A Four-phase, Menstrual Cycle-specific Yoga Module to Enhance Menstrual Health: A Development, Validation and Feasibility Study

Background The menstrual cycle involves cyclical fluctuations in ovarian hormones that produce phase-dependent changes in neurocognitive function, emotional regulation, pain sensitivity and physical performance. Yet most therapeutic interventions, including yoga, apply uniform practices across the cycle, overlooking these physiological transitions. A phase-specific yoga approach may better accommodate these hormonal changes. Purpose This study aimed to develop, content-validate and assess the feasibility of a four-phase, menstrual cycle-specific yoga module to support menstrual health. Methods The study had three phases. (a) The development phase involved a systematic review of classical and contemporary yoga texts alongside relevant scientific literature. (b) In the validation phase, 11 experts validated the module using a three-point Likert scale; content validity was established using Lawshe’s Content Validity Ratio (CVR). (c) Feasibility was tested in a pre-post pilot study among female university students with premenstrual syndrome (PMS). 15 participants completed an 8-week intervention comprising five sessions per week. Outcomes included intervention fidelity, face validity, PMS symptom severity and PMS-related quality of life (PMS-QoL). Results The validated module retained 12/21 practices for the menstrual phase, 30/31 for the follicular phase, 25/33 for the ovulatory phase, and 19/28 for the luteal phase (all CVR > 0.59). The feasibility study demonstrated 100% acceptance and retention with no adverse events. Practices were rated easy to learn, with minor modifications required for some postures. High satisfaction and perceived benefits were reported for managing phase-related difficulties, emotional regulation, mood, strength, flexibility and balance. After 8 weeks, PMS symptoms decreased significantly, and PMS-QoL improved across physical, emotional and social domains. Conclusion The four-phase, menstrual cycle-specific yoga module was feasible, acceptable and associated with preliminary improvements in PMS symptoms and PMS-QoL. Aligning yoga practices with phase-dependent psychophysiological changes may offer a physiology-informed strategy for promoting menstrual health. Further controlled trials in broader eumenorrheic populations are warranted.