Is It Safe to Practice Inversions During Menstruation?

As a yoga teacher, that is still one of the questions I receive most frequently. Many students have been taught that inverting during menstruation (i.e., practicing poses such as handstand, forearmstand, headstand, or shoulderstand) is unhealthy and unsafe, and that it should be strictly avoided—only to then practice with another instructor who says that doing inversions during menstruation is just fine. Yoga teachers seem divided on the topic.

For the most part, B.K.S. Iyengar’s school of yoga forbids inversions during menstruation. The Ashtanga Vinyasa School created by Sri K. Pattabhi Jois encourages taking a “ladies’ holiday” during the first three days of one’s period (i.e., refraining from practice altogether during this time). Countless other schools of hatha yoga are either strongly against or undecided as to whether practitioners should invert during their periods.

So what's the truth? Is it safe to do inversions while menstruating or not?

According to yogic philosophy and ayurveda, apana, downward flowing energy, is responsible for both healthy elimination (including urination and other excretions) and reproductive cycles (including menstruation). It is thought that inverting the body (specifically, the uterus) while menstruating disturbs the natural movement of apana.

However, in contemporary yoga classes there are often inconsistencies in the application of this theory, as poses such as standing forward folds or downward facing dog (which also invert the uterus) are typically not considered to be contraindicated for students who are menstruating.

Traditional hatha yoga holds that mula bandha can also disturb the natural downward flow during menstruation by creating an energetic “lock” that holds menstrual fluid in the body, rather than allowing it to naturally release. Mula bandha, or the root lock, is practiced during many vigorous forms of yoga (notably Ashtanga) and is discouraged during menstruation, due to the restriction of apana it is said to create. This is why some schools (including Ashtanga) advise students to take a break from a vigorous physical practice during their periods.

During menstruation, the body is shedding and releasing the lining of the uterus in a downward flow. But does turning the body upside down really reverse that natural flow?

Biologically speaking, the “downward” flow within the body’s tracts is not disturbed by the body’s orientation to the ground. People who are bedridden can still urinate, despite the fact that they lie in a horizontal position all day long. And it is possible to swallow even when upside down. Further, blood is pumped both with and against gravity within our bodies—more evidence that the orientation of our body does not alter the natural movements of our body’s systems. Similarly, the natural downward flow of menstruation will not reverse directions if you pop up into a handstand. In fact, even in the zero gravity of space, where there is no “down,” the direction of menstrual flow for astronauts has remained unchanged.

Just as no one alignment cue fits all in yoga practice, no one directive fits everyone in this situation either.

It was previously believed that inverting during one’s period would lead to retrograde menstruation, in which blood would flow in the opposite direction through the fallopian tubes and result in the presence of uterine tissue in the pelvic cavity—tissue that would embed itself there and lead to endometriosis. More is now known about endometriosis, and its relationship to retrograde menstruation is not as clear-cut as once believed.

First of all, it seems the majority of women experience some degree of retrograde menstruation (90% of women in one study), while only about 10% of women develop endometriosis (as do some men who have had estrogen treatments). The current view is that (at least in the absence of “overwhelming amounts of endometrial cells”) endometriosis occurs when there is an impaired immune response, and/or when the endometrial cells themselves are “abnormal”—i.e., in secreting higher than usual levels of inflammatory cytokines, which make them more likely to embed and grow outside the uterus. In most people who experience what we might call a “normal” amount of retrograde menstruation each month, the immune system deals well with any stray uterine cells in the pelvic cavity, so that the majority of us will never develop endometriosis.

Further, according to at least one expert, you needn’t worry that inversions will increase retrograde menstruation (and consequently, your chances of developing endometriosis), because uterine contractions, rather than your orientation to the ground, are responsible for the flow of menstrual blood. That would explain why we can menstruate when floating in space in the same way we do when standing upright on the ground.

Your Perspective

Just as every yoga practitioner experiences each asana differently, so too does every menstruating person experience their period differently. Some people have debilitating pain from cramps, some experience low energy levels, and some find that their menses produce no disruption at all to their everyday lives. Just as no one alignment cue fits all in yoga practice, no one directive fits everyone in this situation either.

Typically, doctors will advise people to listen to how their bodies feel and then decide what is best for them. They advise that there are no known reasons to caution against inversions during menstruation, other than how one feels in the moment.

I often encourage my students to practice the deepest yoga during menstruation. And no, that does not mean pushing the body to its furthest limits or sweating as much as possible. It simply means turning your attention inward and listening closely to your body.

When I listen to my body, on some days I find that inversions help to boost my low energy. On other days, inversions worsen the pain from my cramps. I treat each cycle as a new moon—because that is exactly what it is. Each day that I step onto my mat, my body feels and behaves differently than it did the day before. Days when I have my period are no exception.

So, I listen carefully to what my body craves, and I nourish it in the best way I know how. Some days that could mean holding handstand for three minutes. Some days that means holding supta baddha konasana for this same amount of time. And some days, that means practicing my yoga off the mat—taking my practice beyond physical asana.

Sources and Further Reading

1. Sourial, S., Tempest, N., & Hapangama, D. K. (2014). Theories on the Pathogenesis of Endometriosis. , 9.

2. Causes of Endometriosis: Several Proposed Theories.

3. Belluck, P. (2016, April 21). Periods in Space Are Not That Different, Though a Bit More Complicated.

4. Halme, J., Hammond, M., Hulka, J., Raj, S., & Talbert, L. Retrograde menstruation in healthy women and in patients with endometriosis. [Abstract].

5. Wade, L. There’s No Reason to Skip Headstands During Your Period.

6. Bieber, E. J., Sanfilippo, J. S., Mahmood I. Shafi, I. R., & Shafi, M. L. (2015, p. 205). Clinical Gynecology, Cambridge University Press.