Menstruation & Inversions

During a typical yoga class there may be several people who are currently menstruating. When the class sequencing moves to the stage where inversions are practiced, I offer to provide anyone passing on inversions an alternative that’s a better fit for their circumstances. I do not tell students to pass on inversions because they’re menstruating.

Occasionally I’ll share the background for my suggestion that practitioners refrain from inverting while menstruating. Sharing this background, publicly talking about menstruation, especially in front of other men, helps reframe menstruation culturally as an untaboo, normal, and helpful subject to address. This sharing of information, and the discussion which emerges from it during class, takes considerable time. So it is impractical to do so every time we practice inversions. It wouldn’t meet the needs of students who’ve been attending for years and have spent valuable class time listening and discussing previously. And, at the same time, it’s necessary to share the information with students who are new to the class, or who are new to inversions.

At times I receive feedback from third parties after speaking about inversions and menstruation during class. They report hearing one of my students say something about my explanation to which they take issue. Something gets lost in translation, or the outside party has a different take on the subject.

To make the most of our in-class time together, to inform those who need the information, and to help reduce the noise in the signal broadcast outside of class, I’m writing this brief piece to share with students. It conveys my perspective on the subject and hopefully provides enough information for students to self-determine the best course of action when inversions are presented in class.

Four primary elements constitute the background for my suggestion that practitioners refrain from inverting during menstruation.

First, I understand that inverting during menstruation feels empowering. That it asserts the practitioner controls their own body and the choices related to their reproductive organs. That it affirms menstruation is not a barrier to their goals, performance ability and success. I applaud their desire to claim and act upon their own rightful agency; to model for others strength in the face of cultural expectation. Each person can determine what actions/inactions best serve their personal motives and act accordingly. Want to invert? Please do. Don’t want to invert? Please don’t.

Second, inversion during menstruation brings an associated risk with endometriosis. The cause of endometriosis is not yet determined(1). Retrograde menstruation is one of many competing theories exploring the cause(2). It says that endometrial debris can migrate backward from the expected pathway and take residence in the peritoneum, contributing to endometriosis(3). Although this theory is not without issues and cannot explain all incidences of endometriosis(4), it is still currently being considered as a contributor and possible trigger to endometriosis. The Mayo Clinic(5) and National Endometriosis Society(6) both list retrograde menstruation as a possible factor in endometriosis development. The risk of endometriosis taking root by inverting during menstruation is low, but it is still non-zero. As long as the cause is unknown, the theory of retrograde menstruation as a contributor to endometriosis is not disproven, and nationally recognized public health organizations consider it a risk, it seems prudent to me to suggest students avoid inverting during menstruation to help reduce their risk of adverse health events.

Third, during menstruation the blood descends from the uterus and exits the body. It moves inferiorly (away from the head) in anatomical terms. Yoga helps us unite in harmony with nature. Spending time in poses which encourage a superior (towards the head) migration of discharging blood, while the organism’s design moves it inferiorly, calls into question the ego’s role in yoga practice. One understanding would be that yoga helps the ego become congruous with, and synchronized to, the wholeness of life and it’s movements.

Forth, a number of well respected, senior-level, female yoga teachers advocate for students to refrain from inversions during menstruation, and some advise modifying practice more substantially during menstruation.

“During the monthly period (48 to 72 hours) complete rest is advisable. Asanas should not be practiced...Normal practice may be resumed from the fourth or fifth day.”(7)

“During menstruation the following must be avoided: [listed below]. Under no circumstances should headstand and shoulderstand be performed.”(8)

salamba sirsasana and sirsasana variations
sarvangasana and sarvangasana variations
urdhva prasarita padasana
paripurna navasana
jathara parivartanasana
urdvha mukha paschimottanasana II
supta padangusthasana
utthita hasta padangusthasana
ustrasana
urdhva mukha svanasana
dhanurasana
urdhva dhanurasana
dvi pada viparita dandasana

“During Menstruation, practice only the sequences for that period [listed below]. Inverted poses are not suitable, because they disturb the blood flow.”(9)

First 48-72 hours:
Viloma I Pranayama
Restorative version of supta baddha konasana
savasana

Sequence to start on day 3, 4 or 5:
ardha uttanasana
padangusthasana
utthita trikonasana
utthita parsvakonasana
baddha konasana
supta baddha konasana
upa vista konasana
virasana
parvatasana in virasana
supta virasana
matsyasana
savasana

Lastly, I am aware that it is becoming popular for yoga teachers to advise students to invert during menstruation. To test it and see how they respond. That if they don’t feel bad afterwards, then its ok for them.

Many students struggle to connect with the more subtle aspect of alignment, sensation and anatomy. Finding the lesser trochanter, a hard, prominent, bony protruberance on the upper-inner thighbone presents an exceptional challenge for most students, to say nothing of the obturator foramen. Students struggle to place their awareness at and then feel these basic, gross, macro structures.

Can they really be expected to discern whether endometrial tissue migrated to a problematic location while inverting during menstruation? Do we think they can feel units of endometrial tissue migrating through deep inner space? Can they be realistically expected to have the interoceptive skill to track whether hormone signaling between the reproductive organs and the pituitary gland was negatively affected when they inverted during menstruation? Simply because the student does not sense anything amiss does not mean that unhealthy process development was avoided.

I find this approach beyond my comfort zone as a yoga teacher, guiding students in pursuit of health. I understand other yoga teachers think differently. For those teachers who are interested in exploring this approach, I encourage them to entreat local medical scientists, and their own student base, to design a longitudinal study so that we can start building a statistically significant dataset which pertains directly to yogic inversions during menstruation. It would be fantastic information to have, and support millions of practitioners worldwide in dropping irrelevant handed-down edicts for those menstruating, while bolstering their confidence in choosing how to modify their practice to secure their health.


sources

1 - Bulletti C, Coccia ME, Battistoni S, Borini A (August 2010). “Endometriosis and infertility”. Journal of Assisted Reproduction and Genetics. 27 (8): 441–7. doi:10.1007/s10815-010-9436-1. PMC 2941592. PMID 20574791.

2 - van der Linden PJ (November 1996). “Theories on the pathogenesis of endometriosis”. Human Reproduction. 11 Suppl 3: 53–65. doi:10.1093/humrep/11.suppl_3.53. PMID 9147102.

3 - Fauser BC, Diedrich K, Bouchard P, Domínguez F, Matzuk M, Franks S, Hamamah S, Simón C, Devroey P, Ezcurra D, Howles CM (2011). “Contemporary genetic technologies and female reproduction”. Human Reproduction Update. 17 (6): 829–47. doi:10.1093/humupd/dmr033. PMC 3191938. PMID 21896560.

4 - Endopaedia website (2018) Retrieved from http:endopaedia.info.

5 - Mayo Clinic website (2019). Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/expert-answers/endometriosis-causes/faq-20455781

6 - Endometriosis Association website (2019). Retrieved from https://endometriosisassn.org/about-endometriosis/causes

7 - Iyengar, Geeta S. (1990) “Yoga: A Gem for Women” (p. 77). Kootenay Bay, BC: Timeless Books.

8 - Iyengar, Geeta S. (1990) “Yoga: A Gem for Women” (p. 78). Kootenay Bay, BC: Timeless Books.

9 - Iyengar, G. S., Keller, R., Khattab, R. (2010). “Iyengar Yoga for Motherhood, Safe Practice for Expectant & New Mothers” (p.395). New York, NY: Sterling Publishing.