Womb Yoga Manual

20/7/2016

2015 Str oud W om b Yoga manual

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Course Manual for

Womb Yoga Well-Woman Yoga Therapy Yoga for women’s health and vitality

Stroud 11 -14 June, 2015 http://webcache.googleusercontent.com/s http://webcache.googleusercontent.com/search?q=cache:http://ww earch?q=cache:http://www.yonis w.yonishakti.co/s hakti.co/sites/default/fi ites/default/fi les/fi les/2015%2520Stroud%252 les/2015%2520Stroud%2520Womb%2520Y 0Womb%2520Yoga%2 oga%252 52… …

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Course design & tutoring

Uma Dinsmore-Tuli Contributing tutors: Marinella Benelli and Sundari Miranda Falconer

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World as Womb, Womb as World Why is women’s health so important? And why do so many women do yoga? The answers to these two questions are connected. There is a powerful link between women and yoga now. The roots of yoga’s reverence for the feminine power of shakti, the feminine energy of the life force, are rooted in the philosophies of ancient India. The very words that are used to describe women’s bodies signify power, spiritual dignity and cosmic connections. In Sanskrit, the language of yoga, the term garbh grha, which literally means the ‘womb house’ refers to the innermost space of any temple, the holy of holies, the inner sanctum. The word yoni, which means womb, vulva, and vagina, is understood to be the cosmic gateway through which the power of shakti enters the world, both in terms of giving birth, and in i n terms of the creative powers of manifestation, of the prana shakti working her way into our world through women. In the Rg Veda Veda, the oldest of the Indian sacred texts, the goddess Aditi squats down to gives birth to all al l the gods through her yoni, yon i, and in

Shame, guilt and disgust at the natural healthy functioning of women’s menstrual cycles has already created an ecological disaster because of the ‘discrete’ disposal of non biodegradable and toxic t oxic products from the sanitary protection industry; synthetic hormones from hundreds of millions of contraceptive pill users worldwide have already polluted our waters, and everywhere on the planet women are exploited and underpaid. It is time to awaken to the connection between our wombs and our world: to see that the way we care for our planet mirrors the way we treat our women and girls. The mirror works two ways: the rape and destruction of the natural resources of our planet is an expression of the disrespect in which women and our bodies have been held. Yet there is an enormous turning of the tides right now: millions of women practising yoga are awakening to a higher consciousness of the importance of their own health, selfesteem and spiritual well-being as a positive step towards planetary change. Things are truly shifting. And women’s immense involvement and passion for yoga is a truly vital part of this change. We can encourage, support and assist women as they practise yoga by sharing those practices that best nurture and nourish the power of the life force in women. We can teach yoga with respect and honour for women’s cycles. And with conscious awareness and respect

http://webcache.googleusercontent.com/s http://webcache.googleusercontent.com/search?q=cache:http://ww earch?q=cache:http://www.yonis w.yonishakti.co/s hakti.co/sites/default/fi ites/default/fi les/fi les/2015%2520Stroud%252 les/2015%2520Stroud%2520Womb%2520Y 0Womb%2520Yoga%2 oga%252 52… …

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Course design & tutoring

Uma Dinsmore-Tuli Contributing tutors: Marinella Benelli and Sundari Miranda Falconer

Page 2

World as Womb, Womb as World Why is women’s health so important? And why do so many women do yoga? The answers to these two questions are connected. There is a powerful link between women and yoga now. The roots of yoga’s reverence for the feminine power of shakti, the feminine energy of the life force, are rooted in the philosophies of ancient India. The very words that are used to describe women’s bodies signify power, spiritual dignity and cosmic connections. In Sanskrit, the language of yoga, the term garbh grha, which literally means the ‘womb house’ refers to the innermost space of any temple, the holy of holies, the inner sanctum. The word yoni, which means womb, vulva, and vagina, is understood to be the cosmic gateway through which the power of shakti enters the world, both in terms of giving birth, and in i n terms of the creative powers of manifestation, of the prana shakti working her way into our world through women. In the Rg Veda Veda, the oldest of the Indian sacred texts, the goddess Aditi squats down to gives birth to all al l the gods through her yoni, yon i, and in

Shame, guilt and disgust at the natural healthy functioning of women’s menstrual cycles has already created an ecological disaster because of the ‘discrete’ disposal of non biodegradable and toxic t oxic products from the sanitary protection industry; synthetic hormones from hundreds of millions of contraceptive pill users worldwide have already polluted our waters, and everywhere on the planet women are exploited and underpaid. It is time to awaken to the connection between our wombs and our world: to see that the way we care for our planet mirrors the way we treat our women and girls. The mirror works two ways: the rape and destruction of the natural resources of our planet is an expression of the disrespect in which women and our bodies have been held. Yet there is an enormous turning of the tides right now: millions of women practising yoga are awakening to a higher consciousness of the importance of their own health, selfesteem and spiritual well-being as a positive step towards planetary change. Things are truly shifting. And women’s immense involvement and passion for yoga is a truly vital part of this change. We can encourage, support and assist women as they practise yoga by sharing those practices that best nurture and nourish the power of the life force in women. We can teach yoga with respect and honour for women’s cycles. And with conscious awareness and respect


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each woman theiscosmic gateway to immense creative power embodied. It is through the health and well-being of women that we ensure the happiness of the whole family, of the whole community. If we see each womb as a ‘world’ then we can see that the environment of the womb is the creative space for future life, and for the powerful, healing, creative projects of women around the world. If we see the world herself as the womb in which we live, then we can understand how important an ecologically responsible attitude is to the creation of positive health in women. In terms of the health of our planet, our ‘womb’, we are at a turning point now.

for ourof own cycles we can cycles thelife natural world andhonour bring the profound healing to our planet. pl anet. We are healing the world, one womb at a time. Together, in circles of power and love, we are helping this change to happen. We are assisting at the birth of a new consciousness that respects and honours the cycles of the life force, in women and all beings. Yoga is really quite a revolutionary force for spiritual and practical change right now, and promoting women’s health and freedom is the key to a future of peace and cooperation, respect and honour. We start one womb at a time, one woman at a time. Jagadambe mataki Jai! All power to the great mother of the world!

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Overview This course is all about yoga for women’s health and vital energy. It shares techniques to feel, nurture and build the feminine energy of Shakti for the practical healing and benefit of women in all stages of life. It is geared for yoga teachers and experienced practitioners who sense that yoga could be of more practical use to all women in managing health, vital energy and well-being. The course presents therapeutic and enlivening yoga practices to support all experiences of femininity throughout a woman’s life. Topics covered included menstruation, pre-menstrual tension, fertility, sub fertility, optimal fertility, assisted conception, feminine sexuality, breast health, and peri-menopausal mood swings, headaches and hot flushes. It addresses health issues related to the pelvic floor, including postnatal recovery and prolapse, and other issues of concern to such as hysterectomy, surgery for prolapse, anaemia, osteoporosis, and eating disorders. Some

issues are presented as case studies and others are addressed as topics arise in discussion with the group. All these issues are addressed within the context of a yoga therapeutic understanding of feminine emotional life, lunar cycles and the play of the elements in the female body. The course encourages you to think and feel for yourself, and aims to provide you with practical tools from yoga therapy and to help you to build programmes specially suited to the needs of women seeking full vitality and well-being. The course combines theory and practice to offer you fresh perspectives, new understandings and a deep appreciation of the healing power of yoga as therapy to optimise health and delight in feminine energy. Practices taught include mantra, asana, pranayama, mudra, bandha, deep relaxation including yoga nidra, meditations and some simple self massage techniques.

Please note that most of this manual (with the exception of Ruth Gilmore’s session notes) is work in progress, excerpted from YONI SHAKTI: A Woman’s Guide to Power and Yogawords November 2013 © Uma Freedom Freedom through Yoga Yoga and Tantra, Tantra, published by Yogawords Dinsmore-Tuli 2013. See www.yonishakti.co and also at www.yogamatters.com http://webcache.googleusercontent.com/s http://webcache.googleusercontent.com/search?q=cache:http://ww earch?q=cache:http://www.yonis w.yonishakti.co/s hakti.co/sites/default/fi ites/default/fi les/fi les/2015%2520Stroud%252 les/2015%2520Stroud%2520Womb%2520Y 0Womb%2520Yoga%2 oga%252 52… …

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SPECIAL THANKS TO SIVANI MATA for the beautiful formatting,

transliterations, translations and illustrations for the mantras, and for the Maha Lakshmi Stotrum all at the end of the manual. All done with LOVE XXX JAGADAMBE MATAKI JAI! For heart melting MA BHAJANS and KIRTAN with Sivani Mata, please see www.naturalmysticbhajans.co.uk

www.facebook.com/naturalmysticbhajans

© Uma Dinsmore-Tuli and Ruth Gilmore, 2008 - 2015

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Contents Endometriosis Endometriosis – a special message 42 ESSENTIALS

Introductory thoughts 2 Overview 3 Contents 4 Schedule 5 PRACTICES

Mudra: Greeting the womb with love 6 Heart womb river greeting greeting 7 Honouring Honouring the elements 8 Pentads in Samkhya and yoga 9

Asana sequences : Honouring Honouring prana shakti 10 Standing full hands womb pilgrimage 11 Standing heart-womb river greeting 12 Other asanas from the practices 13 Pawnee Women’ Women’ss Dance of Life 14 Menstrual/fertilit Menstrual/fertilityy sequence 15 Base position for Chandra sequence 16 Golden cosmic womb 16 Five dimensions of being /pancha kosha 17 Menstrual Menstrual Mala –yoga for menstrual cycle 18

ANATOMY/PHYSIOLOGY NOTES

Anatomy & Physiology notes prepared by Ruth St C .Gilmore The pelvis and pelvic organs 43 Pelvic floor musculature 44 Breasts 44 Menstrual cycle 44 Hormonal control of menstrual cycle 45 Menopause 46 Challenges to female health Dysmenorrhoea 46 Menorrhagia 46 Fibroids 47 Cervical Cancer 47 Endometrial Carcinoma 47 Tubal blockage 48 Subfertility 48 Polycystic ovary syndrome 48 Endometriosis 48 Pelvic floor weakness 48


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2015 Stroud Womb Yoga manual

Brief notes on yoga nidra 23

Breast cancer 49 Bones and calcium metabolism 50 Stress and sympathetic nervous system 50

PHILOSOPHICAL AND PRACTICAL FOUNDATIONS CASE STUDIES

Foundations of positive menstruation 24 Alexandra Pope: ‘Power of menstruation’ 25

Inner seasons / moon within 26 What is menstruality? A statement 27 Ayurveda and (menstrual) cycles 28 Sexuality and women’s health 30 The deer exercise 31 How can yoga support fertility? 32 Yoga to avoid when seeking to conceive 33

More on fertility and yoga 34 Postnatal recovery and prolapse 36 Postural re-education and prolapse 37 Understanding pelvic angle /organ support

Case study 1 (off the pill but no baby?) 51 Case study 2 (miscarriage) 53 Case study 3 (miscarriage/s) 55 Case study 4 (endometriosis) 57 Case study 5 (subfertility) 58 Case study 6 (prolapse) 59 Case study 7 (fibroids) 60 Case study 8 (menopause) 61 Womb Friendly Yoga Manifesto

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38 Peri-menopause 39

Menopause as a journey of Self discovery

Bibliography / resources 66 Learning consolidation quiz: 67 Sacro-iliac stabilising practice: 73 Menstrual cycle chart: 74 Mantras and shlokas: 75 ff

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Yoga and Osteoporosis 42 © Uma Dinsmore-Tuli and Ruth Gilmore, 2008 - 2015

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5

Page 6 Day 1: Thursday

Day 2: Friday 12 June Day 3: Saturday 13

11 June

Day 4: Sunday

June

14 June

Healthy menstruation,

Menstrual challenges,

Postnatal recovery,

Menopause, beyond –

fertility

subfertility

prolapse, peri-

cyclical wisdom and

menopause

integration

This first day begins at 1030. Please arrive1000, so you can settle in.

0830 start each day – please arrive promptly – as we begin with a welcoming morning yoga nidra:

you really don’t want to miss that!

each morning, with specific focus each day to set tone and promote intuitive connection with the theme, healing insights.

0900 – Mantra, chants, meditation and mudra

1030 Welcoming yoga nidra. 1100 Introduction: shakti circle. A model practice for well woman yoga therapy group sessions

1130 Key yogic, tantric, ayurvedic understandings of

0930 Satsang – shakti circles morning check in small groups: menstrual health and fertility

1000 Ayurvedic approaches

0930 Satsang – shakti circles morning check in small groups: postnatal recovery and perimenopause

0930 Satsang shakti circles morning check in small groups: menopause and beyond

1000 Postnatal recovery, including case studies on uterine prolapse, split rectus

1415 Collaborative consolidation. 1515 questions arising

1100 cultural contexts for postnatal recovery – and

1100 Menopause: Frances’ story, every woman’s


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women’s health. 15 Seasons of the cycle : foundations of healthy menstruation

to menstrual cycles – 11 00 Practice - honouring the monthly cycles, positive sexuality, fertility yoga and breast health sequence

1200 Practice - menstrual mala – seasonal variations. Yoga therapy for healthy menstruation and fertility

links with perimenopause. 1130 Practice - yogic remedies for prolapse, useful practices for pelvic health postnatally, peri-menopausally – selfcare and postural reeducation

collaborative learning

chants to the divine feminine

exercise

1600 Anatomy and physiology: menstruation and fertility yoga therapy case studies 1700 Yoga and menstruation, happy sisters/. Discussion.

1730-1800 Afternoon, themed

1245 1115 Understanding menstruality and integrating yoga therapy and cyclical wisdom. 1300 -1400 lunch + +

1300-1400 lunch daily – 1400 – 1500 walk in the Heavens – 1530 daily

1600 Structure and function: the female pelvis and the three sisters: experiential anatomy and geography

journey. 1200 practice – yoga for menopause

1600 Anatomy and physiology, including postnatal recovery and menopause – the links, and postural support … 1630 sacro iliac stabilizing practices for pelvic health

Yoga Nidra practice each day - restore, renew, revive

1430 Collaborative learning exercise feedback 1500 Practice – as requested: Coming home to ourselves, yoga practice for women’ well being.

FINISH 1630

Homework –reflecting on longer questions in learning exercise.

1800 – 1900 DINNER

1600 menstrual 1930Practice case studies: yoga for yoga therapy healthy menstruation: honouring the premenstrual tension menstrual pain, endometriosis, menstrual anaemia

1600 Practice - Fertility 1930 case studies: yoga for yoga: the support supporting of fertility

FINISH 2030 Homework – reading essentials in manual, Tara chapter Yoni Shakti

FINISH 2030 Homework – reading intro to Yoni Shakti

1610 Practice, sacro 1930 Menopause, theiliac stabilizing wider picture: sequence, case studies, and constitutional differences.

1710 Slide show. Spirals and circles, understanding links

2000 taking it home+ beyond: shakti circles


FINISH 2030 Homework – reading manual +Tara in YS

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Greeting the womb with love:


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Heart-womb river gesture/ hridaya-yoni-nadi mudra (above) (above right) - Heart space gesture / hridaya mudra (illustration: the fertility yoga seq by Uma Dinsmore-Tuli in The Baby Making Bible Emma Cannon (Macmillan 2010)

Above: Heart-womb river greeting gesture (Hridaya-yoni nadi namaskara) © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Movement and sound meditations: greeting the womb with love Heart-womb meridian: the river of energy between love and creativity

All of these greetings begin with consciousness in the heart and bring it to the womb. The channel through which the awareness flows is the heart-womb meridian, a pranic link between the energies of the heart and those of the womb. This particular meridian is acknowledged both in Traditional Chinese Medicine (heart-uterus meridian) and in Ayurveda, the ancient Indian medical system that shares the same philosophical framework http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%252…

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of understanding (Samkhya darsana ) that underpins the whole of yoga. I refer to this energetic connection between heart and womb as the Hridaya-Yoni Nadi , which literally means the river (nadi) of energy that flows between the space of the spiritual heart (hridaya) and the source of creation or the womb ( yoni). Heart-womb river-ocean greeting gesture: (Hridaya-yoni nadi-sagara namaskara)

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2

5

6

9

10

3.

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4

8

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Honouring the elements with sound and gesture (Tattwa bija mantra puja) Use the same ‘twist and give’ gesture shown for earth to honour each element in turn, sounding the bija mantra as you move:


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earth (LAM), reverence to mother earth. Then water (VAM);

(YAM)

fire (RAM)

space ( HAM) close up of space mudra.

heavenly crown lowered back to earth.


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Pentads in Samkhya and yoga (based on Swami Satyasangananda Saraswati’s presentation in Tattwa Shuddhi) http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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PANCHA

PRITHVI

APAS

AGNI

VAYU

AKASHA

TATTWA

Earth

Water

Fire

Air

Ether / Space

Gandha (smell)

Rasa (taste)

Rupa (form)

Sparsha (touch)

Shabda (sound)

(5 elements)

Tanmatra (5 subtle essences) Jnanendriya (5 organs of

Ghrana (nose)

Jihwa (tongue)

Chaksu (eyes)

Twacha (skin)

Srotra (ears)

Payu (anus) Excretion

Pada (foot) locomotion

Pani (hand) grasping

Vak (speech) expression

Heavy

Upastha (genitals) Reproduction Cool

Hot

Erratic

Weight Cohesion

Fluidity Contraction

Heat Expansion

Motion, Movement

Diffused, Space giving

Secure Stable

Creative/fertile /potent

Powerful/ directed

Loving Giving

Authentically expressive

Red

Blue/grey

Black/ multicoloured translucent

knowledge) Karmendriya (5 organs of action) Elemental

Mixed

Nature Elemental Qualities

Positive Manifestation

Colour

Tattwa yantra

Yellow

White

Quadrangular

Crescent moon

Triangular

Hexagonal

Bindu/dot

Muladhara

Swadisthana

Manipura

Anahata

Vishuddhi

Lam

Vam

Ram

Yam

Shape/ symbol Chakra Energy centre Bija mantra

Ham

Seed sound

Ahamkara ego

Buddhi discrimination

Manasa thoughts

Chitta psychic content

Kosha Layer of being

Annamaya

Pranamaya

Manomaya

Vigyanamaya

Prana vayu

Apana

Antarkarana State of mind

Prana

Samana

Udana

Pragya intuition

Anandamaya

Vyana

Vital flow Hasta mudra Hand gesture

Prithvi thumb to ring

Apas thumb to little


Chin thumb to index

Hridaya: index to thumb root, thumb to mid & ring

Padma / Kamala Open lotus

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Honouring prana shakti Standing heart-womb river greeting ( Hridaya-yoni nadi namaskara / tadasana )


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Honouring prana shakti Standing full hands womb pilgrimage These practices reconnect your awareness to your womb or womb-space as the seat of a nourishing inner wisdom. They are simple but powerful greetings that use movement, breath and gesture to direct consciousness into the heart of the womb. The practices integrate awareness of the womb as a physical organ or literal space, and as a symbolic connection with Mother Consciousness. This consciousness exists energetically within every woman as the sacred potentials for love, nurture, generosity and creativity: the qualities of the womb herself. To experience these qualities as real powers in our lives is to embrace our ancient blood wisdom. This embrace is initiated by offering loving greetings to the womb/wombspace within us.

Start and follow with standing heart-womb river greeting on previous page


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Honouring prana shakti – standing Heart womb river – ocean dive (Begin with Standing heart-womb river greeting gesture) Follow with Standing heart-womb river-ocean gesture/discovering the ocean


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Other asanas from the practices Fierce goddess roars/ devijai utkatasana

Prana mudra

nataraja variation

Squatting tree


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Pawnee Women’s Dance of Life Performed by the women of the Pawnee tribe of the Cherokee nation to promote and nourish their heart connection with the earth as women, farmers, mothers, sisters, wives, wise women. This beautiful and accessible movement sequence promotes a powerful connection between the heart and the earth. It is very similar in many ways to some of the yoga sun salutation modifications for pregnancy in the rest of the manual, and also to the golden circle practice. It provides a lovely option for a standing, energising practice suitable through all stages of pregnancy because it can be so easily adapted to suit everyone and has a powerful spiritual message that is easily felt through its physical effects. Sub text: Open to the feminine side, integrate in the heart. Stand ready and willing. Open to the masculine side, integrate in the heart. Stand ready and willing. Turn to face the next direction, gather unwanted energy. Stand ready and willing. Offer out to that direction all energies and qualities you wish to be free from. Draw in from that direction all energies and qualities you wish to take on. Integrate in the heart. Stand ready and willing. Actions: Initial opening and closing only: Salute the North (silence, left hand on heart, right palm raised._)

Start of each round: Amatikewa-ah (Left out) Nyohey (Squat to salute the Earth) Oh Shona (Raise hands to salute the Sky) Hi-i no, Hi-i no (Circling down hands into the Heart) Hey-i yaah (hands open ) (Repeat above twice - left, then right) Turn 90 degrees to face East Hey, Hi-i no (Gather unwanted energy) Heyah !! (Throw out left) Hi-i no, Hi-i no (Haul-in wanted energy to Heart) Hey-i yaah (hands open) Return to start, repeating in each direction. Final round silent.

Thanks to Martin Barker, Interfaith Minister, for sharing the words and http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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actions to this and to the morning who practised this dance eachdance, day, barefoot in Santosa the morning dew dancers in the Healing Field Meadow in Somerset during the Santosa Festivals 2008 - 2011. Thanks also to Ben Jarlett, singer, for sharing a beautiful new tune to the words at the Cotswold camp in 2011


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Healthy menstruation/fertility practice: structuring concepts: swadisthana chakra, apana prana, links between annamaya & pranamaya koshas 1.

preliminary earthing ‘pawanmuktasana’

practice:

[pelvic / ankle & foot health] toe flipping at appropriate angle front foot stretch with weight sole of foot stretch (heel up) with weight loose foot, ankle, knee, buttock jiggle

• • • •

OR seated lotus feet breathing 2.

savasana [ease / flowing breath / healing recovery of resting body]

• low abdominal breath • full yogic breath wave awareness • anuloma viloma (psychic triangle breath) 3. seed/flower [opening space across pelvis / clearing breath into throat and chest] • knees wide • arms above head • synchronise both movements with breath 4.

supta pawanmuktasana [foetal comfort pose / rhythmic rocking / massage for belly / breath awareness] • squeeze close on exhalation 5. kandharasana /setu bandha sequence [pelvic movement awareness / flexibility] • sacral tilt and clock • neutral lift and lower • full lift and lower

9. mudras / bandhas in wide knee shashankasana [pelvic floor awareness] • ashwini mudra • sahajoli mudra • moola bandha 10. Womb Pilgrimage / chakki chalanasana [movement from hip / shakti bandha] • clockwise & anti clockwise 11. chandra sequence (move on exhalations. Do left side first) [lunar practice / easeful way into reenergising of pelvic area] See next page for base position illustration. • vajrasana namaste, rise on knees • left foot forward, arms spread wide • left arm back, then right arm back • left arm down, then right arm down • left hand to right foot, right hand to left foot • namaste, left foot back to vajrasana • majariasana • parvatasana [downward dog] raise and lower each leg • shashankasana • vajrasana namaste, then rise on knees

12.

padadhirasana • balancing breath with hands


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under armpits 6. Sita’s story / advasana rest [ease / surrender / breath awareness check] • pubic bone to floor awareness 7. bhujangasana & shashank bhujangasana [pelvis grounded / some women find it works well for menstrual pain / NB contra-indicated for fibroids] shashankasana [pelvis grounded / some women find it works well for menstrual pain] • fists in groins

13.

nadi shodana pranayama

14.

VAM chanting - swadisthana awareness

15.

yoga nidra [lake, moon, reflections and water current] can be done in the golden cosmic womb restorative pose (see over for illustration)

8.

Chants for connecting with feminine aspect of the divine energy


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Base position for Chandra namsakara (see previous page for instructions)

Golden cosmic womb /hiranya garbha restorative pose aka ‘The queen’


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Illustrations from the ‘yoga fertility sequence’ (Uma Dinsmore-Tuli) in Emma Cannon’s The

Baby Making Bible. Macmillan . 2010


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Pancha Kosha Sequence Integration of asana, mudra and mantra


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Case © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Menstrual mala A circle of yoga for your menstrual cycle Introduction

A mala is a circular string of beads used for meditation: each time a bead is passed through the fingers, another mantra or prayer is recited (audibly or mentally). It is similar in function to a rosary: the beads serve to count the number of repetitions and to keep the mind focused on the practice. The mala beads can be used with lightness and ease, passing rapidly around the circle, flicking swiftly from one bead to the next to provide an almost subliminal source of familiar comfort; or the beads can be used with great intensity, holding tight to each one as the mantra or invocation is repeated, to provide strength and support in a time of challenge. Because the beads are strung in a circle, the practice is always cyclical, bringing the practitioner back to a fresh start at the end of each cycle, just like our menstrual cycle. With each repetition of the cycle we grow in understanding and awareness. This circle of yoga practices can function like a mala: as a circular string of relaxed practice to create balance and ease on the journey through the cycle’s monthly rhythm. The individual yoga practices can also be used in a more focused manner, to assist with the difficult physical or emotional passage at a particular point in the monthly rhythm, perhaps a place that causes struggle or pain, during which time it is helpful to focus more on certain practices that provide relief. So you can keep the circle of practices ticking over throughout your cycle or you can focus on practices to bring relief at certain points, or (most likely) you can do a mixture of both. Whether you are using the practices for the creation of a general balance in your cycle, or to relieve difficulties associated with certain parts of that cycle, the circle of yoga practices brings benefits by focusing your mind on the practices suited to each part of your cycle, and by deepening your http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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awareness thewithin cyclical fertility. There is nothing it. The arc of the circling cycles holdsofus its nature rhythm,ofand this yoga practice giveslinear us theabout opportunity to deepen our connection with the rhythm of life itself. As deeper understanding grows through the practice of yoga we learn that certain experiences during our cycle need simply conscious management and support: for example deeper rest, finer awareness through meditation, or more profound release through breath and movement. And so at the centre of the circle is a set of core practices to provide balanced support for natural fertility throughout the cycle. The central programme is a month-long commitment, in that it is suited to most days. All the practices are entirely safe to practice if you have conceived that month. They include a range of active and passive practices to create balance throughout the cycle, building a harmonious relationship between times when we are more able to give out (energy, emotions, focus, activity) and times when we need to focus more within, to be protective of our quiet space and inner life. But there is no sense of rigidity: no need to do all of it everyday. Be aware of the circular nature of the cycle and recognise that there will be days when you feel like doing less, but other days will circle round when you feel more engaged with the more active practices. The deep aim of this circle of women’s yoga practices is to enable you to accept and honour the rhythms of your monthly cycle. The heart at the centre of the Circle: a women’s practice to create balance throughout the cycle

Bear in mind that an authentic and healing practice of yoga never works simply with the physical body. All these practices work with the dance of the elements from which we are created (earth, water, fire, air and space) to create a sense of good balance and health to benefit your energy body, and your mental and emotional life. To keep this consciousness of the holistic nature of the practices, always begin by centring your breath and returning your awareness to breath throughout each practice as you mentally connect with the elemental forces awakened by each practice.


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1. Full yogic breath and inner awareness (in super deluxe savasana ) – (five to ten minutes) 2. Seed to flower: alternating between opening and protection (three to five minutes) 3. Shakti Bandha – freeing of feminine energy (three to five minutes) 4. Chandra sequence: honouring the moon (with variations) (five to nine minutes) 5. Forward bend (and restorative variations) (three to five minutes) 6. Lying twist (still and moving variations) (three to five minutes) 7. ‘The queen’ (Golden Womb) (five to fifteen minutes) 8. Yoga nidra with prana vidya for reproductive organs (five to forty five minutes) 9. Mudras and meditations for honouring feminine power (three to fifteen minutes) The maximum amount of time you might want to spend on this whole programme would be 110 minutes for a full leisurely practice. An abbreviated version could take fifteen minutes, or a short complete version would be about half an hour. There are suggestions for modifications and adaptations to suit your cycle after the descriptions of the practices. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Tailoring the core practice programme to your changing needs

These nine key practices are at the heart of my recommendations for promoting a positive connection with the rhythms of the menstrual cycle. They form the heart of a feminine practice of yoga that is safe and supportive through your whole cycle, and also safe if you are in the very early stages of pregnancy. However, it is likely that at certain points in the cycle you will wish to modify this basic sequence. There are two approaches to modifying the basic practice: If you need to make changes because of pressure of time, then it is best to follow this guidance: practices 1, 7, 8 and 9 are always worth making time for, but they can be shortened to take less time. Instead of spending 5 minutes with practice 1, do 2 minutes. Practices 7 and 8 work best in combination, and are effective even if you spend only 10 minutes. If you need to make changes because of how you are feeling in response to your cycle, then you can adapt the basic sequence to meet your needs, either by making use of the restorative variations (for example if you feel less inclined to be active, use the supported version of the forward bend, and the still versions of the lying twist) or by removing or adapting practices 2, 3 and 4 and replacing them, or expanding your focus within them according to the cycle-specific recommendations described below. The key to gaining a positive benefit from your practice of yoga is to focus your attention within: practice 1 is always the place to start. Gauge your own needs and respond to the cyclical changes by honouring the place you are in. Yoga during pre-ovulatory phase

The focus for yoga practice here is to nourish and grow. Give full attention to your full yogic breath and allow yoni mudra to help you connect with your ovaries, nestling just beneath your palms. This can be the time to focus your attention on a sense of growth and expansion: pay attention to the full owning feeling of the sunflower open position, and extend into your fingertips as you practice Chandra namaskara (honouring the moon). This can be a good time in the cycle to experiment with strengthening and opening practices such as the half moon pose (number 7 in the moon salutation sequence). Add three or more repetitions of this © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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pose during the moon salute. It is also a good time to work with the hare-cobra pair of poses from the moon salute (number 7), so add in up to seven extra variations of this part of the sequence. The camel pose can also feel good at this time of the cycle, and fits well within the moon sequence, just before the final forward bend: Camel pose (Ustrasana)

This stage can also be a helpful time to use a therapeutic inversion: Half shoulder stand (vipariti karani)

Yoga during ovulation

The focus for yoga practice at this time can helpfully be to nourish and release potential. During this part of the cycle, the half shoulder stand (described above) can be enjoyable, and some of the more opening, liberating movements of the dog pose and its variations (number eight in the moon salute) are appropriate. Alternating the cobra (number 7 in moon salute) with dog can also be very strengthening and vitalising at this time, and if you enjoy the camel pose, then include that in your programme too. For meditation practice, let the heart-womb mudra guide your awareness within.


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If youwith experience painand on settle ovulation, adaptations the hare afford to relief: twoand fists your hands them these into the groin areaofbefore youpose foldmay forwards, bringmake warmth pressure into the ovaries; and/or place a blanket over your lower back and have a friend hold the ends of blanket firmly down either side of your hips, bringing even pressure and warmth into the lower back. If you are practising alone, then using the weight of a sand bag on the lower back can have similar benefits. If you don’t have a sand bag then use a warm hot water bottle on the lower back, or a large bag of pulses or beans on the lower back in this pose. Yoga during the pre-menstruum

Let the focus of your yoga practice during this part of the cycle be to nourish and grow. Gentle but rhythmic repetition of the shakti bandha (stirring the porridge) can help to dissipate any physical congestion. Be sure to allow sufficient rest period, and if you are feeling edgy, then use this powerful adaptation of the full yogic breath to release physical and mental tension: Golden thread breath

The Golden thread works well in any position, but be aware that if you practise lying down you are likely to fall asleep. Tune into a gentle pattern of breathing that is effortless. If you find it easy to do Full Yogic Breath use that as your starting point. Take an extra yawn, release jaw, throat and teeth. Allow there to be a very small space between top teeth and bottom teeth, between top lip and bottom lip: just enough gap that you might imagine a piece of tissue paper held between the lips, such a small gap that it is practically invisible. Breathe in through nose. Breathe out between slightly parted lips. Feel a fine cool breeze passing out between lips. Cheeks, lips and face are relaxed. There is no pursing the lips. They are soft. Feel breath travelling in through nose, and out through mouth. Allow the breath to be so fine that it feels as if a fine golden thread is spinning out between the lips. It’s a thin, golden thread, like embroidery yarn, smooth, and silky, spinning out with every exhalation. Allow each exhalation to lengthen, without forcing, but simply letting the out breath increase in length, as the Golden thread of breath spins out into the air in front of you. With each inhalation allow for breath to go in through nose and feel the breeze of exhalation travelling between lips, into the air in front of your closed eyes. Let the end of the Golden thread carry the mental attention farther and farther away with each exhalation. The heart of this practice is softness. You are not pursing the lips, or making them tight as if to whistle. The lips are soft, and the breath passing between them is silent and gentle. The lengthening of the exhalation is achieved effortlessly: simply because the gap through which the breath passes is so tiny, it takes a long time for all the breath to get out. There is no sense of force; simply watch the breath lengthen, following it out into the space in front of you. It should feel entirely effortless, completely comfortable and soothing. If you are struggling to exhale because the gap is too small, then simply widen the gap. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Any exhalation is an antidote to pain and tension. The Golden thread’s extended exhalation makes this antidote more powerful. The longer the exhalation, the more effective this breath is as a form of pain and anxiety management. While staying within the comfortable limits of your own easy pace of breath, the longer the exhalation, the farther out the mental attention travels, and the further out the attention travels, the more the body can relax into a quiet, mind free space of healing and ease. The longer the exhalation is, the greater the distance between mind and body. Allow the golden thread of the breath to travel out as far as is comfortable for you, and let the body make a voyage back to its natural healing state of easeful rest. When the mental awareness is at the far end of the long exhale, then the body can rest.

In addition, these balancing breaths can help to cope with the demands of mood swings or turbulent emotions. Use them at the end of your yoga programme, just before the meditation.


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Breath balancing pose [padadhirasana]

This is a simple way to develop breath awareness and a balanced flow of breath in the nostrils. It promotes an even, measured pattern of breath and helps to creates a calm and attentive frame of mind. Sit on your heels or on a bolster or cushion to support the kneeling posture comfortably. Have a straight spine, and let the shoulders drop away from the ears. With your hands resting on your thighs, watch the breath for seven rounds as you establish a full yogic inhalation and exhalation. When the breath is rhythmic and even, cross your arms over your chest, tucking the right thumb under the left armpit and the left thumb under the right armpit. Work the thumbs up high into the warmth of the armpits, and then let the elbows drop down towards your waist. Close the eyes and focus the attention on the flow of the breath into and out of the nostrils. Be aware of a triangular pattern of breath, as the air flows into the nostrils and up the sides of the nose to the tip of the triangle at the point between the two eyebrows. Be aware of that same triangle as the breath flows down from the bridge of the nose to the two nostrils. When you are ready, release thumbs from under armpits and rest the backs of the hands on the thighs. Observe the pattern of the flow of the breath in the nostrils. Note any changes that may have occurred Yoga during menstruation

Let the focus for your yoga practice at this time be to nurture, release and cleanse. Avoid all inversions. Be prepared to be still. But if movement feels right, use soft rhythmic repetitions Use the shakti bandha softer and more rhythmically, and only do those elements of the mood sequence that feel right to you. Often the hare pose feels comforting, and the version of the cobra described below. If you experience pain during this time, then the hare pose variations described in the ovulation section can be helpful. Also too, it can be comforting to rest on the back and hug the knees into the chest in, drawing the thighs in close to the belly on the exhalation [apanasana]. Supportive forward bends can also provide comfort and relief. Sitting on the floor with legs out straight, have a bolster between the legs and rest forwards over it as a support. Use cushions or blocks to raise the height of your support until you can easily rest your forehead on it without straining your back. If you prefer a higher support, then have a chair between your legs, with a cushion or bolster on the seat, to provide support for your forehead as you rest forwards. For some women, painful menstrual cramps are better relieved by backward bending than forward bending. It is best to experiment for yourself to find what works for you. The Camel pose (for instructions see the pre-ovulatory section above) and the snake pose are both backward bends may be helpful in the relief of pain during your bleeding time, but it is also likely that regular practice of these poses throughout the rest of the cycle may help to prevent or lessen future suffering of this kind. So if you regularly experience pain during menstruation, endeavour to practise these poses as part of the core programme. They fit well within the moon salutation sequence, just at the end before the final forward bend. Snake pose


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If you experience painful cramps, you may find that this version of the cobra pose provides relief. Lie flat on your front with your forehead on the floor and your arms by your sides. Have your legs straight, your heels together. Bring your arms behind your back, moving your elbows as close together as you can. Place the palms together and interlock the fingers. Roll your shoulders down and back away from your ears, squeezing your shoulder blades together. Exhale. As you inhale, lift your head and raise the front of your chest up away from the floor. Exhale. Slowly lower the arms back down onto the back, tuck in the chin and gently rest the forehead on the floor. Move freely with the breath, up on the inhale and down on the exhale. If the pose suits you at this time, remain in the chest lifted position for up to seven breaths. Keep your neck long and your ears well away from your shoulders. Feel your belly moving against the floor as you breathe fully. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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If you feel in need of balance and comfort during your bleeding time, you may enjoy a resting version of the seated alternate nostril practice described in the pre-menstrual yoga section above. This version can be done lying down at the start or end of your yoga programme, it has the same effect as alternate nostril breathing, but with no hands: Psychic triangle balancing breath [anuloma viloma]

Establish a full yogic breath. Visualise the triangle of breath in the nose, and imagine it coming up and down each side. The counting for the rounds is the same as the version with the hands. Always have a sense of breathing up and down the two sides of the ‘triangle’ of the nose, so that the two nostrils are the bottom corners of the triangle and the point between the two eyebrows is the top of the triangle. One complete round draws the inhalation up through right nostril, exhalation out through left, inhalation up through left nostril and exhalation out through right nostril. Always feel that this practice is flowing easily and freely, never over-strain or fight for the breath. Let it flow. Inner silence meditation [antar mouna] is a powerful way to settle with stillness into the core of

your experience. It can be especially helpful when practised during menstruation. Antar mouna can teach us to observe and understand the patterns of our own thoughts and emotions. You can practise it on its own, or at the end of your yoga programme. prog ramme. Sit or lie comfortably in any pose that feels absolutely easeful. Close your eyes and establish a Full Yogic Breath. Allow your awareness first to be with the sense of hearing. Listen to all the sounds which you can hear. Start with bringing your attention to the loudest ones first, and then gradually draw the focus of your awareness in closer until you attend only to the quietest, closest sounds. Be aware of the sound of your own breath as it comes in and goes out. Then shift the focus of your attention to the sense of touch. Become aware of the sensation of the breath passing into and out of the nostrils. Feel the cooler air coming in and the warmer air going out. Be aware of all the different textures and temperatures which you can detect through the sense of touch. Feel if there is any difference between what you can feel on covered, and uncovered skin. Then return to feeling the passage passage of air in the nose. Then shift the attention to the sense of smell. Be aware of any odours and aromas around you. Give your full attention to the sense of smell. Then shift your attention to the sense of taste. Be aware of the tongue inside the mouth. Notice if there are sweet tastes, salty tastes, bitter, hot or astringent tastes. Give the sense of taste your full attention. Then shift your attention to the sense of sight. Look into the closed eyelids and be aware of whatever you may see there. Are there colours or shapes? Patterns, movement? Or blackness? Whatever there is to see, give your full attention to the sense of sight. Finally, return your attention to the sense of hearing, and become aware of the intimate sound of your own breath. Allow that breath to get a little louder, and use the sound of that breath as a bridge back out to becoming aware of other sounds in the room. Then widen your awareness until you are aware of sounds out in the wider world. When you are ready open your eyes.


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Brief Notes on yoga nidra Best resource for further listening and practice www.yoganidranetwork.org Beware! Yoga Nidra is a powerful practice, working on deep levels of subconscious / unconscious. Ensure your own complete familiarity through self practice before http://webcache.googleusercontent.com/s http://webcache.googleusercontent.com/search?q=cache:http://ww earch?q=cache:http://www.yonis w.yonishakti.co/s hakti.co/sites/default/fi ites/default/fi les/fi les/2015%2520Stroud%252 les/2015%2520Stroud%2520Womb%2520Y 0Womb%2520Yoga%2 oga%25 5…

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teaching. Key stages in yoga nidra

1 2 3 4 5 6 7 8 9

PREP PREPAR ARA ATION TION : SET SETTLI TLING NG// RELAXA ELAXATIO TION N SAN SANKALP ALPA (re (resolut olutio ionn / res resolve olve)) ROTATIO TION OF CONSCIO SCIOU USNES SNESSS PAIRS OF OPPOSIT ES BREA BREATH THIN ING G / BODY ODY FLOOR FLOOR AWAREN ARENESS ESS VISU ISUALISA LISATI TIO ONS IN CHIDA IDAKASH SANKALPA EXTER EXTERNA NALIS LISA ATION TION & RETUR ETURN TO ALER ALERT T STA STATE FINISH

Guidance on using yoga nidra

1 Experience live yoga nidra often. Preferably focus your experience upon one main teacher until you get really comfortable with it. Then experience the practice with a variety of other teachers. Don’t analyse too much how you react – just experience the practice. 2 To supplement your ‘live’ experiences, work also with audio recordings. Preferably start out with many repeated listenings to a single recording. Then branch out into comparative listenings with a range of other voices. 3 Once you have had some months of experiencing yoga nidra – then bring your conscious, rational mind into operation to sharpen your understanding of the shape and form of yoga nidra: transcribe a couple of your favourite tapes and investigate the differences. 4 Steps 1 – 3 will help you to be absolutely familiar with the form and content of the practice. Work to deepen your understanding of the practice by daily yoga nidras – live and recorded. 5 Start to use the form and a variety of different practice contents on yourself with unspoken mental commands until it feels effortless – you never have to pause to recall what comes next. 6 Make recordings or your own yoga nidras – try them yourself and see how they make you feel. 7 Practise on yourself – using unspoken mental commands and your own recordings and those of your favourite teachers for many months before you even consider using it with students and/or clients. 8 Be patient. Only when you have spent some time with steps 1 – 7, maybe over a period of months (or years) can you begin to teach the practice safely and confidently. Tips for teaching yoga nidra

1. Ensure your students are really comfortable before you start. Fuss about it, and be picky. It’s worth it. 2. Ensure you are absolutely comfortable before you start. Except in the event of an emergency or serious abreaction from your students, DO NOT MOVE whilst you are giving the practice. It’s really unsettling to try and focus on a voice that sounds like it is coming from different places. 3. Don’t do anything else whilst teaching yoga nidra (including looking at other notes, silently turning pieces of paper etc.) – even if you think no-one will notice, they will. 4. Watch your students like a hawk. Watch their breath, their slightest movements, alterations in facial muscle tone etc. Be absolutely attentive to them. 5. Keep your voice clear, with an even volume. Alterations in pitch and tone and pace can be useful modulate these changes to meet the needs of the students. 6. Don’t rush. Give necessary time, especially at crucial junctures such as the repetition of the sankalpa and the externalisation of awareness.

PLEASE be aware that abreactions are possible. This is a profound and transformative practice. It is immensely powerful. Respect it fully. If you don’t feel ready to work with it – then use simpler and less profound relaxation practices instead.


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Foundations of fertility and positive http://webcache.googleusercontent.com/s http://webcache.googleusercontent.com/search?q=cache:http://ww earch?q=cache:http://www.yonis w.yonishakti.co/s hakti.co/sites/default/fi ites/default/fi les/fi les/2015%2520Stroud%252 les/2015%2520Stroud%2520Womb%2520Y 0Womb%2520Yoga%2 oga%25 5…

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menstruation Key understandings from yoga, tantra and ayurveda on women’s health, well being and fertility

The foundation of fertility is a healthy menstrual cycle.

The characteristics of a healthy menstrual cycle are rhythmic regularity (not necessarily everyone has a 28 day cycle, but each woman has her own rhythm and pattern. The menstrual pattern accompanying ovulation from the ovary on one side may differ from the pattern accompanying the menstruation with the ovary on the other side.

Fertility is a function of

OJAS - the ‘juice of life’, one’s inner vitality, nourishment, essence,

expression of sexuality and fullness. When levels of ojas in the body are high, then the reproductive system functions well, fertility is optimal. Bear in mind, that in the ayurvedic understanding, the organs of the reproductive system are the ‘last carriage’ in the train of other systems and organs to receive nutrients and energy, so are therefore often the first to display signs of disruption caused by erratic lifestyle, insufficient diet or continued stress. It is as if the ‘buffet car’ of nourishment never gets to the end of the train, and so the reproductive organs are unable to function well, and fertility levels drop. Irregular periods, painful periods and other menstrual problems often reveal deep insufficiencies in terms of self nurture and sufficient rest. For example, it is well known that women with very low body weight or those engaged in very intense exercise regimes often cease menstruating, but it is also true that that stress, emotional disturbance, grief and lack of support can also cause periods to stop, sometimes for months or years at a time. (For a gripping account of this, see Luna yoga). Requirements for fertility

Ayurveda has a clear agricultural metaphor that is helpful in understanding the interconnections between the different aspects of fertility: Season (rtu) – menstrual cycle Field (kshetra) – woman’s body (womb especially) Seed (bija) – ovum (and sperm) Juice (rasa) – ‘the cocktail of blood, hormones, mucus and other secretions that fertilise the field and nourish the seed’ See also the importance of physical well being and satisfaction in sexual life See Ayurv Svobo da Ayurveda eda for Women – a guide to vitality and health by Robert Svoboda Also Women’s Power to Heal Through Inner Medicine by Maya Tiwari


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The Power of Menstruation By Alexandra Pope Do you suffer from menstrual problems? Do you dread getting your period every month? Maybe you think of it as a curse or something you just put up with. Or, could you be one of a growing number of women who are waking up to the power of the menstrual cycle, and using that knowledge not only to heal their bodies but also to be more creative and empowered in their lives.

The menstrual cycle is a hidden resource in a woman’s body that once tapped in to can become the means of a rich psychological psychol ogical and spiritual exploration. A woman can open to inner forces that illuminate, guide and support the unfolding of her life journey—this can help her manifest her goals, fulfill her creative calling, and deepen in to her spiritual nature. Recovering the power

There are two distinctive movements of energy in the cycle—the first is one of growth leading from menstruation to ovulation. This is a natural movement outwards away from an intimate connection to your inner self to a refocusing on your outer work and others. This growth phase is about asserting your will and going to create and shape your life. The second impulse of energy is from ovulation to menstruation. This gradually draws you back deeply into yourself again. This second movement creates more sensitivity and permeability giving you greater insight, insi ght, a capacity to sense into the complexity and depth of things, and in so doing to mature. You move from a singular focus in the first half of the cycle to multi- focal awareness, channeling and managing much more tension and therefore creative potential. In the growth phase you have a natural clarity about what needs to be done and the focus and motivation to do it. As the cycle turns and you enter the second half it’s less about © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

producing and more about sorting sortin g and refining what you have produced. You have a different kind of energy and motivation—it’s insight in to what’s working and what isn’t, and a drive to sort it out. Gradually this may give way to a feeling of letting be that fully takes over once you begin to bleed. Don’t be fooled that this letting be is somehow a waste of time. On the contrary you should think of it as a time of potentialising what w hat you do. By allowing things t hings to just be for a while, something happens. Other forces can come in whether it is support from others or your own deep wisdom that offers insights and clarity. As you pull back you create the literal and psychic ps ychic space for these things to emerge. At menstruation itself a woman can potentially potentially enter a more expanded consciousness, consciousness, experiencing highly charged altered states that can be ecstatic and visionary.

The key to unlock these inner talents is awareness and respect for the changing rhythm of your cycle. Chart it on a daily basis and get to know your own distinctive pattern of mood and energy over a whole menstrual month. The changing moods are like different sources of power that you can learn to draw on to manifest a more fulfilled and creative life Discovering your ‘hot spots’

The more you pay attention the more you will discover hot spots - times of more intense feeling. Whether pleasurable or challenging these days are moments of power, as though you are being charged by another level of reality. You’ll find hot spots for such things as: causing trouble—a good thing—that’s the moment when you’re not censoring yourself; high productivity; least tolerance or conversely a time of feeling very magnanimous; a high time 26

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for partying or the secret time for dreaming or getting guidance; the darkest, most alone time; and the time of most tenderness when you can experience exquisite intimacy including with your beloved. Make a mental note, or mark them in your diary, especially if you find yourself caught out by the challenges of your hot spots. And then capitalise on them! It is possible to transform your experience of menstruation from pain to power. Restoration of the wisdom of the cycle is deeply healing and enlivening. You will find stress can fall away and this alone eases symptoms. A greater kindness towards yourself will seep in and you may experience more motivation to do whatever it is you need to heal and achieve your goals. As one woman said “I have been filled with new energy, hope, inspiration and power. I seem to be getting more out of each

day and feel happier and thankful to be alive and in charge of my destiny and life choices.” With over 20 years experience as a psychotherapist, Alexandra is author of The Wild Genie: The healing power of menstruation (Sally Milner Publishing, 2001) and co-author of The Pill: are you sure it’s for you? (Allen and Unwin, 2008) She has pioneered a new approach to women’s psychological and spiritual development based on the power of the cycle. She now works as a facilitator, coach and healer in the UK and Europe offering programmes for women based on her work. For more information on Alexandra’s workshops, books, coaching and counselling: www.wildgenie.com www.womensquest.org

Connecting to your inner seasons of the menstrual cycle and the ‘moon within’ In all my Womb Yoga classes and workshops, I begin by greeting each woman and her womb, and then discovering where it is in the menstrual cycle that each woman is. A beautifully vivid and poetic way to reconnect with ourselves and our cycles is to understand that each part of the menstrual cycle corresponds to a season: Pre-ovulation = springtime Ovulation = high summertime Pre-menstruum = autumn and harvest Menstruation = wintertime

It can also be helpful to focus attention on the phases of the moon and to honour how they relate to our cycles too. These seasonal and lunar metaphors help women to understand the menstrual cycle in a broader context, to appreciate the cyclical nature of life, and of the ebb and flow of our energies. It also helps us to understand the patterns of other cycles such as the creative cycle, or pregnancy, or the coming into peri-menopause. When we have respect for the shifts and changes of all life cycles then we begin to understand how important it is for us to honour our own cycles – of the seasons and the ‘moon within.’


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What is Menstruality?1 A statement from Alexandra Pope

Menstruality is the female life process of menarche, the menstrual cycle, menopause and the mature years. It is the woman’s ground, ‘the mother cycle’, out of which rises the initiatory path to motherhood that is conception, pregnancy, birth and breastfeeding. Menstruality describes the precise and multi–layered biological, psychological and spiritual system of evolution within the female body. Menstruality is the actual lived experience of this process, the knowledge that a woman accumulates or grows down into, and the field consciousness that this embodied knowledge generates. Menstruality is a means of naming and exploring the ineffable, mysterious forces within a woman— the hidden powers that are released when consciousness is brought to bear on our biological life changes. Menstruality is both a woman’s unique Calling or Power and the evolutionary path by which she realises that Power. Menarche, menstruation and menopause are the key way stations of initiation or Awakening to the Power. The menstruating years are the practice ground for realising it, and the mature years a time of deep fulfilment of that Calling or Power. Menstruality describes a woman’s journey of individuation from ego–based consciousness to participatory consciousness—an extraordinarily integrated and complete system of psychological and spiritual growth. Menstruality is a language, a way of articulating a woman’s experience that is rooted in natural lore and the process of evolution. It is how women pass on our knowledge of our feminine life process from one to another. It is a shared way of being. Menstruality is a living body of knowledge that evolves through each individual woman’s experience and sharing of the process. Our menstruality experience exists within a context - this beautiful planet of ours. It awakens us to our responsibility for the planet. Our menstruality is a deeply internal process that takes us into the most intimate places within and within that reveals the World, the Whole, and our role in serving that. It is a unifying consciousness that connects us to all of life. Menstruality is the Feminine in action. It is the channel through which the Feminine can be experienced and integrated back into our lives and on to the planet. Through consciously working with our menstruality we provide the channel for restoring the power of the Feminine in to all the areas of our lives. Menstruality is a journey to love, an experience of being held by the ineffable, the Divine. www.womensquest.org www.menstrualityonline.com www.menstruality.com


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2015 Stroud Womb Yoga manual 1

The term menstruality came into being to describe the female life process in 2004 when New Zealand psychotherapist, Jane

Catherine Severn, wrote an article Menstruali ty: th e great feminine gestalt in the Gestalt Journal o f Australia and New Zealand. She was concerned with th e fact that we did no t have a word to describe what she calls t he 4 M’s—menarche, menstruation, menopause and the mature years. And withou t a word, the full power of this process could be easily ign ored or dismiss ed. To remedy this she prop osed the word menstruality. We are indebted to Jane Catherine for bring ing th is word into b eing. Our description of it is wholly our own. To learn more about the wonderful menstrualit y work of Jane Catherine go to www.lunahouse.co.nz


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Ayurveda and the menstrual cycle Material prepared by Marinella Benelli (www.earthmoonmala.com). Please contact Marinella for any queries about Ayurveda and women’s health Ayurveda, the five elements and the three doshas

Ayurveda, the science of life or living , is India’s ancient comprehensive system of holistic health care that includes yoga, massage, nutrition and lifestyle. Ayurveda developed from the observation of nature and its laws, and so it’s based on nature’s five great elements, the panchamabutas: earth, water, fire, air and ether/space. The five elements are present in the human body manifesting as tissues, organisms and systems, and are constantly interacting, working together and finding balance. According to Ayurveda, the five elements are co-ordinated and managed by three forces, or doshas: Vata, Pitta and Kapha, that are responsible for all human biological, psychological and pathological functions.

Vata is a combination of Air and Ether/Space; it is the moving force whose seat is in the colon, and also governs pelvic region, bladder, urinary tract, legs and arms, bones, the nervous system and the mind; Pitta is a combination of Fire and Earth; it is the force of assimilation whose seat is in the small intestine and also governs stomach, umbilical area, sweat and lymph glands and the blood; Kapha is a combination of Water and Earth; it is the force of stability whose seat is in the chest and also governs thorax, neck, head, fat tissues and the joints. The concept of dosha is unique to Ayurveda and is used to describe an individual’s unique constitution, called prakruti, set at time of conception and birth, but subject to adjustments and shifts throughout our entire lifetime, such as food, lifestyle, life cycles and the seasons, mind and emotions, relationships, events and any other change. This is our temporary unbalanced condition, called vikruti. The doshas and the four seasonal cycles

Ayurveda sees the qualities of the three doshas in the environment and in the cycles of nature, as well as in four very important seasonal cycles in our life. 1. Times of the day Kapha time morning 6-10am – and evening 6-10pm Pitta time midday 10am-2pm and night time 10pm-2am Vata time afternoon 2-6pm and early morning 2-6am 2. Seasons of the year

Season EARLY SPRING March-April LATE SPRING April-May SUMMER June-September EARLY A UTUMN September-October LATE AUTUMN October-November WINTER

(for most temperate countries) Accumulating

Aggravating

Treatment

Pitta++

Kapha+++

Reduce (P) and (K)

Pitta+++

Pitta++

Reduce (P)

Vata++

Pitta+++

Reduce (P) and (V)

Vata+++

Vata++

Reduce (V)

Kapha++

Vata+++

Reduce (V) and (K)


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November-March

Kapha+++

Kapha++

Reduce (K)

Ayurveda suggests to reduce the dosha that will be imbalanced in the following season before it gets aggravated. For example: follow a Pitta reducing diet in early spring before it becomes aggravated in late spring, with symptoms of spring fever and hay fever. 3. Digestion

AFTER EATING

Kapha predominates, as it is the mass of food ingested

Pitta starts increasing as the digestive fire (agni) has been fed with material (food) that needs to be processed


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AFTER DIGESTION

Pitta predominates: digestive fire is working hard, transforming the food into nutrients and wastes Pitta cools off, as everything has been reduced and passed onto Vata to be moved to the right end

the

Vata accumulates, as nutrients and wastes move around in the system Vata works the hardest to assimilate nutrients and expel wastes

4. Lifespan

Childhood (0-16) is Kapha time – time of physical growth. Children are soft, loving and cuddly. Kapha problems such as coughs or glue-ear may develop. Adulthood (17-50) is Pitta time - time to organise, manage, work hard, build a career, and have a family. Pitta imbalances such as acne, hyperacidity, heart problems etc. can develop during this stage of life. Later life (50+) is Vata time - the time of wisdom. Elder people are thinner, drier and lighter. Vata diseases such as osteoporosis or Alzheimer’s can develop during this time. The fifth cycle: Ayurvedic Understanding of the Menstrual Cycle

Women enjoy an extra cycle, the menstrual cycle, which is directly linked with the lunar cycle. Ayurveda considers the menstrual cycle a self-healing, cleansing and rejuvenating process to keep the womb, the body and the mind clean from toxins in order to live in harmony and alignment with nature, and also to prepare for a healthy conception and pregnancy . So the menstrual cycle is the core of the health, wellness and happiness for a woman

in her childbearing years and beyond. A balanced cycle is determined by the balance of the doshas themselves, which rules at different stages: Kapha phase is the proliferative phase: from the end of the flow until ovulation (oestrogen hormone is at its peak). The water element prevails during this phase ( yin phase) and asks us to nourish ourselves and build up for a healthy ovulation and second part of the cycle. A stronger and more dynamic yoga practice is more suitable in this phase. Pitta phase is the secretory phase: from ovulation until the flow begins (the progesterone hormone takes over). The fire element prevails in this phase ( yang phase) in which we shift from full ovulatory power to the degeneration of the endometrium and the vulnerability of the premenstrual phase. A slower and gentler yoga practice and a well balanced diet are crucial during this phase! Vata phase dominates during the days of the flow – Apana Vayu is responsible for the downward flow of menstruation, transporting the menstrual blood out of the body. The Air element prevails during this phase; this is the time for absolute rest and renewal of the body: take time off, eat well, rest, sleep more, practice yoga nidra and create a stress-free environment (also tech-free) around you! Typical Vata Cycle

Typical Pitta Cycle

Typical Kapha Cycle

Irregular cycle Scanty flow with thin blood, often dark or with clots

Usually regular Heavy bleeding that can last for longer time; intense blood, bright red colour Medium-strength cramps

Regular cycle Average quantity of pale, mucous-like blood

Abdominal and lower back pain

Dull pain or cramps during


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and cramps Spotting either before or after main flow Pre-flow constipation/loose stools Pre-menstrual anxiety, interrupted sleep or insomnia, nervous tension, mood swings, forgetfulness, ungroundedness Cravings for salty and savoury foods

Acne, skin rashes or other inflammations Loose stools during or just before periods Pre-menstrual irritability and anger, headaches

bleeding, in the back of the belly Vaginal itches and yeast infections Stiffness in the back and limbs and slow digestion Prone to water retention, swollen breasts and bloating, lethargy and drowsiness

Increased appetite and cravings for sweet and spicy foods

Craving for sweets and attention


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Sexuality and women’s health There are so many ways in which positive experiences of sexuality can improve women’s health that an empowered encounter with this powerful manifestation of prana shakti, the life force, is really foundational for a woman’s well being, whether she is single or partnered, celibate or sexually active, young or old, homosexual, bisexual or heterosexual, a mother, a maiden or a crone. Fertility

A happy and fulfilling experience of sexual intercourse with the intended father of the child is an absolutely crucial ingredient in optimising fertility. Unfortunately, it is often the first casualty when the desired conception does not happen when planned. Pre-menstrual syndrome

The positive flow and release of sexual energies can be of huge assistance in relieving the tensions and difficulties associated with PMS… but then so often this and other Menstrual difficulties

Are greatly assisted by practising attentive cycle awareness, and a delightful side effect of practising such awareness is a heightened consciousness of the natural ebbs and flows of sexual feelings and responses through the cycle, so in some ways a respectful honouring of a woman’s sexual feelings is a really effective support and encouragement for developing monthly cycle awareness. Such awareness also makes it possible to plan for and respond appropriately to needs arising in the cycle (in particular the need for rest) rather then being

looking to re-establish their own naturally occurring hormonal rhythms. Prolapse

The physiology of female sexual response cycle is such that the entire cervix and womb are lifted up high and away from the vaginal opening by engorgement of tissue with blood and any rhythmic muscle movement. Christine Kent, in her book on pelvic organ prolapse includes an entire chapter on sex, and she has this to say ‘the levator ani muscles of the pelvic diaphragm contract and release as excitement and stimulation continue. At the height of this accelerating muscle contraction and nerve stimulation, the uterus contracts and rises out of the vagina. (Kent:112). She warmly encourages women with prolapse to embrace their sexuality, and, in the context of a programme of self-help including postural reeducation to tone and reposition the abdominal organs, and provide support for the pelvic organs, she believes ‘Sex is one of the best activities to aid in this process.’ Breast health

It is absolutely crucial to understand the


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caught by surprise and reacting to these that experiences: for example understanding by day 26 she often feels snappy and tired can help a woman to organise better rest (and/or restorative yoga) to prevent the problems arising the in the first place or to have helpful management strategies to cope. One preventive measure for severe menstrual cramps is positive experience of orgasmic release of the muscles in the uterus, and one perspective on anger (in addition to the recognition that it often, in terms of PMS is simply a result of not noticing our body’s signals that request more rest) is that it is unresolved sexual tension… certainly a remedy worth exploring. The Deer exercise described on the next page is also helpful, especially for women coming off the pill and

primary of theContrary breasts intorelation to femalesignificance sexual response. many of the common assumptions about the importance of the clitoris, and patterns of sexual activity that emulate the usual excitement-arousal-orgasm pattern of male sexual response, for women, the deepest encounter with sexual pleasure needs to be focused on the breasts. There are many positive encouragements to regular massage of the breast, and frequent self-massage has the added advantage of helping a woman to be very familiar with the normal patterns of shift and change in her breast tissue (for example in tune with the menstrual cycle) in order to identify unusual growths and thus help to prevent breast cancer. So not only is there a physiological benefit of assisting support and


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positive breast health, but there is the added plus of breast massage being a pleasant kind of ‘medicine’ to take. For women who have had a breast removed, or otherwise surgically altered, the energetic flow of prana to the breasts remains very powerful.

Many of the tensions and difficulties associated with PMS can surface, along with additional delights such as memory loss and vaginal dryness and loss of libido. Positive engagement with sexual energy is a great support during the time of uncertainty and (often) exhaustion.

For the best discussion of the importance of respect, honour and love for breasts for women’s well-being, happiness and sexual satisfaction I recommend Diana Richardson’s Tantric Orgasm for Women and Mukunda Stiles Tantric Yoga Secrets. Both texts set out very beautifully the meditative approach to tantric encounters with human sensuality, and clearly convey the healing power of love in all dimensions of our being.

Post menopause

Peri-menopausal difficulties

There is much prudery and negativity around the sexual power and pleasure enjoyed by many older women, and a mistaken perception that post menopausal women have no interest in sensuality or sexual experiences. From the perspective of yoga, that acknowledges all energy as one, and sexual energy is just one manifestation of it, then later life can be a time where the skills, experience and heightened awareness developed over years of practice can mean that sexuality, with all it’s attendant health benefits can continue to be a vibrant part of life for as long as a woman chooses, in whatever way suits her best (alone, with her partner, in meditation).

Deer Exercise As a practical and effective self-help remedy for PMS, period pain, troubling hormonal fluctuations at peri-menopause, and infertility, I also recommend the Deer

Exercise, a well-known Taoist practice that has been beautiful taught and explained by Lisa Bodley and is included in her book Recreating Menstruation which is available as an e-book. There are many inspiring testimonials to its efficacy here: http://www.shemiranibrahim.com/eliminate-pms-deerexercise/. The exercise is also described in Alexandra Pope and Jane Bennett’s book The Pill and on http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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a number of Taoist websites including http://www.umaatantra.com/female_deer_exercise.html Deer Exercise: done in siddha-yoni asana a) The Breast Massage:

Warm your hands by rubbing them vigorously together. Now place them over the breasts. Lightly rub in upward and outward circles. The hands travel together up the inside of the breasts toward the face, then outwards, downwards, inwards, and upwards again. b) Mulabandha with awareness at third eye

First, rest your hands in your lap. Form your hands into fists by encircling your thumbs in the other fingers. This activates a number of important acupressure points. Next, tighten the muscles of the vagina as though contracting it. Keep breathing in a deep, relaxed manner while holding the contraction as long as you comfortably can. You only need to do this step once after each 36rotation breast massage. During the contraction, try to keep the anal sphincter and stomach muscles relaxed while squeezing and lifting only the vaginal muscles. Opinions vary about the best numbers, but Pope and Bennett (following Lisa Bodley) suggest minimum 36 times and maximum 360 circles of the breasts. Repeat the whole sequence twice, and it can be done twice a day. Because of the pelvic lift it is not recommended during menstruation or pregnancy.


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How can Yoga support fertility? 1

As a therapeutic tool yoga is effective and complete. It addresses the needs of the whole person. For example, a yoga therapy programme attends to the health of the physical body through movement and breath, appropriate nutrition, and deep healing rest, as well as providing clients with a huge range of breath, visualisation and focusing practices that work with attitudes, emotions, thoughts, concentration and many other emotional, intellectual and spiritual aspects.

2

In terms of reproductive health, the conscious and systematic movement of the physical and energy bodies through asana (postures) has a balancing effect upon the endocrine system and supporting healthy hormonal balance.

3

The deep relaxation attained through breath and focusing practices reduces stress levels, steadies the heart and breathing rates and enables people to fully relax and allow the body to recuperate and restore itself. This experience of restorative calm promotes positive thoughts and feelings that come with a quieter, more accepting mode of being.

4

This quieter and more balanced, relaxed state can help to regulate menstrual cycles and can be conducive to healthy conception.

Short practical session

1

Essential rest pose with knees up on chair/bolster

2

Full yogic breath with awareness techniques (using hands)

3

Basic pelvic awareness, tilts and lifts with full yogic breath (base position has feet on floor


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4

under bent knees) Pelvic opening position

5

Energising breath and movement synchronisation (arms moving above and below head, knees opening and closing)

6

Seated pelvic energiser (‘churning the mill’ with legs open)

7

Standing postural adjustment and walking energiser

8

Gentle moving twist with breath and arm movement synchronisation.

9

Deep relaxation (Yoga Nidra) in rest pose


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Yoga practices to avoid when seeking to conceive See also the Womb Friendly Yoga manifesto in the back pages of the manual. Generally speaking, any practice which feels depleting or competitive should be avoided completely. When you are seeking to build your natural fertility, then there is no place for speed and heat in your yoga practice because you can deplete your energy reserves if you do asanas too fast, hold them for too long, or get too hot. Aim always to work at a pace that does not disrupt the natural easy flow of your breath (with practice this can mean you breathe easily even during fairly vigorous asana practice). Work at a rhythm that creates pleasant warmth, not sweaty heat. Above all let the focus of your yoga be upon your own inner experience, and avoid any yoga teaching that fosters a competitive ethos in the class that may distract from your inner focus on your own breath. During menstruation avoid inversions, and encourage instead the downward movement of energy (apana) which governs the menstrual flow.

What to avoid: Whilst attendance at some forms of general yoga classes can be a positive investment in reproductive health, it is very important to note that not all forms of yoga are helpful. If you plan to refer clients to yoga classes in the hope of supporting conception, it is best to avoid strenuous, fast or heating forms of yoga such as (in order of the least suitable first): a.

Hot yoga or Bikram yoga


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b. c. d.

Ashtanga vinyasa yoga Vinyasa flow yoga Shadow yoga

e.

Sivananda yoga Iyengar yoga - but note that in fact restorative Iyengar classes are IDEAL!

f.


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Further reading on Yoga, fertility and menstruation (Excerpts from contributions to Emma Cannon’s book The Baby Making Bible , Macmillan) Yoga and fertility: natural support for an experience of abundance

When you begin to explore your own natural fertility, seeking to conceive a new life, then you can enter a time of major life change, which has the capacity to transform your way of being at every level. Yoga is of great practical assistance during this time, because its techniques of breath, movement, meditation and relaxation support your natural fertility. A sensitive and appropriate practice of yoga for women seeking to conceive responds to the physical changes and emotional shifts of their experience with yoga remedies and preventives that can help you to understand natural fertility as a special state of health, a time of well-being and delight. But yoga is much more than just a helpful practical companion to support the physical aspects of natural fertility. Yoga’s underlying philosophy of ‘union’ provides a framework of understanding that enables you to adapt with grace and acceptance to deep levels of emotional, energetic and spiritual change. The desires and longings which lead you explore your own natural fertility can create heightened mental and emotional experiences, or volatile shifts through a broad spectrum of feelings http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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and thought processes. The yoga systems of breath awareness, deep relaxation, visualisations and meditations provide you with effective ways to process the sometimes overwhelming shifts of mood, attitude and perceptions that can be part of exploring your fertility. Simple but profound techniques of breath awareness and hand gesture, together with deep relaxation and mantra (sound work) can equip you to navigate safe passage through this frequently challenging and demanding time. During such a time, the powerful challenges of these many physical, energetic and emotional transformations can lead women to access the intuitive wisdom in which the system of yoga is grounded. This wisdom can be brought to consciousness through the experiences of your physical body, vitality, thoughts and feelings. Yoga provides very natural support for the experience of abundance of natural fertility. The practice of yoga brings conscious awareness to a woman’s natural cycles and subtle shifts of energy and emotion associated with the different stages of our cycles. Becoming more conscious of messages from the physical body can lead to an uncovering of intuitive wisdom. Through this intuitive wisdom comes a profound connection with the joyous pulse that powers the universe, and this can help women to encounter the adventure of the cyclical nature of fertility in a spirit of acceptance and joy. How does yoga boost Natural Fertility?

An experience of natural fertility is fundamentally an experience of fully integrated health. The physical body, our levels of vitality, our emotions and mental function are all interconnected, and the health of any single aspect of our experience is completely dependent upon our wellness at every level of being. Yoga offers a very clear model for understanding this interplay between the physical world, the energy that animates it, our emotional life and the cosmic perspective of unity with the life force or prana. Yoga teaches that we inhabit not one but five bodies. Our physical body is both surrounded and pervaded by energy. Conscious attention to our breath provides the link between physical experience and the energy, which determines the nature of that physical experience. So our breath is the bridge between our flesh and blood, our physicality and our vitality, our energetic sphere of influence in the world. In yoga the flesh and blood body is called annamaya kosha – anna meaning food, maya meaning ‘full of’, or made from, and kosha meaning sheath, or layer: so the physical body is our physical manifestation, literally built from food. Without energy to animate this ‘food body’, it is lifeless. There © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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is another body, or another ‘layer’ of experience animating the physical. In yoga this is the pranamaya kosha (meaning the body that is full of prana, or life force). Most people cannot see this energy body, but it is what we feel pervading and surrounding our physical body. In the yoga understanding of the energy body there are networks of energy channels called ‘nadis’ or ‘rivers’, which largely correspond to the network of energy meridians recognised in Chinese medicine. In both systems, full vitality and good health, including reproductive health, depends upon the free flow of energy through these channels. In yoga we use movement, breath, sound and the movement of mental focus of awareness to free blockages in these energy rivers. In addition to these two bodies – the physical and the energy bodies – there are three further layers, or koshas. The body of emotional and mental responses, our likes, dislikes, opinions and reactions is called the manomaya kosha, or the layer of the mind. Then comes the vijnanomaya kosha, or the place where we access a more intuitive wisdom beyond the individual mind and emotions of the previous kosha. T he last of the five is anandamaya kosha, or the bliss body, where the individual distinctions of the previous four bodies melt away, and there is an experience of unity, or harmonious connection. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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In practical terms, the shift in levels of awareness through these five yogic ‘bodies’ helps to explain the relationship between our state of mind, and the postures and sensations of the physical body. When you feel physically at ease, well rested, well fed and relaxed, when your chest is free and open, your spine free and mobile, your head lifted and neck long, it is easier to feel openhearted, balanced and receptive to the positive experience of natural fertility. A positive emotional state, grounded in physical well-being, promotes a deeper more nourishing breath that boosts your energy levels, helps you to observe the distractions of the mind with some equanimity and can lead you to access aspects of higher wisdom. This in turn helps you to connect with an intrinsic state of peaceful abundance that provides the profoundest spiritual support and structure for an understanding of natural fertility. Yoga practice naturally promotes the awareness that leads to this state.

What kind of yoga is best?

The most appropriate yoga for women seeking to optimise their fertility is any practice that feels comfortable, that encourages the mental attention to travel within, and promotes an awareness of how best to adapt and change the practice to suit different times in the menstrual cycle. This means it needs to be slow enough to enable you to move with conscious awareness, so as not to over strain or cause injury. The most beneficial yoga practice at this time enables you to flow with the natural movement of your breath, respecting your own limitations and enjoying your body as it is, at each point in your cycle. Yoga is most effective when practised little and often, so a regular daily commitment to a short practice is more beneficial than a single long weekly session. The specific practices described in chapter XX set out a sample programme that is safe and nourishing to use at home throughout your cycle, and offers appropriate modifications and adaptations to respond to your changing needs each day throughout the month. The aim of a supportive and nourishing yoga practice is that it adapts to meet your needs rather than vice versa.


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Notes on Prolapse & Postnatal recovery The key concern in managing prolapse is to take a holistic approach that enables the woman to cope with her experience in daily life without further aggravating the condition. Education and understanding is crucial, because there is so much misinformation about the pelvic floor and the organs within the pelvis.


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The practices set out in the case study programme are of help, and the most useful starting point is a combination of semi supine and supported standing practices: it is important for the woman to be able to put into practice what she has learnt when she is standing and walking.

Helpful techniques include:

1 Prithvi mudra for grounding and support 2 Bridge position with clear and precise foot and toe engagements to lift the medial arch of the foot (pada bandha) and provide a clear channel for supportive energy to travel up to pelvic floor. Also using the support of bolsters and/or blocks to lift and tilt the pelvis during this work is very helpful and provides immediate relief from the downwards dragging sensation 3 Semi supine vaginal mulabandha with healing breath and tiny supta uddiyana bandha 4 Bridge position with arm movements and supta uddiyana bandha 5 Soles of feet against the wall from supine: enabling gradual ascent into half shoulderstand with uddiyana and mulabandha. 6 Postural re-education: see over


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Postural re-education & women’s health Crucial to any recovery (or indeed prevention) of prolapse is to address:

The Myth of the Pelvic Floor . Consider the natural and healthful curve in the lumbar spine and the correct position of the pelvis when it is tilted forward, to allow the pelvic organs to rest above the http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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support of the pubic bones. In this position, the pelvic ‘floor’ is in fact towards the back of the pelvis and not at the bottom. This means that the support of the pelvic organs can be understood to come from good positioning to provide maximum support, from the boney structure of the pelvis and the surrounding postural muscles, and is not entirely reliant on the ‘hammock’ or sling of muscles that we usually call the pelvic floor We shall explore the effects of anteverted and retroverted pelvic positioning on the support system for the pelvic organs. The crucial understanding is that the instruction to ‘tuck the tailbone under’ is not in the least helpful to promote optimal support for the pelvic organs, and in fact can be seen to promote stress on the pelvic floor and in fact, long term, to lead to prolapse of the pelvic organs due to insufficient support.

The very best references on this are Christine Kent’s book Saving the Whole

Woman and her useful website and forum /www.wholewoman.com/

The key understanding here is that the L5/S1 junction needs to be freely moving yet lengthened and supported by the ‘inner corset’ of deep postural muscles in order to enable the ideal tipping angle of the pelvis to position the pelvic organs over the pubic bone for maximum support. Other bodyworkers who have observed the importance of anteverted pelvic positioning in terms of general health and freedom from back pain (as well as prevention and management of prolapse) include Esther Gokhale, whose book 8 Steps to a Pain Free Back (free chapter can be downloaded from her website: www.egwellness.com) is offering very similar guidelines. The diagrams overleaf are helpful in encouraging our understanding. As yoga teachers it is vital that we do not encourage people to ‘tuck under’ the pelvis, but rather understand the importance of more subtle understandings that promote lengthening of the lumber spine and inner support from the postural muscles, including the pelvic ‘floor’ muscles.


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Understanding the relationship between pelvic angle and pelvic organ support http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Christine Kent in Saving the Whole Woman (appendix three, page 168) offers this exercise to ‘Demystify pelvic outlet contractions’. I have added yogic instructions for the breathing so that we can better connect with it from a yoga perspective: 1 Counter-nutated pelvis:

Lie down, bend the knees and put the soles of the feet on the floor. Exhale and do mulabandha, feeling how the tailbone can be drawn closer to pubic bone. Contract rectus abdominus. Inhale Now maintain this position as you exhale and bear down as if you are pushing your organs to the vaginal opening. Feel how the pubococcygeus muscle offers no resistance (a moderate prolapse will come easily down) 2 Nutated pelvis

Now arch the small of your back.

Inhale. Feel your pelvic diaphragm tighten as it lengthens from pubic bone to tailbone and tightens across the middle. Extend rectus abdominus by pushing navel out and over pubic bone. Feel the contraction of the transverse abdominus deep across the lower belly. Now maintain this position as you bear down, as if you are pushing your organs to the vaginal opening. Feel how with the pelvis in this position, the organs are being held at the front of the body and can thus resist the forces of intra-abdominal pressure.

‘These are the dynamics of pelvic organ support created and sustained by natural female standing posture’

(ie with the natural curve of the lower back, NOT the tail tucked under.) ‘So called Kegels (pelvic floor exercises) do not life the muscles up, they only move them slightly forward. The key to maximising the benefit of pelvic outlet contractions is to do so while keeping the lumbar curve in place. Try it both ways, pelvic tilted forward and pelvis tilted back , and you will see for yourself that …the (pelvic floor exercise) is a lot less effective in the backward tilt… (Kent 2006: 153). Standing cat with agnisara kriya NB Unsuitable during menstruation, pregnancy & immediate postnatal period

With the intention of maximising the beneficial anti-gravitational forces of inter-abdominal pressure created in agnisara kriya, Kent has also developed what she calls ‘Whole Women Fire Breathing’ which integrates the pelvic tilt of the cat pose with the pose of agnisara kriya: exhaling into uddiyana bandha with a very rounded back and inhaling with an arched back. I find this exercise works well after practising “Decompression of the pelvic organs” as set out in Mother’s Breath and based on Calais-Germain’s female pelvis exercises.


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Notes on peri-Menopause Basic understandings for effective yoga responses – from bud to seed

The heart of a positive yogic response to the experience of menopause is to embrace the experience as a fabulous opportunity for re-evaluation, reflection and change at every level of being. It is important 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. This cycle can be understood for a woman as having moved through the experiences of: girlhood (bud), through womanhood (flowering), including motherhood or involvement in myriad other creative and nurturing conceptions, gestations, births and nurturings of projects and creations in the world (fruiting) to pass through the great change and arrive at menopause (re-seeding the future).

The heart of yoga philosophy in terms of the acceptance of each moment as it is (Santosa ) is here presented to all women, often wrapped up in layers of tapasya or disciplined attention, and providing the opportunity for the practice of ahimsa towards oneself, in terms of offering tenderness and forgiveness to oneself. Deep nurture and sharp awareness are the keys to utilising the tools of yoga to help minimise and harmonise hormonal fluctuations, and offer relief and support during times of challenge: So the best approach comprises both Prevention and Relief as described in the case study on the next page. One of the most difficult aspects of the peri-menopause 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 with pranayama and meditation to promote acceptance of change in preparation for a safe journey through the passage to power. It is also important to acknowledge the powerful influence which culture and environment has upon our expectations of the experiences at this point in women’s lives, and to see the positive role for menopausal and post menopausal women in our families and wider social networks. The yoga practice of SATSANG has huge importance here, and the support, sharing and wisdom of older women is absolutely crucial to the positive experience of menopause. As a great support for this experience of satsang I warmly recommend Francina, Suza. 2003. Yoga and the Wisdom of Menopause: A guide to physical, emotional and spiritual health at midlife and beyond. Health Communications Inc. Deerfield Beach, Florida. Inspiring combination

of true life stories from yoga women, and sound advice from an Iyengar yoga perspective. Especially helpful sections on yoga and peri-menopausal bleeding, osteoporosis and the emotional experience of menopause. For a thoroughly informative read on the subject of menopause I encourage you to engage with Foxcroft, Louise. 2010. Hot Flushes, Cold Science: A History of the Modern Menopause . Granta Books. London. A gripping account of the medicalisation and cultural construction of what we understand to be the menopausal experience. Compelling.


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Menopause as a journey of Self Discovery Material prepared by Frances Lewis BWY. For enquiries about yoga retreats, and yoga for menopause, and to buy Frances’s book The Divine Dance in the Sacred Landscape of Britain (with Adeline Abad-Pedrosa), please visit www.franceslewis.co.uk or call 07891 219 688

The changing of the hormones and periods stopping often coincides with children leaving home and or parents dying. And if a woman has not had children – then there is the mourning of the end of that potential. Also more recently women who have babies at a later age may come into menopause as their children come into adolescence. Nothing really prepares us for this time of change and loss. Often women experience – hot flushes, dry skin, and loss of libido, aching muscles and joints, mood swings, insomnia, back ache, inability to make a decision. All of these or none of these symptoms may be accompanied by a deep questioning: What is the purpose of life? Who am I? And what is my purpose? Menopause is a time of change, a major life transition. I have a sense that women during this time are being called upon to become truly authentic and truly in their power. To walk into the wise woman role, to draw on all of their experiences from life, to integrate all that learning from the bumpy road of life so far. And to give up all the lifting and carrying and doing that is so much a part of the younger years. We live in a culture of fear and poverty mentality, such deep old fear, personal fear, family fear and cultural fear. So it is no wonder that there can be a lot of physical stiffness and pain and mental confusion and emotional release during menopause. All change whether perceived as positive or negative involves grieving. It is my sense that the hot flushes are power surges or rushes of creative energy. It is my sense that all the physical aches and pains are related to the way we block our powerfulness and authenticity. The confusion and the disturbed sleep a reaction to the sometimes overwhelming changes that are going on. It is a strong and beautiful healing phase and any unfinished healing will come up for attention. I recommend lots of quality time with your self. Write, dance, sing and rest. Time in nature, simply watching the clouds go by or walking with a steady pace. Create a personal sanctuary where you can put up a do not disturb sign. Maybe call it your womb space. Not shared and not entered by anyone unless invited. Space to moan and groan and rest and maybe when the energy comes, to be creative and make a mess for no reason. Again I also recommend lots of rest – time to rest and integrate - do not underestimate the healing power of rest. Maybe connect with the full moon and the seasons of the year – so that you are connecting in with other cycles of life. This can be very simple. Devising a menopausal ritual can be very liberating. Honouring this major life transition in an open way with friends and or relatives can be very helpful in making sense of this change. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Connect with other women, maybe a menopausal group or mixed age women's group. I recommend gentle Yoga and time to explore the full and spontaneous breath and lots of deep relaxation. Many holistic therapies can help ease and support this transition without suppressing the grieving that is required. Homoeopathy, Counselling, Acupuncture, Nutritional advice, Massage, Ayurveda etc. Begin to really listen to your intuition. Most of all go gently with love – Namaste Frances Menopause as a journey of transformation - books

The Wisdom of Menopause by Dr Christiane Northrup, ISBN

– 13 978 - 0553386721 This is a very wise and loving book about all aspects of menopause – I strongly recommend this book to all women nearing or during menopause. Also Women’s bodies Woman’s Wisdom by the same Dr Christiane Northrup. I read both of these books during my 8 month menopausal gap from teaching. The Seven Sacred Rites of Menopause by Kristi

Meisenback Boylan Santa Monica Press ISBN – 13 978 - 1891661136 The vast majority of books on menopause do not address what every transitional woman instinctively knows: menopause is much more than just a list of physical ailments; it is a spiritual journey. This book outlines the seven rituals, or stepping stones, that a woman moves through on her menopause voyage, marking her way through midlife. What your Doctor may NOT tell you about menopause by Dr John

Lee ISBN – 13 978 – 0446691420 This book was recommended by Doctor Lee at Victoria Cross Surgery – Swindon. This is about the hormones in the water system from the contraceptive pill. The tap water is contaminated with hormones and you are getting a dose whether you take the pill or not. This is an ecological disaster that has already happened. This is adding to menopausal symptoms as well as low sperm count in men. This doctor favours progesterone cream and vitamin supplements and does not support HRT. Eat your way through the menopause by Marilyn Glenville ISBN –

13 978 - 1856264686 Very enjoyable and informative recipe book for menopause. I have really enjoyed trying out recipes from this book. I always respond well to eating nourishing delicious home cooked food made with love.

Menopause by Dr Miriam

Stoppard ISBN – 13 978 – 0751334265 She details the advantages and disadvantages of Hormone Replacement Therapy. Some women may choose HRT to ease the way through this major life transition. However, if the motivation is to keep young and attractive and full of the kind of energy a younger woman has then there will be a loss of the potential for maturity and deep wisdom that is so required in this culture. The Divine Dance in the Sacred Landscape of Britain by Frances Lewis

& Adelina Abad-Pedrosa

ISBN – 13 978 – 098551447 From ancient hill forts to dramatic cliff tops by the sea, from churches to caves - this book has everything to tempt you and invite you out of your armchair into the spectacular healing landscape of nature and earth energy. This book provides a beautiful insight into the journey that Frances and http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Adelina followed as they danced and photographed all the points where the Michael and Mary ley lines meet in Britain. ‘This book came out of my menopause’ says Frances – the journey was a pilgrimage to balance the male and female energies within ourselves and around the world. We believe it has the potential to bring us into a saner, more sustainable way of living. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Notes on Yoga and Osteoporosis The yogic and ayurvedic perspective on osteoporosis connects it to our root chakra, to the earth, and to our sense of being stable, supported, sheltered and safe. In her astonishingly powerful book ‘Women’s Power to Heal: Through Inner medicine’ Mother Maya Tiwari observes that ‘osteoporosis is a condition that literally relates to strength and support in the body and the sense of security in the mind. It occurs most frequently in women who have psychologically not come to terms with the absolute and personal reality of their own ageing, death, and dying.’ (225) She also presents a number of rejuvenating ayurvedic tonics and medicines, and promotes very positively the idea that osteoporosis is in fact a reversible condition. Nutrition, food sadhana and meditation are key to the ayurvedic response to the condition. The possibility that osteoporosis is reversible and certainly preventable is also borne out by the inspiring work of Loren Fishman and Ellen Saltonstall, whose fabulous book Yoga for Osteoporosis: yoga that builds and preserves strong bones, the complete guide (2010 Norton, New York) sets out a full range of asanas to build bones. Osteopenic (early signs of possible osteoporosis) and osteoporotic versions of all poses are included, and the emphasis is on WEIGHT BEARING poses to build strength: ‘Yoga safely stresses bones without impact…with many poses that avoid moving joints altogether, yoga has been shown to strengthen bones without any evidence that it weakens joints. …There are other books on osteoporosis and yoga, but the Fishman and Saltonstall one really takes the biscuit.

Special message about Endometriosis This message is from Adrienne Egan, Mayan Abdominal Massage therapist and ex-chair of the Irish Endometriosis society. Adrienne has been living with Endometriosis for decades: “Endometriosis is not to be underestimated. It can be devastating on all levels, affecting quality of life, ability to work and fertility. In some cases surgery is unavoidable. It’s a condition that requires long term care, including dietary changes, supportive bodywork, healing modalities, and lifestyle changes. It is vital to address the health and state of the body’s energetic system, making sure all blocks to the free flow of energy are dismantled. It is possible to live well with Endometriosis but it takes effort and a self care routine that needs to be maintained. The rewards for this effort can be great and deeply healing, reaching further than just the

Irritation and pressure from the bleeding often causes severe pain and the formation of adhesions which can cause further complications as organs become ‘stuck’ together. physical level to how we perceive 'the feminine principle' within ourselves and its/our place in the world.

• Endometriosis is classified in stages 1 -4 : • I – Minimal II – Mild III– Moderate IV – Severe • Many patients often experience associated pathology such as chronic pelvic pain, dyspareunia (painful sex), dysuria (painful urination), Interstitial cystitis, intestinal upset, fatigue and lower back pain. • Build up of blood around ovaries produces large blood-filled cysts (chocolate cysts) or endometriomas. Unlike regular ovarian cysts these do not resolve themselves. • Diagnosis can be difficult – it can take some time, which can be stressful. There is an average of 10 http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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years between onset of symptoms and diagnosis. Currently the only way to diagnose is through laparoscopic surgery. • Treatment – arrest of menstrual cycle by continuous oral contraceptive use or similar suppressants; pregnancy results in temporary relief; surgery to remove tissue (Diathermy (burning) or Excision (precision cutting)) is often necessary, usually laparoscopic. • Infertility affects 30-40% of women with endometriosis and is common as the disease progresses.


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Anatomy and physiology notes from Ruth Gilmore ([email protected]) The mind and the body are two sides of the one coin – anything that changes one will affect the other FEMALE REPRODUCTIVE SYSTEM Consists of two ovaries, two uterine (Fallopian) tubes, the uterus, vagina, external genitalia and the breasts. The urethra is embedded in the front wall of the vagina, while the uterus lies between the bladder and the rectum.

Uterus

Shaped like a small inverted pear. Consists of fundus (domed part), body (main part) and cervix (neck). Muscular wall (smooth muscle) = myometrium. Lining = endometrium, deepest layer remains, while more superficial layer is replaced after the menses, builds up in anticipation of pregnancy and is shed each (non-pregnant) month. The cervix consists of fibromuscular tissue and projects into the upper vagina. It contains numerous mucussecreting glands in its lining. Uterine (Fallopian) tubes One end is attached to the uterus, the other end is open and lies near an ovary. The ovary end is widened and has a frill of soft finger-like projections (fimbriae). Infections can make the tube walls stick together, so the tubes become blocked.

Ovaries

Two small oval structures lying close to the open ends of the uterine tubes. Produce ova (eggs) and hormones (including oestrogens, progestins and inhibin). No new egg cells are made after birth, when about 2 million are present; these decline to several hundred thousand at puberty. These egg cells are immature, in a state of “arrested development”. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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The monthly cycle of egg maturation begins at menarche and ends at menopause. Mature ova contain half the chromosome number of other cells (23 instead of 23 pairs).

Vagina

Distensible soft muscular tube, with friction- and germ-resistant lining, similar to that inside the mouth. Having no mucous glands, it is lubricated by cervical mucous glands and by 'weeping' of the walls. Cervical mucus varies in quantity and consistency during the menstrual cycle. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Vagina has a slightly acid pH during reproductive life, this inhibits growth of most opportunist bacteria. External genitalia The perineum = diamond-shaped region bounded by the ischial tuberosities (sitting/buttock bones), pubic symphysis and coccyx. Vulva = area of external genitalia.

Labia majora (outer lips) enclose small labia minora (inner lips), that meet above at the clitoris. A "wishbone"-shaped mass of erectile tissue lies within labia minora and clitoris. Clitoral erection is produced by parasympathetic nerves causing dilatation of clitoral arteries (filling erectile tissue with blood) and constriction of the corresponding veins (preventing blood escape). Urethral opening lies just below (behind) clitoris. Vagina lies below (behind) urethra. Anal opening lies just behind (below) vagina. Vestibular (Bartholin's) glands secrete lubricant mucus into vestibule (vaginal opening).

Pelvic Floor Musculature

Hammock-shaped sheet of skeletal muscle attached to internal walls of pelvis. Muscle fibres arranged around urethral/anal openings preserve continence. Supports pelvic organs – bladder, uterus, and rectum. Muscle sheet is strengthened by circulating oestrogens and by use in regular sexual activity.

Breast

Breasts = mammary glands + fat (variable amounts). Each breast is supported by suspensory ligaments attached to underlying chest muscle, but can move quite freely against the chest musculature.


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Mammary tissue = milk-producing cell clusters + ducts opening on to nipple. Lymphatic drainage of breast tissue is complex – most passes to lymph nodes on same-side axilla (armpit), but it can follow other pathways, including into the abdomen and across the midline. Breast tissue is affected by hormone levels during menstrual cycle.

Menstrual cycle:

Occurs 'on average' every 28 days from menarche (first day of first menstrual period) to menopause (gradual end of reproductive life). Day 1 = first day of vaginal 'blood' loss (menses = dissolved endometrium and some blood). Menstruation lasts on average 1 – 7 days, loss = 35 – 50 ml blood. After the menses, proliferative phase – repair and replacement of endometrium. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Day 14 = ovulation. After this, secretory phase – endometrium develops in anticipation of fertilisation. In cycles of less/more than 28 days, ovulation occurs about 14 days before the onset of the period. If no fertilisation, endometrium degenerates and dissolves, resulting in the menses. The first half of the cycle is “oestrogen-dominated”, the second half is “progesterone –dominated” Every month several egg cells begin the maturation process to develop into primordial follicles, under pituitary control. Each month usually only one of the primordial follicles in one or other ovary develops to full maturation while the others degenerate. The “egg of the month” grows further, fluid forms around it and a blister-like secondary follicle is formed. The mature follicle (1 cm diameter) moves towards the ovary surface and at ovulation it bursts, releasing the ovum into the peritoneal cavity. Follicle rupture can cause one-sided lower abdominal pain for a few hours (Mittelschmerz or midcycle pain) – pinpoints ovulation time. The remaining site in the ovary reorganises to become a corpus luteum, a site of oestrogen and progestin hormone production. Chemical attractants steer the ovum towards the uterine tube opening. It is wafted by cilia along the tube into the uterine cavity, taking 2-3 days. Fertilisation by a sperm usually occurs in the tube. Sperm have a "nosecone" bag of enzymes that soften the outer covering of the ovum, eventually allowing one sperm to penetrate the ovum and fertilise it. A couple of days after fertilisation a fertilised ovum (by now developed into a hollow ball of cells) will go on to implant (embed) in the thickened endometrium. An unfertilised ovum dies and a few days later is passed out of the uterus with the degenerated endometrium http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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as the menses. Hormonal control of the Menstrual Cycle

Hormones circulating in the blood co-ordinate the events each month in the ovaries and the uterus. The pituitary gland lies under the brain, suspended by a stalk from the hypothalamus. It consists of two parts – anterior pituitary and posterior pituitary. The anterior pituitary is stimulated by the hypothalamus to secrete several hormones, including some that affect the ovaries. FSH – follicle stimulating hormone – stimulates a primordial follicle to develop further every month after the menarche, and stimulates the production of oestrogens by the ovaries. LH - Luteinising Hormone – induces ovulation (ovum release) in the ovary and stimulates the subsequent production of oestrogens and progestins from the corpus luteum. As the ovum develops, surrounding follicle cells secrete oestrogens – these enhance bone/muscle strength, maintain secondary sex characteristics, affect the nervous system, including sex drive and female behaviour, and bring about repair and regeneration of the endometrium. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Just before ovulation, oestrogen levels peak. A surge of LH causing ovulation occurs. Inhibin is secreted by the follicle cells and inhibits further FSH secretion after ovulation. After ovulation, LH causes the corpus luteum to form, and progestin (especially progesterone) secretion begins. Progesterone causes thickening of the endometrium in preparation for the arrival of a fertilised ovum, also causes a slight increase in body temperature. If no fertilisation occurs, the corpus luteum degenerates after about one week. Progesterone and oestrogens levels then fall sharply, triggering off a response from the hypothalamus, beginning the cycle again. Menopause

Gradual process around 45 - 55 years, ovaries fail to produce oestrogens or progestins. Early menopause due to ovariectomy surgery or auto-immune disease is associated with higher risk of osteoporosis. Symptoms due to oestrogen lack – vaginal dryness, atrophy of internal and external genitalia. Other symptoms presumed to be linked with oestrogen lack – hot flushes (25% have these), sleep disturbance, night sweats, headaches, irritability – but link not proven. No evidence that weight gain is oestrogen-linked, probably lifestyle/psychological link. Weight redistribution (thickening waist), chin hair, thinning of head hair all linked to the influence of the small http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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amount of testosterone normally produced by the female adrenals – there being insufficient oestrogen to swamp its effect. No evidence that menopause is directly associated with any increased degree of psychiatric disturbance.

CHALLENGES TO FEMALE HEALTH Dysmenorrhoea

Pain associated with menstruation. Often improved after pregnancy. Symptoms – crampy lower abdominal pain, sometimes low back pain, lasting several hours around onset of period. 10% of women lose working days regularly. Caused by uterine contractions and slight cervical opening, especially if clots are present in flow. Can be accompanied by nausea, dizziness, colic, diarrhoea. Made worse by also having PID [pelvic inflammatory desease], fibroids, endometriosis. Treatment – anti-prostaglandin analgesics (painkillers) (ibuprofen, aspirin, paracetamol), in severe cases, oral contraceptives or other hormonal combinations, taken continuously (only under medical supervision).

Menorrhagia

Excessive bleeding during periods. Experienced by about 10% of women. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Average blood loss is 40ml per period, with wide range of normal. More than 80ml regularly will result in anaemia. Associated with early spontaneous abortion (miscarriage), fibroids, endometriosis, infections of uterine tubes/ovaries, IUDs, endometrial cancer, hormonal imbalances, menopause, hypothyroidism. Treatment – depends on cause. 'D & C' (dilatation & curettage) sometimes used, also can provide diagnostic samples for biopsy. Laser removal of the endometrium layer (endometrial ablation) sometimes suitable as an alternative to hysterectomy. Fibroids

Benign tumours of myometrium (muscle layer of uterus). Can become very large. Often multiple. Present in about 20% women. Uncommon under 30 years. Atrophy (reduce in size) after menopause. Can cause pain, menorrhagia and infertility. Treatment – surgical removal (myomectomy), or hysterectomy when large (commonest reason for hysterectomy).

Carcinoma of the Cervix (cervical cancer)

Second commonest cancer of women after breast cancer. In UK incidence is rising despite screening programmes, about 2000 deaths/year. Age of onset is dropping. Vaccine campaigns should reduce incidence in future. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Is preceded for several years by a recognisable and easily diagnosed non-invasive condition of cervical lining cells, the basis of cervical smear tests. Generally symptom-free until late stage – some countries (eg Sweden) have made screening almost compulsory – with good results. Strong positive correlation with STD transmission of viruses, especially human papilloma (genital wart) virus and herpes simplex (genital herpes) virus. Risk factors – young age of first sexual activity, number of partners (high risk in prostitutes), smoking, circumcised partner reduces risk. Treatment – early detection of pre-invasive stage and removal of affected cells prevents cancer development. Otherwise surgery and/or radiotherapy can help, success low in late diagnosis. Endometrial Carcinoma

Much less common than cervical cancer. Mostly in age group 50 – 70 years. Commoner in childless women. Often associated with high levels of oestrogens in blood. Risk factors – late menopause, obesity, oestrogen-secreting tumours, oestrogen-only HRT. Symptoms – irregular bleeding, especially after menopause. Diagnosis is by D & C, followed by hysterectomy. With early diagnosis the outlook is excellent. In invasive stages radiotherapy may be used also. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Tubal blockage

Very commonly the result of infection and inflammation of the tubes (salpingitis), usually from PID (Chlamydia, gonorrhoea etc), but can be from peritonitis or after childbirth or abortion (spontaneous or therapeutic). The infection may go unnoticed at the time. IVF can achieve pregnancy in some cases.

Subfertility (f ormerly called infertility)

The inability of a couple to conceive after one year of unprotected intercourse. Numerous causes: 30 – 40% male problems, 20% uterine tube blockage, 15% idiopathic (no cause found). Absent or infrequent ovulation – can be due to hormonal problems in hypothalamus/pituitary, thyroid, ovaries, also premature menopause, and PCOS.

Polycystic Ovary Syndrome (PCOS)

Commonest cause of amenorrhoea (no periods) and oligomenorrhea (scanty periods) in clinical practice. Numerous small cysts (arrested follicles) and a thickened surface layer develop in the ovaries, impeding ovulation. Associated with increased secretion of androgens (testosterone) and low levels of oestrogens. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Hirsutism (excess body hair) and acne are common findings Causes not understood, probably complex. Fertility problems may be helped by drugs, eg clomiphene (Clomid) to stimulate ovulation.

Endometriosis

Endometrial tissue is found in abnormal sites – on ovaries, within the myometrium, uterine tubes or scattered through the peritoneal cavity or further afield (lungs, nose etc). This tissue responds to monthly stimulation by hormones as does the normal endometrium, bleeding during the menses. Irritation and pressure from the bleeding often causes pain. Build up of blood around ovaries produces large blood-filled cysts ('chocolate' cysts). Most patients are in socio-economic groups 1 and 2. Diagnosis can be difficult - it can take some time, which can be stressful. Cause uncertain – the theory of retrograde flow of menses into tubes sometimes blamed (often used as reason why inversions are unwise), but many women have this when lying down, without developing endometriosis. An associated immune deficiency is thought to be present as normally the immune system would destroy any stray cells. Thus some now classify endometriosis as an auto-immune condition. The alternative theory that embryonic cells that will become endometrium stray from their allotted site via the blood during development is also a possibility. Treatment – arrest of menstrual cycle by continuous oral contraceptive use or similar suppressants, pregnancy results in temporary relief, surgery to ablate (remove) deposits often is necessary, usually laparoscopic. Pelvic Floor Weakness

Pelvic floor muscle tone is sustained by circulating oestrogens; often weakens after menopause. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Associated with childbirth, especially having had several children, or perineal damage associated with difficult delivery. Lack of tone can result in prolapse of bladder, uterus or rectum, which either sag down (partial prolapse) or come right down to appear externally (complete prolapse). 50% of parous women (women who have had children) will have some degree of prolapse, about 10% of these have symptoms. It occurs only rarely in nulliparous (childless) women. Weakness can affect sphincters closing urethra and/or anal canal, causing incontinence. Urinary incontinence is common; two types – 'stress' (on coughing, jumping etc) and 'urge' – need to urinate with little warning. They can co-exist. Three-quarters of sufferers won't tell partner, 90% won't tell family or close friends. About 2 million women in UK have urinary incontinence to some degree. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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25% of new mothers have urinary leakage during the first 3 postnatal months, 4% have faecal incontinence. 15% will continue with urinary problems longterm. Pelvic floor exercises without other treatment can improve 70% of women by 70%. Urge incontinence is due to instability of bladder control, nerves controlling bladder outlet are over-sensitive. Improves with bladder training programme. Physiotherapy with biofeedback, electrical stimulation, use of weighted vaginal cones, or surgery may be required for some. HRT can improve urge incontinence, and other drugs are available.

Carcinoma of the breast (breast cancer)

Commonest women’s cancer, affects 1 in 12 in UK, commonest cause of death between 35 and 54 years. About 5% of tumours caused by dominant genes, about 9% thought to have hereditary factors. Other risk factors – having no children, early menarche, high socio-economic group, high-fat diet, high-dose oestrogen therapy.

Symptoms – lump may be felt, skin dimpling, nipple inversion or discharge, change in breast contour. Pain can accompany inflammatory changes in lump. Treatment – lumpectomy, simple mastectomy (removing breast and lymph nodes), radical mastectomy (removing breast, underlying muscle, lymph nodes), If there is evidence of spread to nodes – chemotherapy; if evidence of local spread or if tumour is diffuse (not a 'lump') – radiotherapy. Oestrogen-blocking drugs are useful, eg tamoxifen and newer derivatives. Secondary spread is by lymph channels or blood, to armpit nodes then to lungs, bones and liver. Can spread via lymphatics to other side, or to abdominal nodes. One-third of women have lymphoedema of the arm after mastectomy. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Bones and calcium metabolism:

Calcium in the body exists as solid material in bones and in solution in the blood. Bones consist of active cells (osteocytes) and protein fibres (collagen) embedded in a background matrix of hard calcium complex. The collagen is arranged along the lines of mechanical stress of the bone. Where stresses are maximal, bone is solid (compact bone). Where stresses are less, bone is like hard sponge, forming a network with spaces (cancellous or trabecular bone). http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Throughout life, the calcium complex is being dissolved and replaced on a daily basis, in such a way as to maintain blood calcium levels within a narrow range of normal. These processes (calcium metabolism) are controlled primarily by parathyroid hormone and vitamin D. Bone mass increases up to the mid-30's then declines. Some women are 'fast bone losers' after the menopause, especially if menopause is premature. Adequate dietary intake of calcium is important (1000mg/day, ideally 1500mg/day menopausally), also 400-800 i.u. vitamin D. A minimum of 30 mins weight-bearing exercise 3 times/week has been shown to be beneficial (not swimming). Smoking accelerates bone loss.

Sympathetic Nervous System:

Part of the autonomic part of the nervous system, governing internal functions, sweating and regulation of blood flow by its constrictor effect on artery diameter. Is responsible for activity in everyday life, eg stimulates the body during all movement and exercise. In acute situations heightens alertness and prepares one for action by the FFF reaction (fright, flight or fight). This does not represent the day-to-day level of activity of the sympathetic, but is designed to be activated only when danger is perceived. During FFF, adrenaline pours out of the adrenals into the blood. When quiet and relaxed, adrenaline production here is minimum. FFF is designed for acute episodes and dies away quite quickly afterwards. Chronically-raised stress levels result in permanently-raised adrenaline production. Panic attacks are FFF occurring in response to an idea or a false stimulus – conditioned response. They can disturb breathing patterns enough to cause hyperventilation – this reduces the amount of CO2 in the blood so much that light-headedness and tingling in the fingers can occur. Most people are ashamed of panic attacks and do not admit to them.


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Case Study 1: off the pill but where’s the baby? J: aged 31, bursar and marathon runner seeking to conceive Reconnecting with awareness of the menstrual rhythms Prefatory comment: http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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This case study is presented first because the story here gets to the heart of a very common feminine experience: that of total disconnection from the rhythms of the cycle, and lack of awareness of the potential of healthy menstruation as the key to health and fertility. The most striking thing about the initial meeting for this client was the repeated attempts which it took to discover when she had actually begun menstruating. Three times when asked about this the client mentioned the date 2007, which was in fact the year when she stopped taking the contraceptive pill. It was only on the fourth enquiry when I pushed again to find out about the beginnings of her menstrual experience, that the client actually reconnected with those early periods. She in fact began menstruating at 14, and explained that she had encountered no problems for the first two years, but then (coinciding with some profound and eventually terminal health issues which her brother had experienced at this time, and with a change of school to college) she began to experience such profound debilitating pain and heavy bleeding that she was prescribed the contraceptive pill by the family GP. On further enquiries, it turned out that the ‘unbearable’ nature of the periods was usually one day of having to be at home, off college, and resting in bed with pain and heavy bleeding. She felt that the contraceptive pill which she had been taking had helped her to manage her periods, making them lighter and reducing the pain so that she did not need to miss school, college or need to rest. She took it for over ten years continuously, and expressed great surprise that this might have had any impact at all on her problems with ovulation and conception when she decided to come off the pill with a desire to conceive. The picture here is very widespread - that extended (over decades) use of the contraceptive pill has entirely and effectively disconnected young women from any of the wisdom or insight that may have come to them through the experience of the natural menstrual cycle, so when they come off the pill it is almost as if they have never really menstruated at all and need to begin afresh with a programme of awareness and honouring the moon and their cycles in order to access the wisdom that they have been denied. This client was playing the numbers game, and kept meticulous records of the dates and onsets of her © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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period, and so had discovered that the cycle on the left side was longer than the cycle when the right ovary was ovulating. She had acquired a precise mathematical understanding of the cycle but was unaware that her cycle might have any connection with the cycles of the moon, or indeed that understanding the rhythms of the cycle could provide any insight into the mood swings and http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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fluctuating levels of vitality and debilitating lack of energy and ability to relax that she had come to yoga to gain teachings on. First session was a group session for women’s health, after which she reported that she felt the most relaxed she had done in years. She returned for a one to one session, in which I took a case history, and taught the following practices with the intention of creating a short home practice that could be done when she returned home from work: Full yogic breath Ujjayi pranayama Sounded breath ‘I CAN breathe!!’ Super deluxe savasana with calves resting horizontally supported on chair. Supta baddha konasana, moving into the seed/flower sequence with ujjayi pranayama


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Case study 2/ Miscarriage

Recovery from and promotion of ovulation with a view to a healthy natural conception. A: Client background and presenting concerns This married woman in her early thirties sought yoga therapy in the days immediately following a miscarriage (after 8 weeks of pregnancy). She had been taking the fertility drug Clomid to promote ovulation. She is from India, lives in London, and has until very recently led an extremely busy professional life, running her own business, and needing to make frequent very long haul flights for business projects. She has made big changes in her life, deciding to slow down, take more rest time and focus on conceiving a child. She says ‘This is my priority now’. She has done some yoga in the past, and was following a daily pranayama programme involving kapalabhati and nadi shodana. She arrives for the first session with her husband, who is very supportive and engaged throughout the session.

B: Therapist response New moon! Time for change and new beginnings – focus during session, Initial session 90 minutes, follow up session two weeks later 60 minutes. Aim in first session to provide healing, restful practices to promote balance and nurture following the miscarriage. First programme given: 1 Super-deluxe savasana - rest pose with knees up on chair/bolster 2 Semi-supine - Full yogic breath with awareness techniques (using hands in yoni mudra). 3 Ujjayi breath to use with synchronised movements. 4 Basic pelvic awareness tilts and lifts with full yogic breath (base position has feet on floor under bent knees). Focus on EARTH, grounding the feet. 5 Seed to flower: alternating between opening and protection. (Mini-Shakti bandhas from supta baddha konasana with healing, synchronised breath and movement: arms moving above and below head, knees opening and closing: followed by restorative supta baddha konasana. 6 Seated pelvic Shakti bandhas (‘churning the mill’) freeing of feminine energy with legs open. Focus on feet anchoring and hips circling. Followed by supported savasana. 7 Gentle moving lying twist with breath and arm movement synchronisation. 8 Restorative side lying with deep relaxation (yoga Nidra). This also could be done in the reclining supta baddha konasana:’the queen’ (see page 246 of ‘The Baby Making Bible’ Learning support provided: Simply Calm CD for Ujjayi and yoga Nidra. Also a marked copy of Yoga for Living: Feel Confident with the practices, which she had done, annotated.


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Page 55 Second programme provided (two weeks later)

1 Re-cap on the breath and synchronised movement, as per first Sequence, items 1 – 5 2 Plus the Chandra Sequence (see previous pictures at end of document) 3 Yoga Nidra with shins resting in baddha konasana up on a chair.

C: Examples from this case history In the first session it was noticeable that the client was breathing very erratically. She was anxious, vulnerable and wanting to heal but not knowing quite how to go about it. She expressed great surprise at how gentle the programme was, in comparison with other approaches to yoga, which she had encountered. She also expressed great relief that this was the case. She was clearly surprised by her lack of connection to her feet and inability to move and ground her toes and heels. Her husband was keen to help her connect with this part of the programme. She was noticeably calmer at the end of the session. Second session, she was very keen to attend – coming over in her lunch hour immediately after consultation with her GP. She was delighted to share the effects of her practices ‘ It feels right’ she said. She had more facility with lengthening her breath, more connection to her body.

D: Practical effect of Yoga therapy in this case This young woman was highly motivated and keen to heal and conceive. Her husband was very supportive of her change in lifestyle and shift of focus. She practised almost every day following the first session, usually about 25 minutes for the breath and movement, and then with the yoga Nidra (15-20 minutes in the evening). At the second session she was evidentially more grounded, with higher vitality and also a sense of clear focus and positivity. She explained that she had enjoyed the yoga, that it had given her a focus to help her slow down, and that she was committed to taking time to heal naturally: she said her GP had suggested taking Clomid again, because she had not yet ovulated (2 weeks after miscarriage) but the client decide she would prefer to wait and see if and when her period resumed naturally. She said she felt the yoga gave her tools to feel positive about her cycle returning naturally and she would work in this way and wait and see. She was very positive about the second session, and planned to continue practice.


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Case study 3: Miscarriage/s Supporting recovery from previous miscarriage/s, and promotion of healthy menstruation with a view to a healthy natural conception. A: Client background and presenting concerns This very fit, healthy and vital single woman in her mid forties sought yoga therapy in the months following a miscarriage in the previous year (after 8 weeks of pregnancy). She had recently split with her partner ‘the love of her life’ and was fully aware of her own distress. They had previously done two rounds of IVF in the past three years, and she had conceived, but miscarried on both occasions. She also spoke about three previous abortions she had had after conceiving with ‘the wrong men.’ She lived in the rural far North, and came to the yoga therapy session in London, where she was attending a training day. The client was a highly intelligent and creative freelance filmmaker, who is fully conscious of her deep desire to change the focus of her life away from work and towards family. She described it as a ‘very deep, primal urge’ whose power she acknowledged. She described herself as ‘super-fertile’ – citing the ease with which she had always conceived in the past, and her mother and sister who both had four children ‘without meaning too’. She expressed pain and sadness that this ‘super fertility’ seemed to be passing, and she was fully aware that at her age and in her present circumstances that the likelihood of conceiving with her chosen partner was very slim. She was also investigating IVF with donor sperm and adoption. She had previously practised yoga over many years, mostly from books, and sometimes on a daily basis (during a visit to India). This was her first one to one yoga experience.

B: Therapist response Initial telephone session 30 minutes; follow up session one week later 90 minutes. Aim on telephone to counsel anxiety and get background information and provide guidance on reading and lifestyle as requested by client: recommended Baby Making Bible, and also work by Francesca Naish. Aim in first face-to-face session to listen to story (there was weeping) and to provide healing, restful practices to promote balance and nurture and to get grounded and connected to lunar rhythms. Huge full moon! Very heavy and full – client also premenstrual (her period began the next day) which impacted on the emotional nature of the consultation. The focus was also to empower the client to encounter difficult understandings about herself and her place in life as described in client background. Programme given: 1 Semi-supine rest pose with knees up on chair/bolster 2 Full yogic breath with awareness techniques (using hands in yoni mudra). http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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3 Ujjayi breath to use with synchronised movements. 4 Basic pelvic awareness, tilts and lifts with full yogic breath (base position © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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has feet on floor under bent knees). Focus on EARTH, grounding the feet 5 Bridge pose with Mulabandha, to connect inner and outer worlds. 6 Seed to flower: alternating between opening and protection. (Mini-Shakti bandhas from supta baddha konasana with healing, synchronised breath and movement: arms moving above and below head, knees opening and closing: followed by restorative supta baddha konasana 7 Gentle moving lying twist with breath and arm movement synchronisation. 8 Legs on chair in supported supta baddha konasana for Yoga Nidra with emphasis on SANKALPA which we discussed at length before using a ‘just for now’ sankalpa. Learning support provided: Simply Calm CD for Ujjayi and Yoga Nidra. Also a marked copy of The Baby –Making Bible Yoga fertility Sequence.

C: Examples from this case history The challenge with this client was to balance the support for healthy conception and to address the real possibility that this may not occur easily, or even at all. The balance of the session was very much towards listening (30 minutes). Because the emotions of grief, loss, frustration and disappointment were so vivid, it was important to offer a practice that was spacious and gentle enough to give the client time to settle after all she had spoken of, yet at the same time to give her a grasp on a practice that would be helpful to take away and utilise through the next few months with each stage of her menstrual cycle.

D: Practical effect of Yoga therapy in this case It was evident that the Ujjayi breath provided an immediate sense of power, release and control. “I can feel how useful this will be to me’ she said. There was also a sense of relief that the programme did not set additional challenges or difficulty, but rather provided soothing and comfort, with a sense of movement and release. The client has since been in touch by email, explaining that her period started the next day after the session, and that she was making time in her day to do the relaxation practices because they felt good.


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Case study 4 /Endometriosis – pain management Age 33 Marital status - in partnership Occupation /lifestyle – Head of a charity, lives in London, frequent intercontinental travel. Slight build. Vegetarian

Journey to yoga? – 2 years previous yoga. Through YBT therapy classes and Well Woman yoga one to one session for yoga and hypnotherapy

Presenting issues – intense pain during menstruation.

Since 14 or 15 – so around 16 years. Each cycle, with more intense pain every 3 rd or 4th month, the peak of pain continuing for about 6 hours and so intense that she would usually be admitted to hospital. Usually to A&E for an overnight stay and morphine – the only drug which seems to relieve the pain. Has tried all available pain killers, nothing else works.

Has investigated surgery for removal of endometriosis – but following surgery for removal of fibroids (one golf ball sized, one orange sized – is reluctant for further surgery at present. Programme

Did four or five sessions one to one. Learnt pain management and relaxation techniques based around use of UJJAYI and self hypnosis. After fifth session she called on telephone in the middle of an attack of severe pain. She was seeking guidance in the use of the techniques to manage the pain – spent one hour on the phone being guided through breath and self hypnosis for pain relief. She called later to report that the attack had lasted for 17 hours (10 hours longer than usual) but that much to her astonishment she had not gone to hospital: “The Ujjayi got me through’ http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Further references:

Dian Shepperson Mills ‘Endometriosis’ A comprehensive guide to managing the condition using nutritional change. Her approach is holistic and sits well with yoga therapy.


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Case study 5/ Sub fertility and preparation for conception Age 33 Occupation – TV researcher, lives in London Presenting issues – seeking to conceive, been trying for a baby for 2 years. Route to yoga – acupuncturist and friend recommended

Programme

Two one to one sessions teaching gentle movement to free pelvic energy and key restorative yoga practices using breath awareness and yoga Nidra: Pelvic tilting in kandharasana/ setu bandha Blooming sunflower – rhythmic supta baddha konasana with arm movement Variations from luna yoga Golden thread breath Yoga Nidra in supported supta baddha konasana Recommended using 15 minutes to relax in this pose daily

After two sessions re-appeared some months later in pregnancy yoga class – now mother to two children, son and daughter. Useful resources from Foresight – the organisation for preconception care Also sequences from Relax and Renew, Judith Lasater. See also ‘Getting pregnant faster’ Marilyn Glenville


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Case Study 6 / Prolapse Age: 34 Occupation – ex lawyer, lives in London, now mother of two children - a son 3 years and daughter 8 months

Journey to yoga – Pregnancy yoga on first child, and postnatal recovery yoga and baby yoga on first child. Recently referred by GP to a physiotherapist and specialist women’s health physiotherapist because of prolapse.

Presenting issues – Mild

/medium uterine prolapse following birth of daughter.

Causes discomfort when walking, especially if carrying/pushing weight. Experienced no practical assistance or improvements when following the advice given by GP and the other health care practitioners to whom she was referred. “They just told me to do my pelvic floor exercises’

Programme –

Intense work over four weeks – meeting once a week with set homework between:

Education (responding to needs of pitta/vata mind) – using diagrams, models and books Explanation Breath linked pelvic tilts and lifts from kandharasana Abdominal breath and mulabandha in kandharasana As above, continued using blocks, bolsters and lifts to work in elevated position. Developed to work towards supta uddiyana bandha (see Mother’s Breath and Blandine Calaishttp://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Germaine – The Female Pelvis.

Following weeks developed all of the above to lead into Supta uddiyana bandha 7 repetitions Then working into rhythmic partial shoulderstand against the wall with mulabandha Restorative poses with pelvis elevated Finally developing ability to mobilise all the above in standing and lifting poses. See Women’s Health, London Website for details on varieties and degrees of prolapse


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Case Study 7 / Fibroids Age: 52 Occupation – financial consultant

Journey to yoga – Life long interest in meditation. Regular weekly classes attended for a number of years. Attended women’s yoga retreats. Daily self practice of some asana, but discontinued because of discomfort from the fibroids.

Presenting issues –

Swollen belly – up to around 28 weeks pregnancy gestation equivalent. Tenderness, soreness, pressure when lying on front. Rapid increase in size of fibroids over short period (six months). But previously present for many years. Distress at symptoms, discomfort. Surgery had been recommended but had elected to try alternative methods. Had already made considerable efforts, using homeopathy changes in diet etc.

Programme –

Attendance at women’s yoga retreats annually – and then one to one session. Home practice of YOGA NIDRA – specially developed practice utilising client’s own language, metaphors and concerns – all voiced during a one to one session: the language in the yoga Nidra was http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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all about coming home to herself, about feeling at home in the womb, about truly making space for herself to feel completely at home, to explore the feeling of being at home in her body. Literally her experience was that the fibroid had grown to the size where there was no room for her to be at home to herself and her own concerns in the womb. These feelings also resonated around recent experience of her being in a care-giving role in her family following the serious illnesses of a sister and some extreme demands around family needs. The yoga Nidra was recorded during the one to one session and then used most days thereafter in self practice. There was great commitment to the practice and an immediate experience that this was what was needed.

Effect – by all

accounts, remarkable. On seeing the client at a womb yoga class some four months

later, she was in a totally different place, shape, state: the fibroid had reduced so much in size that it was now no longer perceptible to client – the 28 wk pregnant belly had totally disappeared, she had lost weight and regained vitality – ‘ Look at me in my skinny tight leggings!’ she boasted with glee – taking delight in her improved health and vital energy. She put the shift down completely to the Yoga Nidra practice. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

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Case Study 7 / Menopause Age: 54 Occupation – bank cashier, mother of grown up children and yoga teacher Presenting issues –

‘Mind wipe!’ Unable to think, concentrate or focus. Worried that she would be unable to do her job effectively. Emotional disturbances – extreme mood swings. Hot flushes – drenched in sweat, trembling and raging high temperatures – random onsets – worse at night, but also occur during the day.

Programme –

Attended weekly yoga class and had her own practice too. One to one consultation identified key practices for management and prevention. Management – practices to

use during the day to help handle symptoms:


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sheetali and sheetkari (cooling breaths) to reduce temperature, ujjayi to assist in concentration, breath counting in small batches to hold focus. Golden square breath with full yogic breath to calm emotional disturbances, also breath balancing. Prevention – practices to do

in the evenings and at weekends to burn off excess heat and create a

state of balance and calm: Surya namaskar, whichever version she felt like, up to twelve rounds until heat built and released. Selection of backward bending practices according to inclination – ranging from bridges to urdvha danurasana. Headstand and shoulderstand followed by plough and matsyasana. Nadi shodana in various variations – including psychic nadi shodana and triangle breath. Yoga nidra and meditation each evening before bed, to promote deep sleep. Amaroli for hormone balancing.


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A Womb-Friendly Yoga Manifesto Part 1 / the need for womb-friendliness in the yoga world

Most of the people on this planet who practise and teach yoga are women. Most of these women have wombs. And many of these women have little clear understanding about the effects of yoga practice upon their wombs. This is because yoga was originally developed by men for men’s bodies, and has been, until only very recently, transmitted through exclusively male lineages. Traditional forms of teaching yoga are thus likely to have zero womb awareness, so there is much ignorance and confusion in the yoga world about what happens to our wombs when we practice yoga. The aim of the Womb-Friendly Yoga Manifesto is to ensure that every woman who practises and teaches yoga is fully informed about the key techniques to avoid at certain times, so that she may http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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fully respect and honour the health of her womb throughout her life. When a woman has correct and complete information then she has the power to make appropriate yoga choices for herself. The information provided overleaf sets out the aims and effects of certain yoga techniques and outlines the effects of these practices on the womb. Why bother?

The healthful energies of a woman’s womb are key to her lifelong wellbeing and vitality. In yogic anatomy of the energy body, the womb is the seat of creativity, fertility and capacity to nurture and grow new life, new ideas – to manifest. It is literally the cosmic gateway for shakti (power) within. Yoga is all about refining awareness, of body, mind, breath, emotions and energies: it is about ‘union’ or re-connection with the source of all life. To pay no attention to the changing needs of womb cycles is to neglect the very place within that is the source of vitality and well being. Respect for womb cycles is the foundation of a refined and sensitive yoga practice for women. I encourage you to make the inner harmony and health of your womb your first priority. I encourage you to practice womb-friendly yoga! Uma Dinsmore-Tuli / www.wombyoga.org


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Page 64 Womb-friendly yoga manifesto part 2 / the information ‘Caution please – wombs present’

The following practices need to be handled with caution for female yoga practitioners at many times in their lives Inversions

One of the key purposes of inversions in hatha yoga is to reverse the flow of apana. Reversed apana does not effectively release menstrual flow, so practising inversions during bleeding can lengthen the length of time that you bleed. Practising inversions during pregnancy has an unquantifiable effect on the blood flow to the womb. Since rectus abdominal muscles in pregnancy are necessarily stretched, they are unable to contract to provide the usual source of lower back support during inversions.

close connection to each other. The effects of all three locks when practised together are more intense then when they are practised singly. Pumping breaths (Kapalbhati, Bhastrika, ‘Breath of fire’)

All these breaths use rhythmic abdominal and pelvic floor contractions to facilitate forced exhalations (kapalbhati) or forced inhalations and exhalations (bhastrika). They often activate rhythmic lifting and lowering of the pelvic floor and are frequently followed in yoga practice by application of the bandhas described above to maintain a longer pause after exhalation (bahir kumbhaka). The accurate practice of these breaths both builds


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Postnatal women rarely have the necessary abdominals strength to provide adequate lower back support for accurate practise of inversions Bandhas

The purpose of bandhas (locks) in yoga is to alter and contain the flow of energies in the body. Mula bandha (root lock) when practised in the classical fashion with a lift on exhalation, is intended to reverse apana, and this is the energy responsible for the release of menstrual blood flow and also the flow of blood during healing after birth. (There are alternative breath patterns which can be used to support this flow). Practising a strong or continuous mula bandha during pregnancy can create a thickening of the pelvic floor muscles that may obstruct the passage of the baby in second stage labour. Uddiyana bandha (abdominal lift) brings a powerful physical uplift to all the abdominal and pelvic organs, with the intention of reversing the flow of apana and with the same effects on the release of blood from the womb as described above. This bandha, like Jalandhara bandha (chin lock) works synergistically with the pelvic floor so that when Uddiyana and Jalandhara are practised correctly they tend to involve a simultaneous mula bandha, which will lift the vulva and vagina and reverse the flow of apana within. Maha bandha is a combination of all three previous locks practised at once or in

upon and requires abdominal strength, and so it can be impossible to practise them correctly during pregnancy. The action of these breaths directly and rhythmically compresses, lifts and releases the womb repeatedly. This has an unquantifiable effect on the baby inside the womb, and upon the oxygen and carbon dioxide levels in the blood circulated to the placenta and the baby. It also has the effect of reversing apana, so the same comments about menstrual flow made in relation to the bandhas apply to these breaths. Hot and/or fast yoga

The practice of yoga asana sequences which build heat, or which are done in a greatly heated environment are intended to promote greater flexibility and range of motion in the joints during asana practice. This can be problematic pre-menstrually, during pregnancy or postnatally, especially when lactating, when hormonal changes promote softness in ligaments. Pregnant women tend to be several degrees hotter than usual anyway, and their resting heart rate is much higher than normal, so speed and heat are not particularly nurturing or comfortable at this time. Some peri-menopausal women find hot yoga practice helpful in ‘burning off’ excessive heat, and others find it profoundly enervating and depleting. For women who are seeking to conceive but experiencing difficulties, then intense heat and speed in asana may have a ‘drying effect’, depleting their vital energies and


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compromising fertility. Hot fast yoga during lactation can impact adversely on breast milk production and postnatal recovery. Yoga and womb life: special times

At these special times the practices described above can be especially inappropriate. 1

At the time of conception and during the first three months of pregnancy, the whole of a woman’s pranas are mobilised in the astonishing job of creating new life. It is a delicate time. Great powers working within the womb, and so very little prana is available for anything else.

When menstruating

During menstruation the womb is under the influence of the power of a special prana (or energy flow) called apana that, amongst other things, controls the downward release of menstrual blood. The practice of vigorous pumping breaths and bandhas which reverse apana, can lengthen the time it takes to release

5 During pregnancy (14 weeks +)

As the pregnancy becomes securely established, many physiological adaptations are made by the mother’s body to accommodate the growing baby. They effect every system of the body, most significantly in terms of yoga practice, the cardiovascular system and the


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the blood. Menstruation is a time when prana naturally gravitates to the uterus to effect the shedding and renewal of the womb lining, so often the time before and the time during menstruation is a time when there is simply less available prana to put into a more externalised yoga practice such as asana. 2 When your menstrual cycle is very erratic, or absent, and you are seeking to re-establish a more regular rhythm

At these times it can be wise to avoid the fast and hot yoga in order to focus the energies towards nourishing the body in order to encourage the menstrual cycle to return or to become more regular. 3 When using an IUD (intrauterine device)

The correct positioning of an intra-uterine device is not only essential for its effective functioning, but also for comfort. Pumping breaths and uddiyana bandha can sometimes dislodge IUDs from their correct position, causing pain, bleeding or losing ‘the string’. 4 When seeking to conceive, or during early pregnancy

A woman who is seeking to conceive requires all of her energies to be available to nourish her womb and maintain her health. Very hot and fast yoga practices can compromise the rhythms of the cycle and use the pranas needed for conception. Strong practice of uddiyana bandha can also be disruptive of these energies. © Uma Dinsmore-Tuli and Ruth Gilmore, 2011 - 2015

musculoskeletal system. This means that specially modified yoga practices are best, either in yoga for pregnancy classes, or with a skilled and experienced teacher who has respect for the massive changes that occur in the mothers body, breath, mind and heart during pregnancy in preparation for birth and motherhood.

6

During the postnatal period

However her baby/ies arrived, a woman who has just given birth is in a vulnerable state, physically, emotionally and physiologically. Her joints may be unstable, abdominal and pelvic floor very weak, her emotional state very sensitive and her vitality low. Sleep deprivation and the displacement of pelvic organs are also widespread experiences during this time. Yoga practice during this period can bring many healing benefits, but it needs to be handled very carefully by knowledgeable teachers who are aware that standard approaches to asana and pranayama, including most of the practices on the ‘Caution, wombs present’ list can often do more harm than good. The same sensitive awareness should also be held during periods following miscarriage or still birth. 7

During lactation

In relation to yoga practice, it is important to know that hormones which control milk production and let-down can make ligaments very lax. Fast and heating practices can also adversely effect milk production. 8

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In this time of uncertainty when menstrual cycles may be very erratic, very heavy, or sometimes continuous, yoga practice needs to be responsive to changing, sometimes rapidly changing needs. Although some of the practices on the ‘Caution- Wombs Present’ list, for example inversions and some pumping breaths, 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

Yoga asana (done slowly and steadily) is of proven benefit in the prevention and management of osteoporosis, and many of the pumping breaths and bandhas are of value in optimising vitality. Practice of inversions and fast or hot yoga needs to be cautiously evaluated according to the capacity of the student and her previous experience and encounters with the preceding ‘special times’ (in particular her experiences with pregnancy/ies, the quality


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practices may be superbly helpful for some women but deeply depleting for others.

of her postnatal recovery/ies and the nature of her menopause) which all influence the choice of appropriate yoga after menopause.

9 Post-menopause At a glance table for womb-friendly yoga practice.

Types of yoga practice

(Key: √ = ok; X = avoid; ! = with care; ?? with extreme caution) Times of a woman’s life / times in the menstrual cycle

ns

r fast iyana to d Pum breathsMula bandha Ud bandhaJaland bandha Inversio Ho asana hara

ping During menstruation When menstrual cycle erratic / absent and you are seeking to restore balance When you are seeking to conceive (including during IVF) During first trimester of pregnancy

X X

X √

X ?

X ?

X !

? X

X

!

X

!

X

X

X

!

X

!

X

X

During second trimester of pregnancy During third trimester of pregnancy During immediate postnatal recovery period (first twelve weeks) During extended postnatal recovery period (up to 2 years) During lactation

X X X

! ! ?

X X X

! ! X

?? X X

X X X

!

!

!

!

!

??

! ! ! !

?? X X !

! ! ! !

! ! X

With prolapsed pelvic organs

?? X X ??

√

?? ! X !

During peri-menopause

??

!

!

!

!

??

Post menopause, Age, desire and agility permitting!

√

√

√

√

√

√

With an IUD in place Following miscarriage


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Bibliography and useful websites www.yonishakti.co for downloads from Yoni Shakti – worth checking regularly, new audio and video going up all the time. Top tip for support over menstrual and other explorations of women’s issues from a spiritually inspired point of view is http://www.redschool.net ‘Illuminating the path to power and wisdom’ ! A gem. Yoga therapy resources –it’s worth signing up as a member to get access to the articles and bibliographies. http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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www.iyi.org.uk 1. Women’s Health London , really useful handouts and clear information on full range of women’s

health issues for you and your clients http://www.womenshealthlondon.org.uk/ 2. Natracare’s girls menstruation information, schools project on women’s health: www.natracare.com/p347/en-GB/Teachers-Centre.aspx 3.Big Shakti , Australian yoga therapy site co-founded by Dr Swami Shankardevananda (author of many

Bihar School Yoga Therapy books). Sound, passionate writing and guidance on all things shakti: http://www.bigshakti.com/home/what-is-shakti 4.Calais-Germain, Blandine. 2003. The Female Pelvis: Anatomy and Exercises . Eastland Press: Seattle. Useful reference for this module – try out some of the exercises. 5.Chiarelli, Pauline. Women’s Waterworks. Neem press. A fabulous, world best-selling guide to the female pelvic floor, written by a physiotherapist continence advisor. A free chapter is available to down load at www.womenswaterworks.com 6. Kent, Christine, Saving the Whole Woman is a passionate and sustained argument against the surgical approach to prolapse, it offers some radical rethinking of prolapse prevention and cause. Her online forum is worth visiting for information on this topic http://www.wholewoman.com/ 7. Naish, Francesca, Natural fertility. And see her website www.fertility.com.au Vitally important perspective on fertility and lunar cycles, optimising natural fertility, managing conception and contraception. 8. Northrup, Christiane. Women’s Bodies, Women’s Wisdom; The Wisdom of the Menopause; Mother Daughter Wisdom and indeed anything else by this inspirational US MD are absolutely essential reading. Her website and forum is also well worth a visit: http://www.drnorthrup.com/ 9.Ohlig, Adelheid. 1994. Luna Yoga: Vital fertility and Sexuality. Ash Tree Publishing: Woodstock, New York. Comprehensive and inspiring – full of helpful modifications and good ideas. 10.Pope, Alexandra. The Wild Genie: The Healing Power of Menstruation . (Sally Milner Publishing, 2001); Walking with the Genie: The Modern Woman's Menstrual Health Kit (self published, 2001) The Pill: are you sure it's for you? 2008 Jane Bennett and Alexandra Pope (Allen and Unwin) Alexandra is a real menstrual guru! She runs workshops all over the world and is well worth seeking out. Also her website www.wildegenie.com is full of really valuable links to other useful sites. 11. Saraswati, Sw. Satyananda. 1984 . Kundalini Tantra. Bihar School of Yoga. Munger. Classic reference on chakra energetics. 12. Saraswati, Sw. Satyananda. 1992 [1977]. Nawa Yogini Tantra. Bihar School of Yoga. Munger. Full of insight and helpful yoga guidance on many aspects of womens’ health. Essential reference for this course, but be wary about the guidelines during pregnancy and birth. Apart from that, everything else is trustworthy. In addition, many of the practices taught in the course are described and/or illustrated in detail in the following texts written by the course tutor: Mother’s Breath: a definitive guide to yoga breathing, sound and awareness practices during pregnancy, birth, postnatal recovery and mothering. Sitaram and Sons. London. And 2002. Yoga for Living: feel Confident . Dorling Kindersley. London.Dinsmore-

Tuli, Uma. 2008. Teach yourself Yoga for pregnancy and Birth; Hodder Education, London. Educational resources on supporting women’s health through ayurveda can be found at mother Maya Tiwari’s site http://www.wisearth.org/ayurveda/index.html Useful handouts and briefing on the ecological impact of the sanitary protection industry can be round at the women’s environmental network: http://www.wen.org.uk/ Frances Lewis has inspiring blogs and articles on her site http://www.franceslewis.co.uk/


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Section 1 Mark each statement T or F for True or False in the left hand margin. If you do not know the answer put DK (don’t know). A correct answer scores 1 mark, don’t know scores 0 and wrong answers score minus 1, so DO NOT GUESS! The questions are arranged in groups of five for convenience of marking only.

1.

Luteinising Hormone (LH) secretion is an important trigger for ovulation.

2.

In a menstrual cycle where fertilisation does not occur, the corpus luteum degenerates after about a month’s activity.

3.

In polycystic ovary syndrome (PCOS) endometrial tissue is found in sites other than the uterine lining.

4.

Painful periods are usually associated with spasmodic uterine contractions.

5.

The fundus of the uterus is the part adjacent to the cervix.

6.

The cervix projects downwards into the upper vagina.

7.

The clitoris is the only part of the female genitalia that contains erectile tissue.

8.

The breast lies over the pectoral muscle but is only loosely attached to it.

9.

The vagina contains numerous mucus-secreting glands in its walls.

10.

The perineum is the diamond-shaped area bounded by the ischial tuberosities, coccyx tip and pubic symphysis.

11.

The deepest layer of the endometrium remains after the end of the menses each month.

12.

Egg cells in the ovaries decline significantly in numbers between birth and puberty.

13.

In an ovarian follicle the supporting cells around the ovum produce hormones.

14.

Menarche is defined as the first day of the first menstrual period at puberty.

15.

Ovulation occurs around day 14 of a 21-day cycle.

16.

On day 14 of a 28-day cycle, the uterine endometrium is at its thickest.

17.

Ovulation can produce lower abdominal pain at around the mid-point of a 28-day cycle.

18.

Progestins (including progesterone) produce some increase in breast size and sometimes tenderness just before the onset of the menses.

19.

The menses in an average woman would involve the loss of around 350ml of blood per cycle.


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20.

The bag of enzymes at the head end of a single sperm contains enough enzymes to penetrate through the wall of the ovum.

21.

During reproductive life vaginal secretions are slightly acidic in order to protect against invading bacteria.

22.

By the time a fertilised egg embeds in the endometrium it has developed into a hollow ball of cells.

23.

The lining of the uterine (Fallopian) tubes secretes a chemical attractant that encourages the ovum to enter the open end of the tube.

24.

The finger like processes at the open end of the uterine (Fallopian) tube move to waft the ovum into the open end of the tube.

25.

Each ovary is attached to the uterus by a strand of fibrous tissue called a ligament.

26.

The pelvic floor muscle sheet consists of smooth muscle.

27.

The pelvic floor muscle sheet becomes weaker at the menopause due partly to the drop in oestrogen levels in the blood. The secretion of hormones from the corpus luteum is controlled by the hypothalamus and anterior pituitary.

28.

29.

Urge incontinence is caused primarily by pelvic floor weakness.

30.

Chin hair development in post-menopausal women is due to testosterone secreted by the adrenal cortex.

31.

Chlamydia is the commonest sexually-transmitted disease in UK women.

32.

The uterine (Fallopian) tubes have cilia in their lining that beat in the direction of the uterus.

33.

Previous pelvic infection is the commonest cause of uterine (Fallopian) tubal blockage.

34.

Fertilisation occurs most commonly within the cavity of the uterus.

35.

Clitoral erection occurs due to the action of sympathetic nerves on the clitoral arteries, allowing the erectile tissue to fill with blood.

Section 2

Answer all of the questions from 1 – 5 by putting a tick against the answer or answers that you feel is most correct for each question.

1. Which two aspects of yoga are most likely to be helpful for women who experience a range of difficulties associated with pre-menstrual tension?

Restorative poses ➢ Vinyasa sequences ➢ Swadhyaya (self-study) ➢ Hot yoga ➢


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2. Which three chakras are the most directly influential in terms of issues concerning the female reproductive system?

Muladhara ➢ Swadisthana ➢ Manipura ➢ Anahata ➢ Vishuddhi ➢

3. As a general guide, during peri-menopause, fluctuations in temperature and mood swings can be understood as an imbalance of which two dosha/s?

Vata ➢ Pitta ➢ Kapha ➢

4. As a general rule, in cases of subfertility, what single range of practices are likely be the most valuable in any yoga therapy programme?

Asana ➢ Pranayama ➢ Deep relaxations ➢ Kriyas ➢

5. In management of uterine prolapse postnatally, which two of the following bandhas (in modified forms if necessary) may prove most helpful?

Shakti bandha/s ➢ Uddiyana bandha ➢ Jalandhara bandha ➢ Mulabandha ➢

6. In management of natural fertility, which four of the following aspects of female fertility are observed to provide guidance for conception and contraception?

Cervical mucus changes ➢ Oestrogen levels ➢ Basal temperature ➢ Responses to synthetic hormones ➢ Lunar biorhythm ➢ Cycle awareness ➢

7. During which three of the following times in a women’s menstruating life may non-ovulatory and/or erratic periods be considered perfectly normal?

mid thirties ➢ teens ➢ during breastfeeding ➢ late twenties ➢ during peri-menopause ➢

8. When designing yoga therapy for menstrual difficulties of any kind, which three of the following strategies are the most important first steps?

Sufficient rest around the pre-menstruum

➢


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Regularawareness daily asana practice Cycle diaries

➢


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Twice daily meditation ➢ Lunar cycles and biorhythm awareness ➢ Daily pranayama ➢

9. When teaching yoga to a general class that includes women of childbearing age, which four of the following questions are most crucial to ask (discretely, or publicly according to your relationship with your students) before deciding what is appropriate to teach?

What level of asana practice is usual for you? ➢ Have you had a baby in the past three years? ➢ How long have you been practicing yoga? ➢ What is your favourite style of yoga? ➢ Are you breastfeeding? ➢ Where are you in your menstrual cycle today? ➢ Have you got an IUD? ➢

10. When teaching yoga to women, which three of the following categories of yoga techniques are most likely to require caution from the teacher?

Yoga Nidra ➢ Pumping breaths ➢ Forward bends ➢ Twists ➢ Inversions ➢ Long-sustained standing poses ➢ Uddiyana bandha variations ➢ Restoratives ➢


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Page 72 Section 3: these are longer questions to consider at your leisure – guidance for medal answers will be provided before the close of the course. Please read all the following scenarios and answer all the questions pertaining to each. These case studies are composite characters based on real experiences. A. On menstruation:

Esther is 22 years old, and experiences a very heavy menstrual flow accompanied by extreme pain. She has been told by her GP that the pain may be due to endometriosis, and that further investigations are recommended. Her cycle is fairly short (less than 21 days usually) and she is also very anxious that her menstrual problems will impede her ability to study and perform well in her upcoming degree coursework and exams. She has already been practising ashtanga vinyasa primary series for two years.

1. What do you need to know about Esther and her life to help design a suitable holistic programme of yoga therapy? Write five questions to ask her in the first session. 2. What three key suggestions might you make to her about the suitability of her current yoga practice? 3. What two pain relief practices would you suggest to her to be done during menstruation to manage discomfort? 4. What two prevention practices/strategies would you suggest to her to be done throughout the rest of the month. 5. What two techniques for management of anxiety would you suggest to her to integrate into her life?

B. On peri-menopause:

Joan is 52 and experiencing frequent hot flushes (most nights and 3 or 4 times an hour on a bad day) and erratic mood swings. She describes herself as 'Mrs Angry" and is very alarmed by the level of rage she feels, and by the faintness and weakness and exhaustion that follows the hot flushes. Joan has never done any yoga before, but is fit and well because she has always been a keen swimmer and hill walker. She is desperate for some help and has been recommended to try yoga by her daughter. She is really keen to get started. 1. What do you need to know about Joan and her life to help design a suitable holistic programme of yoga therapy? Write five questions to ask her in the first session. 2. What three general suggestions might you make to her about yogic lifestyle during peri-menopause? 3. What two heat relief practices would you suggest to her to be done during her hot flushes to manage discomfort? 4. What two anger management practices/strategies would you suggest to her to be used during a bout of rage? 5. What other two yoga practices (of any kind: could be asana, or pranayama or anything else) would you suggest to her to integrate into her life with the intention to promote balance and lessen the distressing symptoms she is experiencing? http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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Page 73 3. On subfertility:

Sasha is a 38 year old busy lawyer for an international merchant banking company. She works long hours in the City, travels frequently on long haul flights. She is married and she and her husband are keen to have a family. They have been 'trying for a baby' for the past two years. Sasha has conceived twice in that time, but both pregnancies ended in miscarriage at 8 and twelve weeks respectively. She is considering IVF, but a friend who recently conceived after starting a yoga class recommended yoga and acupuncture first as a route to natural conception, so Sasha is giving the 'alternative' approach a six month trial. She has done a little yoga before, and enjoyed Ashtanga vinyasa and Bikram yoga. Currently though she prefers working out in the company gym with her personal trainer, and when she has the time she likes to run. 1. What do you need to know about Sasha and her life to help design a suitable holistic programme of yoga therapy? Write five questions to ask her in the first session. 2. What two key suggestions might you make to her about the suitability of her current yoga practice and exercise regime? 3. What three general suggestions might you make to her about yogic lifestyle as a means to support conscious conception (this may include some simple philosophical pointers)? 4. What two daily practices would you suggest to her to be done to optimise fertility?

4. On uterine prolapse and postnatal recovery:

Libby is 36 and is mother to one son and 3 daughters: her son is six years old, her oldest daughter is four years old and the youngest two daughters are 4 month old twins. All pregnancies were healthy, and all her children were spontaneous vaginal births in the local hospital. Her first daughter was positioned awkwardly and required ventouse (suction cup) to assist her birth, but the other children were, as Libby describes it 'fairly straightforward births'. The twins were, remarkably 5.5lbs and 6lbs at birth, and the pregnancy lasted for 38 weeks, which is unusually long for a twin pregnancy. Since the birth of the twins Libby has experienced mild uterine prolapse, which especially troubles her when she is pushing the twins in the pushchair - 'it feels as though my insides are outside.' She attributes the problem to getting up and back on her feet too soon after the birth of the twins. Other than this issue, Libby is in good health, but complains of mild lower back ache, a saggy tummy and exhaustion. She comes to yoga therapy primarily for help in managing the prolapse problem, and you are a 'last resort', since she has already seen her GP, and been referred to a physiotherapist, who referred her to a personal trainer at the local gym. None of the previous health care providers has given her anything of help. 1. What do you need to know about Libby and her life to help design a suitable holistic programme of yoga therapy? Write five questions to ask her in the first session. 2. What two key primary practices might you suggest to lessen her distressing experience of prolapse http://webcache.googleusercontent.com/search?q=cache:http://www.yonishakti.co/sites/default/files/fi les/2015%2520Stroud%2520Womb%2520Yoga%25…

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symptoms? 3. What two daily practices would you suggest to her to be done to optimise support for pelvic organs? 4. How do you suggest that Libby integrate yoga practice in her busy life?


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