Can Yoga Actually Help Menopause Symptoms? | A Peri-odical Review

Can yoga, Pilates, tai chi and breathwork actually help menopause symptoms — or are we all just stretching our way through the placebo effect?

In this first official Peri-odical Review, pharmacist Kate Thomas looks at the evidence behind mind-body exercise in perimenopause and menopause. We unpack what the research actually found, where these practices may genuinely help, and where wellness culture tends to get a little bit ahead of itself.

In this episode:

• whether yoga and similar practices improve menopause symptoms
• why the biggest benefits may be in mood, stress and wellbeing
• what the evidence says about hot flushes and physical symptoms
• why mind-body exercise is a support strategy, not a cure
• how sex and intimacy fit into the broader conversation about movement, connection and feeling at home in your body
• why doctors asking you to come back for results is not necessarily a scam
• the problem with direct-to-consumer “wellness” testing and health anxiety as a subscription service

This is a conversation about menopause, medicine, wellness, evidence, and the blurry space in between.

So roll out the mat if you want to.

Or leave it in the corner and go for a walk in the bush instead.

Because you are not doing menopause wrong. 

Transcript

SPEAKER_00 0:00

You're listening to On the Moons, where we have conversations about hormones, midlife, and the moments that make us wonder Is it just me? I'm Kate. I'm a 48-year-old pharmacist and newly minted perimenopausal oversharer. This is where we talk openly about the changes we aren't prepared for, so we never have to feel alone in them again. I acknowledge the Camaragle people of the Iora Nation, the traditional custodians of the land which I am recording today. I pay my respects to elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander peoples listening. Always was, always will be, Aboriginal Land. Hello friends, welcome back to On the Moans, where we take the science, the symptoms, and the absolute chaos of midlife and try to make some sense out of it. Today, we're doing something a little bit different. This is our first official periodical review. Get it? Get it? A journal club, but for people who don't have time to read journals. Today's paper is looking at something that sits right at the intersection of medicine and wellness. Yoga, Tai Chi, Pilates, breath work. Do these things actually help menopause symptoms, or are we just stretching our way through the placebo effect? Let's zoom out for a second. If you've spent any time on Instagram, TikTok, or frankly just walking down any high street in Sydney, you will have seen clinics with claims like balances your hormones naturally, reduce hot flushes with breath work, calm your nervous system, heal your body through movement, and look, some of that sounds lovely. But as a pharmacist, my brain is always doing this slightly annoying thing of going, show me the data.

SPEAKER_01 1:56

Show me the money! Jared, you better yell! Show me the money!

SPEAKER_00 2:00

The association between mind-body exercise and depressive symptoms in perimenopausal women, the roles of urban-rural disparity, social support, and subjective well-being. This is a study published in the journal Menopause, which is the official journal of the Menopause Society. So we're not talking about a random wellness blog here. It was conducted by a group of researchers looking at the relationship between mind-body exercise, things like yoga, tai chi, and similar practices, and menopause symptoms in 709 women. Their aim was to explore whether women who engage in these kinds of mind-body exercises experience differences in menopausal symptoms. Things like hot flushes, mood, sleep, that whole cluster of things we talk about in perimenopause and menopause. So essentially, does doing yoga or similar practices actually translate into measurable differences in symptoms? And importantly, this wasn't an intervention trial where they made people do yoga. This was an observational study, meaning they looked at existing data and compared groups of women who were already doing mind-body exercises with those who weren't. They analyzed the data from a cohort of women and looked at associations between exercise habits and symptom burden. So what they're really asking is, are these things linked? Not necessarily. Does one cause the other? And that distinction is really important because observational studies can show associations, but they can't prove that the yoga or the tai chi or the breathing is the thing causing the improvement. There could be other factors, lifestyle, health behaviors, socioeconomic differences that sit underneath that relationship. And because menopause symptoms are not small, we're talking about hot flushes, night sweats, sleep disruption, anxiety, mood changes, brain fog, joint pain, bone density loss, to name just a few, and these symptoms can go on for years. So if we're going to recommend something or spend money or time or energy on something, the question we all should be asking is, does it actually work? This paper is a systematic review and meta-analysis, which is basically the Beyonce of evidence. It means they didn't just look at one study, they looked at multiple studies, pulled the data, and tried to answer the question more robustly. And what they were specifically looking at was mind-body exercise. So that includes things like yoga, tai chi, Pilates, meditative movement, not high-intensity workouts. This is about slow, controlled movement plus breath, plus mental focus. And its findings are interesting. Overall symptoms, the big line heading is mind-body exercise was associated with an improvement in menopausal symptoms overall. So across multiple studies, women who did these types of exercises reported fewer symptoms, less severe symptoms. That's important. Psychological symptoms, where the effect seemed strongest, was actually in anxiety, mood, and psychological well-being, which makes sense, right? Because these practices often involve breath control, mindfulness, and slowing down. So there is a plausible mechanism here. It's not magic, it's likely working through the nervous system, stress pathways, and possibly sleep. Physical symptoms like hot flushes. Now, this is where we need a bit more nuance. There were some improvements in physical symptoms, including vasomotor symptoms, so hot flushes and night sweats, but the effect was more modest. So this is not do yoga and your hot flushes disappear. This is more, you might feel a bit better overall, and your symptoms might feel a bit more manageable. Quality of life. There is also an improvement in quality of life scores, which honestly is one of the most important outcomes. Because menopause is not just about individual symptoms, it's about how do you feel in your body? How do you function day to day? How much this stage of life is impacting you and your relationships. Now, before we all run off to buy a$200 yoga mat and matching activewear, let's do a quick reality check. Because this is where being a pharmacist becomes slightly inconvenient. Study limitations. The studies included in this analysis had some limitations, relatively small sample sizes, variation in the type of exercise, variation in how often people did it, and some risk of bias. So this is not perfect evidence. And this is the really important bit. This does not replace evidence-based medical treatment. If you are having severe hot flushes, significant sleep disruption, major mood changes, then things like menopausal hormone therapy or other medical treatments remain the gold standard. And I think this is where things can get a bit tricky. Because this kind of data can easily get translated into you don't need medication, just do yoga. And that's not what this paper is saying at all. So how should we think about this? I think the most helpful way to frame it is this. Mind-body exercise is a support strategy. It's something that can improve how you feel, support your mental health, potentially reduce symptom burden. And it sits alongside medical treatment, good sleep, good nutrition, and social connection. And actually, when you think about it, this makes perfect sense. Because menopause is not just a hormonal event, it's a whole body, whole life transition. And things that help regulate stress, breathing, movement, nervous system are probably always going to be helpful. Not because they balance your hormones, but because they help you cope with the changes. And anyone who knows me knows that I am a huge fan of exercise in any form. And I am out of the closet when it comes to admitting that I love yoga and my divine yoga teacher, who every week very patiently takes me through my yoga practice and then tries to sneak in some breath work or meditation at the end in the hopes that I will see the benefits and do it on my own. Sorry, Dee, I know we've been together for nearly 10 years, but I'm still not quite there yet. Time for our verdict. Mind-body exercise for menopause, prescribe with conditions, helpful for mood and well-being, may modestly improve symptoms, low risk, accessible, but not a replacement for medical care, not a miracle cure, not going to fix your hormones, whatever that means. So if you enjoy yoga, Pilates, Tai Chi, not that you needed one, but here is your permission slip to keep going. Because it's probably helping in ways that are real, measurable, and meaningful. And if you hate yoga, you are absolutely allowed never to step foot in a studio again. There are many roads through menopause, and this is just one of them. Go for a walk in the bush. That is a wonderful open-eye meditation that is guaranteed to make you feel better on many levels. And while we're talking about movement, I feel there is one form of physical activity that is conspicuously absent from most menopause wellness conversations that is actually a very good predictor of health status. And that is sex, or at the very least, intimacy. Because if we're going to have an honest conversation about movement, hormones, and well-being, we probably shouldn't pretend that this entire category of human behavior just disappears at 45. Now, let's take the wellness language for a model. Because if I rebranded sex as rhythmic, full-body, somatic movement with breath synchronization, you'd be paying$180 for a class in Bondi. But joking aside, there is actually some interesting physiology here. Sex and intimacy can influence mood, stress, sleep, and connection. And that's through some very real biological pathways. Endorphins, your natural painkillers, oxytocin, bonding and relaxation, dopamine, reward and motivation. So again, not magic, not hormone balancing, but absolutely part of the broader system of how we feel in our bodies. Now, this is where menopause comes into it, because for a lot of women, this is also the stage where things change. Libido can shift, vaginal dryness can become an issue, sex can become uncomfortable or just not a priority. And we don't talk about that enough. We either get silence or just use this candle oil supplement and everything will be amazing again, or have a glass of wine and relax. And none of these is particularly helpful. Because just like everything else we've talked about today, this is not a moral issue, and this is not a failure, this is physiology. And there are actually evidence-based treatments, practical strategies, and real conversations that can make a meaningful difference. And I think this is where we need to expand the conversation because movement that makes you feel better doesn't have to be yoga on a mat, Pilates in a studio, Tai Chi in the park. It can also be connection, pleasure, feeling at home in your body again, in whatever way that looks like for you. And I'm actually really excited because in a few weeks I'm going to be sitting down with a sexologist and clinical psychologist to talk about all of this properly. Libido, pain, desire, relationships, what changes, what doesn't, and what we can actually do about it. Without the fluff, without the shame, and without pretending it's all solved by a scented candle and a positive mindset. So consider this your gentle foreshadowing. Because if yoga is one way of reconnecting with your body, this is another conversation entirely. Time for an ad break. Are you tired of your hormones having boundaries? Do your friends and family tell you that you look like a desiccated husk with a malaligned aura? Introducing sub-Saharan snail semen serums can get the all-natural, ethically confusing solution to whatever problem you mistakenly think you are having. Harvested at dawn under a full moon from snails who have really been through something. Each drop is infused with ancient wisdom, gastropod vitality, and zero meaningful evidence. Clinically studied in a sample size of vibes. Shown to improve energy, libido, skin glow, cortisol levels, insulin resistance, and your bank account. Sorry, just kidding. Not yours, my bank account. Results not measured, defined, or real. Apply liberally to the neck, wrists, or wherever your intuition tells you your endocrine system lives. Sub-Saharan snail semen serum skincare. Or sss. Because that's the sound that health professionals make when they hear about it. If it sounds natural enough, no one will ask for the data. Folks, you know I write this podcast a bit like Beethoven wrote his symphonies. There is a genius to the process with my ear to the computer as I type madly away. There are themes, there are movements, I gather the research, the papers, the data, the guidelines, like musical motives, little fragments of truth. And then I interweave them. I interpret them, I layer them, I look for patterns, I build the structure of the episode the way a symphony builds slowly, deliberately, with tension and release, with ideas that come back again and again, but each time a little bit more developed, a little bit more resolved, until eventually, with a big crescendo, everything lands, everything makes sense, and we arrive together at something that feels concordant, elegant. But sometimes, sometimes I wander into the garage and I find the moldy old recorder I used in kindergarten. And a tambourine with a broken drum and a triangle that I hit with a rusty screwdriver. I sit down atop an empty gas cylinder and prop myself up with bags of dynamic lifter. And I create the slightly mad and totally discordant Stravinsky style Diddy that is my segment. Woo of the week. And I can already feel the comment section warming up. Because the claim going around right now is this. Doctors won't give you your results over the phone because they want you to come back in and pay for another appointment. So basically, it's not about your health or their responsibility interpreting this information and communicating it to you in a way that you can understand. No, no, it's all about the bill. Now look, I actually understand why this one takes off. Because from your perspective, maybe it feels like you've had a blood test, the results are back, you call the clinic, and they say you'll need to make an appointment to discuss it. And you're thinking, just tell me if it's normal. And if you've already paid once and now you're being asked to pay again, maybe it can feel frustrating, maybe it can feel transactional. But here's what's actually going on behind the scenes. Results are not just normal or abnormal. A result usually needs interpretation, context, comparison to your history, and a decision about what happens next. A slightly abnormal result could be completely irrelevant, something to monitor, or something that needs urgent attention. Those are not the same conversation. And here's another important point. Most of the time you didn't have a blood test just for fun. There was a reason. Symptoms, screening, follow-up, medication monitoring. So chances are there's something worth discussing. Even if the result is normal, that can still mean reassurance, next steps, or what do we do now? There's also a safety piece here. Doctors need to make sure that results are understood properly. Nothing important is missed, and you know exactly what to do next. A rushed phone call between patients is not always the safest way to do that. Now, is the system perfect? No. There is definitely room for better communication and more streamlined follow-up. And some clinics are doing this really well. But that's about system improvement, not exposing some kind of conspiracy. And in Australia, it's also worth knowing you can often access your own results through my health record. So you're not being blocked from your information, but interpreting those results? That's when the seven years at university, then at least another six in training, and then expertise comes in. So doctors gatekeeping your results just to make money? Hard pass. What's actually happening is clinical responsibility, time-based funding, and a healthcare system that isn't always elegant. But it's not a scam. And honestly, if your doctor really wanted to maximize profit, they probably wouldn't be running late, skipping lunch, and finishing their notes at 9 p.m. Now, alongside all of this, we're seeing a real rise in something else. These direct-to-consumer testing platforms. You know the ones. Go online, order yourself a wellness panel, maybe throw in a full body scan while you're at it, and a few days later your results just appear on a dashboard. No doctor, no clinical context, just some numbers. And on the surface, it feels empowering, right? Access control, being proactive about your health. But here's where I think it gets complicated. Firstly, cost. You're paying for an out-of-pocket test that may not have been clinically indicated in the first place. So we're not talking about targeted, evidence-based testing, we're talking about shopping for pathology. Second, anxiety. Because the second you start testing broadly, you will find something, a slightly high level here, a slightly low level there, not because you're unwell, but because biology isn't a straight line. And now you're sitting at home staring at a red number on a screen, trying to work out if you're fine or falling apart. And third, this is a big one, unnecessary intervention. Because once something is flagged, it's very hard to ignore. So that can lead to repeated testing, referrals, scans, sometimes even treatment, for findings that may never have caused a problem in the first place. And this is the bit that often gets lost. More testing is not always better medicine. Good medicine is the right test for the right person at the right time, interpreted in the right context. Otherwise, we're not doing healthcare. We're doing health anxiety as a subscription service. If you've enjoyed this episode, our first official periodical review, let me know. And where does that leave us on yoga, tai chi, breath work, all the things that sit in that slightly blurry space between medicine and wellness? Here's the honest answer. They're not nonsense, but they're also not a substitute for evidence-based care. They are tools, and like any tool, their value depends on how you use them, what you expect from them, and what else is going on around them. And I think one of the biggest shifts that we can make in midlife is this. Moving away from what will fix me, and towards what actually helps me live well in this body at this stage of life. Because this is not a problem to be solved, this is a transition to be navigated. And that navigation might include hormone therapy, antidepressants, sleep support, strength training, walking in the bush, laughing with your friends, and yes, maybe a bit of yoga. All of those things can coexist. This is not either or. This is what works for you. And if there's one thing I want you to take away from today's episode, it's this. You are allowed to want evidence, use medication, question wellness claims, and still enjoy the things that make you feel good. These are not in conflict. That's just being a thinking human. And if yoga is your thing, roll out the mat. And if it's not, leave it rolled up in the corner and go for a walk instead. You're not doing menopause wrong. And as always, stay curious, stay skeptical. Move your body in the way that you like to. I'll look forward to your company next time we get on the moans. And as always, you can find me on the socials at Prescribal Pass or on LinkedIn, Kate Thomas, Thomas Dowling Consulting. Bye bye. Sub Sahara and Snail Semen Sub Sahara and Snails Semin Oh god, I can't even say it.