Menopausal symptoms, such as hot flashes, mood disturbances, sleep disturbances, and a decline in bone density, can be distressing and challenging to manage. The conventional approach to managing these symptoms often involves hormone replacement therapy (HRT) and pharmaceutical interventions. However, an increasing number of women are seeking complementary and alternative approaches to alleviate menopausal symptoms while promoting overall health and well-being.1,2
One such approach gaining prominence for its potential benefits is the practice of yoga. Yoga is an ancient mind-body discipline that encompasses a wide range of physical postures, breathing techniques, meditation, and mindfulness practices. Its holistic nature makes it particularly appealing as a non-pharmacological intervention for menopausal symptom management. Yoga’s ability to address both the physical and psychological aspects of menopausal symptoms may offer a comprehensive and integrative solution for women seeking to enhance their quality of life during this transformative phase.3,4
This paper explores the emerging body of research that examines the effectiveness of yoga as a complementary therapy for alleviating menopausal symptoms and improving the overall quality of life among menopausal women. By providing a holistic and natural approach to symptom management, yoga has the potential to empower women during menopause, helping them navigate this transitional period with greater comfort, self-awareness, and resilience.4,5
The present study delves into the physiological and psychological mechanisms through which yoga may influence menopausal symptoms. Ultimately, this review aims to contribute to a more comprehensive understanding of the role of yoga in enhancing the well-being of menopausal women, with potential implications for healthcare professionals and women seeking effective, non-pharmacological strategies to manage menopausal symptoms and improve their overall quality of life.
2. Methods
2.1. Design
A quasi-experimental non-equivalent pre-test post-test control group design was used in the current study. Women with menopausal symptoms, between the age groups of 40 and 55 years, were included in the study. Women who had undergone abdominal surgery in the past year, those with severe musculoskeletal problems, acute inflammatory diseases, intestinal obstruction, hernia, and high blood pressure, and women diagnosed with mental illness were excluded from the study. The sample size was calculated based on the pilot study results. A total 64 women, 32 to the intervention group and 32 to the control group, were selected from 2 different settings. The instruments used to collect information were a demographic pro forma, prepared by the investigator, the Menopausal Rating Scale (MRS), and the Utian Quality of Life Scale (UQOL).
2.2. Measures
A lottery method was used for participant selection within each setting; allocation to intervention and control groups was based on pre-existing settings to prevent contamination. Therefore, the study is appropriately classified as a quasi-experimental non-equivalent control group design and not a randomized controlled trial.
While blinding was not feasible due to the nature of the intervention, the use of validated assessment tools was emphasized, and recommendations for future studies employing blinding strategies have been included.
Although the study employed a quasi-experimental design with a relatively small sample size, the significant improvements observed in the intervention group suggest a meaningful effect of yoga on menopausal symptoms and quality of life. The use of standardized and validated assessment tools further enhances the reliability of the findings. Future studies employing randomized controlled trials with larger samples are recommended to confirm and extend these results.
MRS represents a standardized assessment tool for menopausal symptoms, encompassing various aspects such as hot flashes, heavy bleeding, irregular periods, vaginal dryness, sleep disturbances, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual issues, bladder problems, and joint/muscular discomfort. This Likert scale consists of 11 items rated on a scale of 1–5, aligning with psychometric standards. The items are categorized into 3 domains: Somato-vegetative (items 1–3, 11), Psychological (items 4–7), and Urogenital (items 8–10). Scoring is determined by symptom presence, with the scale ranging from None (0) to Very Severe (4).6
The UQOL measures the perceived well-being of menopausal women. Comprising 23 items, the UQOL evaluates quality of life across 4 domains: occupational, health, emotional, and sexual. Participants respond to each questionnaire item using a 5-point continuous rating scale, ranging from 1 (not true) to 5 (very true of me). The UQOL score is derived by summing the individual item scores, with reverse coding applied to items 4, 7, 8, 11, 12, 13, 15, and 16. Anticipated mean scores for total quality of life, occupational quality of life, health quality of life, emotional quality of life, and sexual quality of life are 74, 25, 21, 20, and 8, respectively.7 The reliability of the scales was 1.
2.3. Data collection
Step 1: Following ethical clearance (FMMC/FMIEC/424/2022), permission to conduct the study was obtained from the hospital administration and Spandana trust. The investigator underwent a yoga course and was certified to teach yoga from Avishkar Yoga Centre, Mangaluru. Clinical Trials Registry of India (CTRI) registration was done with the registration number CTRI/2023/06/053911.
Step 2: The MRS was distributed to women based on the inclusion criteria to screen the severity of symptoms in both settings. The collected data was scrutinized, and 32 women who had experienced mild to moderate symptoms were included in the study; women with very severe symptoms were excluded from the study.
Step 3: Pre-test: The subjects were allocated to both groups through a lottery method from the respective settings. Then, the purpose of the study and participant sheet were explained, and confidentiality was assured. Written consent was obtained from the participants. Baseline pro forma and the Utian quality of life tool were distributed one after the other for both groups.
2.4. Data analyze
2.4.1. Intervention group
Following the pre-test, the researcher demonstrated 12 yoga asanas, namely swastikasana, kapalabhati(kriyas), vajrasana, suptavajrasana, tadasana 1,2, trikonasana, parshwakonasana, paschimottanasa, purvothanasana, pavanamuktaasana, bhujangasana, shavasana 1, Butterfly, bhadahakonasana, and pranayama (ujjayi, anuloma-viloma, Bhrmari shavasana 2). Each yoga asana was performed for 5 min along with 5 min of warm-up and 5 min of cool-down, with a total of a 60-min session per day. The investigator personally observed for 1 month. Thereafter, the subjects were to continue the yoga asanas at home for the same duration and recorded them in a diary. In the second month, the researcher followed the subjects once a week through WhatsApp video.
The women who performed the yoga for at least 5 d a week were retained in the study. Yoga was advised to be done either in the morning or evening for 1 h.
2.4.2. Control group
After pre-test, standard routine care was continued by the subjects.
Step 4: Post-test: The post-test was conducted at the end of the second month in both groups.
3. Results
The majority of the subjects in the intervention and control groups were aged between 40 years and 45 years; the mean age was 46.22 ± 3.49 and 47.37 ± 3.65 in the intervention and control groups, respectively. The majority of them were qualified up to 8–10 std, 59% of them were housewives, above 60% belonged to the nuclear family, above 50% of them reported menarche between 13 years and 15 years, and above 80% were married (Table 1).
Table 1.
The baseline characteristics of subjects in the control and intervention groups (n = 64).
| Variables | Intervention group | Control group | ||
|---|---|---|---|---|
| n | % | n | % | |
| Age, (Mean age, years old) | ||||
| 40–45 | 15 | 46.9 | 7 | 21.9 |
| 46–50 | 13 | 40.6 | 18 | 56.3 |
| 51–55 | 4 | 12.5 | 7 | 21.9 |
| Qualification | ||||
| 1–7 standard | 1 | 3.1 | 3 | 9.4 |
| 8–10 standard | 24 | 75 | 20 | 62.5 |
| Pre university college and above | 7 | 21.9 | 9 | 28.1 |
| Residence | ||||
| Urban | 24 | 75.0 | 23 | 71.9 |
| Rural | 8 | 25 | 9 | 28.1 |
| Occupation | ||||
| Employed | 13 | 40.6 | 13 | 40.6 |
| Housewife | 19 | 59.4 | 19 | 59.4 |
| Type of family | ||||
| Joint family | 5 | 15.6 | 10 | 31.3 |
| Nuclear family | 27 | 84.4 | 22 | 68.8 |
Table 2 reveals that there is a difference between the pre-test and the post-test in the mean and SD of menopausal symptoms in the intervention group and the control group.
Table 2.
Assessment of menopausal symptoms at pre- and post-test in the intervention group and the control group, Mean ± SD (n = 64).
| Menopausal symptoms | Intervention group | Control group | ||
|---|---|---|---|---|
| Pre-test | Post-test | Pre-test | Post-test | |
| Somatic | 7.3 ± 1.83 | 4.75 ± 1.60 | 7.37 ± 1.73 | 8.28 ± 1.72 |
| Psychological | 8.0 ± 1.72 | 4.25 ± 1.58 | 6.84 ± 2.08 | 7.53 ± 2.31 |
| Urogenital | 3.93 ± 1.38 | 1.90 ± 1.14 | 4.50 ± 1.95 | 4.8 ± 2.03 |
| Overall | 19.25 ± 2.90 | 10.90 ± 2.58 | 18.71 ± 3.90 | 20.62 ± 20.00 |
The data presented in Table 3 shows menopausal symptoms in the intervention group compared to the control group, as evident from the mean difference of 8.35 from pre-test to post-test. Additionally, the overall quality of life in the intervention group exhibited improvement, indicated by a mean difference of −17.31 when compared to the control group over the same pre-test-to-post-test period.
Table 3.
Overall difference in menopausal symptoms and quality of life in the intervention and control groups, Mean ± SD (n = 64).
| Type of test | Intervention group | Control group |
|---|---|---|
| Menopausal Symptoms | ||
| Pre-test | 19.25 ± 9.00 | 18.71 ± 3.90 |
| Post-test | 10.90 ± 2.58 | 20.62 ± 4.02 |
| Quality of life | ||
| Pre-test | 73.12 ± 18.08 | 66.50 ± 11.86 |
| Post-test | 55.81 ± 9.78 | 71.59 ± 10.96 |
The data in Table 4 shows a significant difference (P < 0.001) in the menopausal symptoms between the intervention and control groups. Hence, the null hypothesis is rejected, and it can be concluded that the practice of yoga significantly reduced menopausal symptoms.
Table 4.
Comparison of post-test scores of menopausal symptoms between the intervention and control group (n = 64).
| Study groups | Mean Rank | Mann–Whitney, U-value | P-value |
|---|---|---|---|
| Somatic | 84.50 | <0.001*** | |
| Intervention | 19.14 | ||
| Control | 45.86 | ||
| Psychological | 134.50 | <0.001*** | |
| Intervention | 20.70 | ||
| Control | 44.30 | ||
| Urogenital | 103.50 | <0.001*** | |
| Intervention | 19.73 | ||
| Control | 45.27 |
The data in Table 5 shows that the median scores in the intervention group are less than the control group. The P-values (P < 0.001) depict a significant difference in the menopausal symptoms between the intervention and control groups.
Table 5.
Comparison of post-test scores of Quality of Life between the intervention and control group (n = 64).
| Study groups | Mean Rank | Mann–Whitney, U value | P-value |
|---|---|---|---|
| Health | 134.5 | <0.001*** | |
| Intervention | 20.70 | ||
| Control | 44.30 | ||
| Emotional | 323.0 | <0.001*** | |
| Intervention | 26.59 | ||
| Control | 38.41 | ||
| Sexual | 173.5 | <0.001*** | |
| Intervention | 21.92 | ||
| Control | 43.08 | ||
| Occupational | 2.88 (t-value) | 0.006** (Independent t-test) | |
| Intervention | 20.50 ± 4.93 | ||
| Control | 23.59 ± 3.51 |
4. Discussion
The current study investigated the demographics of participants in both the intervention and control groups, revealing an average age of 46.22 ± 3.49 and 47.37 ± 3.65, respectively. Over 62% in both groups had an education level between 8th and 10th grade, and the majority were housewives from nuclear families. These findings align with a study of Egyptian women, reflecting similar age and education distributions. In terms of the onset of menstruation, over 50% in the intervention group experienced it between 13 years and 15 years, while in the control group, it was between 10 years and 12 years. This pattern mirrors results from a Sri Lankan study, where most women began menstruating between the ages of 14 years and 15 years.8
In the studied intervention group, 59.4%, and in the control group, 40.6%, had a perimenopausal history, differing from other Sri Lankan studies.8 A tertiary care center report aligned with the present study, showing mild-to-moderate menopausal symptoms. Rathnayake’s study suggested more severe symptoms post-menopause, contradicting the current findings. Another study noted significant vasomotor and psychosocial symptoms in women aged 40–60 years, akin to the present study’s outcome.9
The study found that yoga significantly reduced somatic, psychological, and urogenital symptoms, as well as overall symptom scores, compared to the control group. Similar improvements in quality of life domains were observed. Other studies supported these findings, indicating yoga’s positive impact on menopausal symptoms and quality of life.10 The current study specifically highlighted the effectiveness of yoga on psychological symptoms and sexual domain complaints. The improvement in sexual complaints may be attributed to enhanced blood flow and pelvic muscle tone, consistent with existing scientific studies.11,12
The Methods and Results sections have been revised to clearly describe the study design, sampling procedure, intervention duration, assessment tools, and key findings. Baseline comparability between groups and statistically significant post-intervention improvements in the intervention group have been explicitly highlighted to enhance clarity and scientific rigor.
Data were collected in 3 phases: pre-intervention assessment, intervention implementation, and post-intervention assessment. After obtaining informed consent, baseline data were collected from both the intervention and control groups using a structured demographic and menopausal history pro forma. Menopausal symptoms were assessed using the MRS, and quality of life was evaluated using the UQOL scale.
Following the baseline assessment, participants in the intervention group underwent a structured yoga program for a period of 2 months, while the control group continued to receive routine care. At the end of the intervention period, post-test assessments were conducted for both groups using the same standardized tools to evaluate changes in menopausal symptoms and quality of life.
The significant improvement in somatic and urogenital symptoms observed in the intervention group can be theoretically explained through neuroendocrine and autonomic regulation mechanisms associated with yoga practice. Regular yoga practice has been shown to enhance parasympathetic activity, reduce cortisol secretion, and improve blood circulation, which collectively contribute to the alleviation of physical menopausal symptoms.
The improvement in quality of life may be explained through psychological and behavioral theories, particularly stress-coping and mindfulness frameworks. Yoga promotes emotional regulation, body awareness, and adaptive coping strategies, which are crucial during the menopausal transition. These mechanisms align with the biopsychosocial model of health, wherein improvements in psychological well-being positively influence physical symptoms and overall quality of life.
Furthermore, the association between menopausal history and baseline variables supports the concept that individual biological and reproductive factors influence symptom perception and intervention responsiveness. The consistent improvement observed across participants reinforces the applicability of yoga as a supportive, non-pharmacological intervention for menopausal women.
This study demonstrates several innovative aspects from theoretical, methodological, and application perspectives. From a theoretical standpoint, the findings support an integrative biopsychosocial framework by illustrating how yoga simultaneously influences physical symptoms, psychological well-being, and overall quality of life during the menopausal transition. Unlike studies that focus primarily on symptom reduction, the present research emphasizes holistic well-being, aligning with contemporary health promotion theories.
Methodologically, the study contributes by employing validated outcome measures, namely the MRS and the UQOL, within a quasi-experimental design that is feasible in real-world community settings. The inclusion of sensitivity and subgroup analyses further strengthens the evaluation of intervention effects, enhancing methodological rigor despite practical constraints.
From an application perspective, the yoga intervention was culturally acceptable and easily adaptable within the local context, where mind–body practices are familiar and socially endorsed. The structured yet flexible nature of the program supports its scalability and sustainability within community and primary healthcare settings, highlighting its potential for integration into routine women’s health promotion programs.
4.1. Cultural relevance and context-specific mechanisms
The effectiveness of the yoga intervention may be partly attributed to its alignment with local cultural practices that emphasize mind–body harmony, discipline, and holistic health. In this context, yoga is not perceived merely as an exercise but as a culturally meaningful practice, which may enhance participant engagement, adherence, and psychological receptivity. This cultural congruence likely amplifies the intervention’s stress-reducing and emotion-regulating effects, thereby contributing to improved menopausal outcomes.
4.2. Comparison with international and cross-cultural studies
Studies conducted in diverse regions, including North America, Europe, and East Asia, have reported beneficial effects of yoga on menopausal symptoms and quality of life. Similar to findings from Western populations, the present study observed significant improvements in somatic and urogenital symptoms. However, compared to studies conducted in Western contexts, the magnitude and consistency of improvements in this study may reflect higher cultural familiarity and acceptance of yoga among participants.
In contrast to some international studies that utilized shorter intervention durations or focused solely on physical outcomes, the present study adopted a holistic approach encompassing both symptom severity and quality of life. Moreover, many previous studies employed highly controlled experimental settings, which may limit real-world applicability. The current study’s community-oriented design enhances external validity and supports its relevance for public health implementation in culturally diverse settings.
Compared with existing literature, this study offers several advantages. First, it integrates cultural relevance into the evaluation of yoga interventions, an aspect that is often underexplored. Second, it employs a comprehensive outcome assessment capturing both clinical symptoms and quality of life. Third, the study emphasizes practical feasibility and scalability, thereby bridging the gap between research and community-based health promotion. These features distinguish the present study from earlier research and underscore its contribution to the field of menopausal health interventions.
The manuscript now acknowledges that findings may not be generalizable to all menopausal women while also highlighting the ecological validity of conducting the study in real-world settings. Recommendations for future multi-center research have been mentioned.
5. Conclusions
In the current study, yoga emerges as a promising and accessible strategy for alleviating symptoms in menopausal women. Its ease of learning, cost-effectiveness, non-invasiveness, and various lifestyle benefits make it an attractive option. Beyond addressing menopausal symptoms, the practice of yoga has the potential to enhance overall well-being, significantly contribute to health promotion, and serve as a preventive measure against chronic diseases. Yoga practice plays a role in fostering positive lifestyle choices and shaping health-related attitudes.
Acknowledgments
The authors sincerely thank all the participants for their cooperation and the Institutional Ethics Committee for approving. Special thanks to the staff and colleagues who provided support during the study.
Notes
[7] Author contribution
Ramyashree S. conceptualized and designed the study, supervised the research process, and drafted the manuscript.
Pramila Dsouza contributed to data collection, analysis and interpretation.
Jyothis assisted in literature review, data interpretation, and manuscript revision. All authors have read and approved the final manuscript and take responsibility for its “content.”
[8] Ethical approval
The present study was conducted following ethical principles, with prior approval obtained from the Institutional Ethics Committee with the ethical Code number: FMMC/FMIEC/424/2022. The study was also registered under the Clinical Trials Registry of India (CTRI), and informed consent was secured from all participants before data collection.