title: Physical activity and mental health outcomes during menopause: A randomized controlled trial Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial A pilot study of a Hatha yoga treatment for menopausal symptoms. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study 12-MONTH FOLLOW-UP OF YOGA AND BIO-FEEDBACK IN THE MANAGEMENT OF HYPERTENSION Effect of pranayam training on cardiac function in normal young volunteers. The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial Clonidine raises the sweating threshold in symptomatic but not in asymptomatic postmenopausal women. Is sternal skin conductance monitoring a valid measure of hot flash intensity or distress?
abstract: Background : Many women experience detriments in mental health during the menopausal transition . Physical activity may attenuate these adverse outcomes but few studies investigating such effects exist . Purpose : This study examined the effects of a 4-month r and omized controlled exercise trial on mental health outcomes in 164 previously low-active middle-aged women ( M age=49.9 ; SD=3.6 ) . Methods and Results : Participants completed body composition and fitness assessment and a battery of psychological measures at the beginning and end of a 4-month r and omized controlled exercise trial with three arms : walking , yoga , control . The results indicated that walking and yoga were effective in enhancing positive affect and menopause-related QOL and reducing negative affect . Women who experienced decreases in menopausal symptoms across the trial also experienced improvements in all positive mental health and QOL outcomes and reductions in negative mental health outcomes . Whether menopausal symptoms increased or decreased across the trial appeared to be determined in part by whether there were increases or decreases in cardiorespiratory fitness . Conclusions : Physical activity appears to enhance mood and menopause-related QOL during menopause , however , other aspects of mental health may be affected only as a result of reduction in menopausal symptoms . Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms CONTEXT The Heart and Estrogen/progestin Replacement Study ( HERS ) found no overall reduction in risk of coronary heart disease ( CHD ) events among postmenopausal women with CHD . However , in the hormone group , findings did suggest a higher risk of CHD events during the first year , and a decreased risk during years 3 to 5 . OBJECTIVE To determine if the risk reduction observed in the later years of HERS persisted and result ed in an overall reduced risk of CHD events with additional years of follow-up . DESIGN AND SETTING R and omized , blinded , placebo-controlled trial of 4.1 years ' duration ( HERS ) and subsequent unblinded follow-up for 2.7 years ( HERS II ) conducted at outpatient and community setting s at 20 US clinical centers . PARTICIPANTS A total of 2763 postmenopausal women with CHD and average age of 67 years at enrollment in HERS ; 2321 women ( 93 % of those surviving ) consented to follow-up in HERS II . INTERVENTION Participants were r and omly assigned to receive 0.625 mg/d of conjugated estrogens and 2.5 mg of medroxyprogesterone acetate ( n = 1380 ) , or placebo ( n = 1383 ) during HERS ; open-label hormone therapy was prescribed at personal physicians ' discretion during HERS II . The proportions with at least 80 % adherence to hormones declined from 81 % ( year 1 ) to 45 % ( year 6 ) in the hormone group , and increased from 0 % ( year 1 ) to 8 % ( year 6 ) in the placebo group . MAIN OUTCOME MEASURES The primary outcome was nonfatal myocardial infa rct ion and CHD death . Secondary cardiovascular events were coronary revascularization , hospitalization for unstable angina or congestive heart failure , nonfatal ventricular arrhythmia , sudden death , stroke or transient ischemic attack , and peripheral arterial disease . RESULTS There were no significant decreases in rates of primary CHD events or secondary cardiovascular events among women assigned to the hormone group compared with the placebo group in HERS , HERS II , or overall . The unadjusted relative hazard ( RH ) for CHD events in HERS was 0.99 ( 95 % confidence interval [ CI ] , 0.81 - 1.22 ) ; HERS II , 1.00 ( 95 % CI , 0.77 - 1.29 ) ; and overall , 0.99 ( 0.84 - 1.17 ) . The overall RHs were similar after adjustment for potential confounders and differential use of statins between treatment groups ( RH , 0.97 ; 95 % CI , 0.82 - 1.14 ) , and in analyses restricted to women who were adherent to r and omized treatment assignment ( RH , 0.96 ; 95 % CI , 0.77 - 1.19 ) . CONCLUSIONS Lower rates of CHD events among women in the hormone group in the final years of HERS did not persist during additional years of follow-up . After 6.8 years , hormone therapy did not reduce risk of cardiovascular events in women with CHD . Postmenopausal hormone therapy should not be used to reduce risk for CHD events in women with CHD OBJECTIVE To determine the feasibility and acceptability of a restorative yoga intervention for the treatment of hot flushes in postmenopausal women . METHODS A pilot trial in 14 postmenopausal women experiencing > or = 4 moderate to severe hot flushes per day or > or = 30 moderate to severe hot flushes per week . The intervention consisted of eight restorative yoga poses taught in a 3-h introductory session and 8 weekly 90-min sessions .  Feasibility was measured by recruitment rates , subject retention and adherence . Acceptability was assessed by subject interview and question naires . Efficacy measures included change in frequency and severity of hot flushes as recorded on a 7-day diary . RESULTS Recruitment was accomplished as planned . The majority of study subjects ( 93 % ) completed the trial . Of those who completed the trial , 92 % attended seven or more of the eight yoga sessions . The majority of the subjects were satisfied with the study and 75 % continued to practice yoga 3 months after the study . Mean number of hot flushes per week decreased by 30.8 % ( 95 % CI 15.6 - 45.9 % ) and mean hot flush score decreased 34.2 % ( 95 % CI 16.0 - 52.5 % ) from baseline to week 8 . No adverse events were observed . CONCLUSIONS This pilot trial demonstrates that it is feasible to teach restorative yoga to middle-aged women without prior yoga experience . The high rates of subject retention and satisfaction suggest that yoga is an acceptable intervention in this population . Our results indicate that a larger , r and omized controlled trial to explore the efficacy of restorative yoga for treatment of menopausal symptoms would be safe and feasible CONTEXT Despite decades of accumulated observational evidence , the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain . OBJECTIVE To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States . DESIGN Estrogen plus progestin component of the Women 's Health Initiative , a r and omized controlled primary prevention trial ( planned duration , 8.5 years ) in which 16608 postmenopausal women aged 50 - 79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993 - 1998 . INTERVENTIONS Participants received conjugated equine estrogens , 0.625 mg/d , plus medroxyprogesterone acetate , 2.5 mg/d , in 1 tablet ( n = 8506 ) or placebo ( n = 8102 ) . MAIN OUTCOMES MEASURES The primary outcome was coronary heart disease ( CHD ) ( nonfatal myocardial infa rct ion and CHD death ) , with invasive breast cancer as the primary adverse outcome . A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke , pulmonary embolism ( PE ) , endometrial cancer , colorectal cancer , hip fracture , and death due to other causes . RESULTS On May 31 , 2002 , after a mean of 5.2 years of follow-up , the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits . This report includes data on the major clinical outcomes through April 30 , 2002 . Estimated hazard ratios ( HRs ) ( nominal 95 % confidence intervals [ CIs ] ) were as follows : CHD , 1.29 ( 1.02 - 1.63 ) with 286 cases ; breast cancer , 1.26 ( 1.00 - 1.59 ) with 290 cases ; stroke , 1.41 ( 1.07 - 1.85 ) with 212 cases ; PE , 2.13 ( 1.39 - 3.25 ) with 101 cases ; colorectal cancer , 0.63 ( 0.43 - 0.92 ) with 112 cases ; endometrial cancer , 0.83 ( 0.47 - 1.47 ) with 47 cases ; hip fracture , 0.66 ( 0.45 - 0.98 ) with 106 cases ; and death due to other causes , 0.92 ( 0.74 - 1.14 ) with 331 cases . Corresponding HRs ( nominal 95 % CIs ) for composite outcomes were 1.22 ( 1.09 - 1.36 ) for total cardiovascular disease ( arterial and venous disease ) , 1.03 ( 0.90 - 1.17 ) for total cancer , 0.76 ( 0.69 - 0.85 ) for combined fractures , 0.98 ( 0.82 - 1.18 ) for total mortality , and 1.15 ( 1.03 - 1.28 ) for the global index . Absolute excess risks per 10 000 person-years attributable to estrogen plus progestin were 7 more CHD events , 8 more strokes , 8 more PEs , and 8 more invasive breast cancers , while absolute risk reductions per 10 000 person-years were 6 fewer colorectal cancers and 5 fewer hip fractures . The absolute excess risk of events included in the global index was 19 per 10 000 person-years . CONCLUSIONS Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2-year follow-up among healthy postmenopausal US women .  All-cause mortality was not affected during the trial . The risk-benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases , and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD OBJECTIVE To assess the feasibility and efficacy of a yoga treatment for menopausal symptoms . Both physiologic and self-reported measures of hot flashes were included . METHODS A prospect i ve within-group pilot study was conducted . Participants were 12 peri- and post-menopausal women experiencing at least 4 menopausal hot flashes per day , at least 4 days per week . Assessment s were administered before and after completion of a 10-week yoga program . Pre- and post-treatment measures included : Severity of question naire-rated menopausal symptoms ( Wiklund Symptom Check List ) , frequency , duration , and severity of hot flashes ( 24-h ambulatory skin-conductance monitoring ; hot-flash diary ) , interference of hot flashes with daily life ( Hot Flash Related Daily Interference Scale ) , and subjective sleep quality ( Pittsburgh Sleep Quality Index ) .  Yoga classes included breathing techniques , postures , and relaxation poses design ed specifically for menopausal symptoms . Participants were asked to practice at home 15 min each day in addition to weekly classes . RESULTS Eleven women completed the study and attended a mean of 7.45 ( S.D. 1.63 ) classes . Significant pre- to post-treatment improvements were found for severity of question naire-rated total menopausal symptoms , hot-flash daily interference ; and sleep efficiency , disturbances , and quality . Neither 24-h monitoring nor accompanying diaries yielded significant changes in hot flashes . CONCLUSIONS The yoga treatment and study procedures were feasible for midlife women . Improvement in symptom perceptions and well being warrant further study of yoga for menopausal symptoms , with a larger number of women and including a control group Objective : To study the effect of yoga on the climacteric symptoms , perceived stress , and personality in perimenopausal women . Design : One hundred twenty participants ( ages 40 - 55 y ) were r and omly divided into two study arms , ie , yoga and control . The yoga group practice d an integrated approach to yoga therapy comprising surya namaskara ( sun salutation ) with 12 postures , pranayama ( breathing practice s ) , and avartan dhyan ( cyclic meditation ) , whereas the control group practice d a set of simple physical exercises under supervision of trained teachers for 8 weeks ( 1 h daily , 5 days per week ) . The assessment s were made by Greene Climacteric Scale , Perceived Stress Scale , and Eysenck 's Personality Inventory before and after the intervention . Results : Of the three factors of the Greene Climacteric Scale , the Mann-Whitney test showed a significant difference between groups ( P < 0.05 ) in the vasomotor symptoms , a marginally significant difference ( P = 0.06 ) in psychological factors but not in the somatic component . Effect sizes were higher in the yoga group for all factors . There was a significantly greater degree of decrease in Perceived Stress Scale scores ( P < 0.001 , independent sample s t test ) in the yoga group compared with controls ( between-group analysis ) with a higher effect size in the yoga group ( 1.10 ) than the control ( 0.27 ) . On the Eysenck 's Personality Inventory , the decrease in neuroticism was greater ( P < 0.05 ) in the yoga group ( effect size = 0.43 ) than the control group ( effect size = 0.21 ) with no change in extroversion in either the yoga or control group . Conclusions : Eight weeks of an integrated approach to yoga therapy decreases climacteric symptoms , perceived stress , and neuroticism in perimenopausal women better than physical exercise Twenty hypertensive patients treated by psychophysical relaxation exercises  were followed up monthly for 12 months . Age and sex matched hypertensive controls were similarly followed up for 9 months . Statistically significant reductions in blood-pressure ( BP ) and antihypertensive drug requirements were satisfactorily maintained in the treatment group . Mere repetition of B.P. measurements and increased medical attention did not in themselves reduce B.P. significantly in control patients Systolic time intervals ( STI ) are non-invasive and sensitive tests for measuring the ventricular performance . It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions . Keeping this in view , the present study was design ed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests ( AFT ) .  Twenty four school children were r and omly divided into two groups of twelve each . Group I ( pranayam group ) subjects were given training in nadishuddhi , mukh-bhastrika , pranav and savitri pranayams and practice d the same for 20 minutes daily for a duration of 3 months . Group II ( control group ) subjects were not given any pranayam training .  STI ( QS2 , LVET and PEP ) and AFT ( RRIV and QT/QS2 ) were measured in both the groups at the beginning and again at the end of three months study period . Pranayam training produced an increase in RRIV and a decrease in QT/QS2 , suggesting an enhanced parasympathetic and blunted sympathetic activity respectively . QS2 , PEP and PEP/LVET increased significantly , whereas LVET was reduced significantly in pranayam group . In contrast , the changes in STI and AFT were much less marked in the control group . Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity . Further studies on a larger sample size may illustrate the underlying mechanism(s ) involved in this alteration & NA ; The issue of what constitutes an effective and realistic acupuncture placebo control has been a continuing problem for acupuncture research . In order to provide an effective placebo , the control procedure must be convincing , visible and should mimic , in all respects , apart from a physiological effect , the real active treatment . The ‘ Streitberger ’ needle might fulfil these criteria and this paper reports on a validation study . This was a single‐blind , r and omised , cross‐over pilot study . Patients were drawn from the orthopaedic hip and knee , joint replacement waiting list . Intervention consisted of either 2 weeks of treatment with real acupuncture followed by 2 weeks on placebo , or vice versa . The prime outcome was a needle sensation question naire and there was a range of secondary outcomes . Thirty‐seven patients were r and omised and completed treatment . Groups were well balanced at baseline . No significant differences between groups or needle types were found for any of the sensations measured . Most patients were unable to discriminate between the needles by penetration ; however , nearly 40 % were able to detect a difference in treatment type between needles . No major differences in outcome between real and placebo needling could be found . The fact that nearly 40 % of subjects did not find that the two interventions were similar , however , raises some concerns with regard to the wholesale adoption of this instrument as a st and ard acupuncture placebo . Further work on inter‐tester reliability and st and ardisation of technique is highly recommended before we can be confident about using this needle in further studies OBJECTIVE To determine the effects of clonidine , which reduces central sympathetic activation , on the sweating threshold in postmenopausal women with and without hot flashes . DESIGN Laboratory physiologic study . SETTING University medical center . PATIENT(S ) 12 healthy postmenopausal women reporting frequent hot flashes and 7 reporting none . INTERVENTION(S ) In two separate sessions , participants received a blind intravenous injection of clonidine HCl ( 2 microg/kg of body weight ) or placebo , followed by body heating . MAIN OUTCOME MEASURE(S ) Core body temperature , mean skin temperature , sweat rate , sternal skin conductance level , and blood pressure . RESULT ( S ) Symptomatic women had significantly lower core body temperature sweating thresholds than asymptomatic women after receiving placebo . Clonidine significantly increased this threshold in symptomatic women but lowered it in asymptomatic women . CONCLUSION ( S ) These results support the hypothesis that elevated brain norepinephrine levels reduce the sweating threshold in symptomatic women , thereby contributing to the initiation of menopausal hot flashes Objective : To examine the validity of using sternal skin conductance monitoring as a measure of hot flash intensity and hot flash distress . Design : Descriptive , prospect i ve , longitudinal data from the 2-week baseline of a larger hot flash intervention study ; 73 breast cancer survivors with daily hot flashes wore a hot flash monitor  and completed a hot flash diary  during two 24-hour assessment periods that were separated in time by 1 week . Results : Data consisted of 569 diary rated hot flashes  ; 46.9 % had magnitude of less than 2.0 micromhos ( insufficient to meet objective hot flash criterion ) and 26.3 % had magnitude of 0.0 micromho ( no change in skin conductance ) . Results from mixed-linear modeling indicated that , although magnitude significantly predicted hot flash intensity and distress , effect sizes were very small : less than 2 % when using all observations , and less than 1 % when using only the subset meeting objective hot flash criteria . Even after adjusting for covariates that were associated with intensity or distress , magnitude explained very little variance in intensity or distress ( < 2.2 % ) . Scatterplots and locally weighted smooth regression curves also revealed very little relationship between magnitude and either intensity or distress . Conclusions : Findings indicate that objective change in sternal skin conductance , an indicator of sweat gl and activity , should not be used as a proxy measure of subjective hot flash intensity or distress . Future research should continue to subjectively measure hot flash intensity and distress when these are important outcome variables to consider
target: A recent cross-sectional analysis in the multiethnic Study of Women ’s Health Across the Nation found that 53 % of the participants used some form of CAM ( excluding diet , vitamins , exercise , and prayer ) and that rates of use generally did not vary by menopausal status or by presence of vasomotor symptoms .
  Significant improvements were also found in sleep quality ( P = 0.02 ) and
background: I n the wake of serious health concerns raised by the Women ’s Health Initiative and Heart and Estrogen/ progestin Replacement Study clinical trials , prescriptions for hormone therapy have declined dramatically , leaving many women without effective treatment for menopausal symptoms .
  Several nonhormonal pharmacologic therapies have shown promise for reducing vasomotor symptoms , including selective serotonin reuptake inhibitors , gabapentin , and clonidine .
  However , most are only modestly effective , and all have side effects that may limit their use .
  A number of herbal therapies are marketed to women as being safe and effective in reducing menopausal symptoms , including phytoestrogens , black cohosh , dong quai , evening primrose oil , and red clover .
  Still , interest in nonhormonal and particularly in complementary and alternative medicine ( CAM ) therapies for menopausal symptoms remains strong .
  The term yoga is derived from the Sanskrit term yuj , meaning Bto yoke^ or Bto unite,^ and the goal of yoga has been described as uniting the body and mind to achieve enlightenment .
  Yoga has become increasingly popular outside of India , with a 2008 survey of 5,050 people estimating that 7 % of US adults practice yoga .
  Clinical trials have also demonstrated many potential health benefits of yoga , including reductions in blood pressure , dyslipidemia , and insulin resistance .
  Although the exact mechanisms of hot flashes remain unknown , physiologic studies have demonstrated that heightened sympathetic nervous system activity plays an important role .
  Small uncontrolled studies have shown that yoga increases heart rate variability and decreases oxygen consumption , heart rate , and blood pressure , all indicative of decreased sympathetic activity .
  In addition to its biological effects , yoga may also have beneficial psychological effects that could lead women to find physical symptoms less bothersome and /or help them to cope better with changes during menopause .
  In this issue of Menopause , Chattha and colleagues report results from one of the largest published trials of yoga for menopausal symptoms .
  Despite the increasing popularity of yoga , a yoga intervention requiring 60 minutes of supervised instruction five times per week may not be practical for many Western women .