It’s Not Just About the Hot Flashes: Menopausal Hormone Changes and Disrupted Sleep 

Extract

Sleep disturbances are common during the menopausal transition, being reported by more than half of midlife women (1). Women are particularly plagued by middle-of-the-night awakenings as they progress through the menopausal transition (2). These sleep disturbances diminish quality of life, work productivity, mood, and increase health care utilization (3), with long-term negative effects on health, most notably cardiovascular health, beyond menopause (4). It therefore is important to determine what contributes to the rise in sleep disturbances across menopause to inform interventions to manage severe and persistent sleep disruption. There is compelling evidence showing that nocturnal vasomotor symptoms (VMS, hot flashes) are one instigator of sleep disturbances, with epidemiological data supporting associations between more frequent and severe VMS and insomnia symptoms, and objective data temporally linking single nocturnal vasomotor events with polysomnographic awakenings (1). However, sleep disturbance in the context of menopause is not completely explained by nocturnal VMS and likely has a multifactorial basis: Potential contributing factors include the changing hormone environment, with progressive decreases in estradiol and increases in follicle-stimulating hormone (FSH), presence of clinical depression, and/or factors coincident with the menopausal transition and aging (eg, sleep breathing or medical disorders, psychosocial stressors).