Menopause is a time of major hormonal, physical and psychological change for women although menopausal symptoms vary from woman to woman. During the perimenopause or transition phase, a woman’s ovaries gradually (over several years) decrease production of estrogen and progesterone. If a woman has her ovaries surgically removed (oophorectomy), periods end abruptly and menopausal symptoms become more severe. One year after menstrual periods have stopped, a woman reaches menopause, on average around the age of 50. From peri-menopause to post-menopause, women report the most sleeping problems. Most notably, these include hot flashes, mood disorders, insomnia and sleep-disordered breathing. Sleep problems are often accompanied by depression and anxiety.
Generally, post-menopausal women are less satisfied with their sleep and as many as 61% report insomnia symptoms. Snoring has also been found to be more common and severe in post-menopausal women. Snoring, along with pauses or gasps in breathing are signs of a more serious sleep disorder, obstructive sleep apnea (OSA).
Changing and decreasing levels of estrogen cause many menopausal symptoms including hot flashes, which are unexpected feelings of heat all over the body accompanied by sweating. They usually begin around the face and spread to the chest affecting 75-85% of women around menopause. Prior to the hot flash, body temperature rises accompanied by an awakening. Hot flashes last on average three minutes leading to less sleep efficiency. Most women experience these for one year, but about 25% have hot flashes for five years. While total sleep time may not suffer, sleep quality does. Hot flashes may interrupt sleep and frequent awakenings cause next-day fatigue.
Treatment with estrogen (Estrogen Replacement Therapy, ERT) or with estrogen and progesterone (Hormone Replacement Therapy, HRT) has been found to help relieve menopausal symptoms. The effects of HRT and ERT vary among women depending on the form taken (pill, patch, gel, cream or injection) and the number of years used. However, recent large-scale U.S. government funded studies, the Women’s Health Initiative, were stopped due to safety concerns since it was found that taking HRT may put women at risk for cardiovascular disease and dementia. For those taking HRT to reduce menopausal symptoms, it is recommended that HRT be prescribed at the lowest effective dose and used only for brief periods, not long-term. It is recommended you talk to your physician about your symptoms, the risks and benefits of HRT and alternative approaches for managing menopausal symptoms, including sleep.
There are alternative approaches for managing menopausal symptoms which may work for you. These include nutritional products and medications such as calcium supplements, vitamin D, and bisphosphonates for the prevention or treatment of osteoporosis (thinning and weakening of the bones); estrogen creams and rings for vaginal dryness; and sleep-promoting drugs for insomnia. All forms of estrogen that enter the blood stream reduce hot flashes.
An alternative treatment for menopausal symptoms may come from soy products (tofu, soybeans, and soymilk). They contain phytoestrogen, a plant hormone similar to estrogen. Soy products may lessen hot flashes, but there are no consistent results for its ability to relieve them. Furthermore, they can have gastrointestinal side effects. Just because it is a natural product does not necessarily mean it is safer to use than other treatments.
Phytoestrogens are also available in over-the-counter nutritional supplements (ginseng, extract of red clover, black cohosh). These supplements are not regulated by the Food and Drug Administration (FDA); their proper doses, safety, long-terms effects and risks are not yet known.
Deciding what, if any, product to use and, if so, for how long, are questions a woman should discuss with her doctor. The answer will depend on personal and family medical history.