Low-dose paroxetine (7.5 mg) improves sleep in women with vasomotor symptoms associated with menopause

Pinkerton, JoAnn V.; Joffe, Hadine; Kazempour, Kazem; Mekonnen, Hana; Bhaskar, Sailaja; Lippman, Joel

doi:10.1097/gme.0000000000000311

Cited by 36 publications

(34 citation statements)

References 43 publications

(55 reference statements)

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“…Hormone therapy effectively treats hot flashes and consequently alleviates subjective sleep problems in many women (Polo-Kantola, 2011). Treatment of hot flashes with either selective serotonin or serotonin-norepinephrine reuptake inhibitors also reduces insomnia symptoms in peri- and post-menopausal women with hot flashes (Ensrud et al, 2012; Ensrud et al, 2015; Pinkerton et al, 2015). Further trials are needed to determine the effectiveness of these and other treatments in improving PSG-defined sleep in women with insomnia that develops in the context of the menopause transition.…”

Section: Discussionmentioning

confidence: 99%

Insomnia in women approaching menopause: Beyond perception

Baker

Willoughby

Sassoon

et al. 2015

Psychoneuroendocrinology

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The menopause transition is marked by increased prevalence in disturbed sleep and insomnia, present in 40–60% of women, but evidence for a physiological basis for their sleep complaints is lacking. We aimed to quantify sleep disturbance and the underlying contribution of objective hot flashes in 72 women (age range: 43–57 years) who had (38 women), compared to those who had not (34 women), developed clinical insomnia in association with the menopause transition. Sleep quality was assessed with two weeks of sleep diaries and one laboratory polysomnographic (PSG) recording. In multiple regression models controlling for menopause transition stage, menstrual cycle phase, depression symptoms, and presence of objective hot flashes, a diagnosis of insomnia predicted PSG-measured total sleep time (p<0.01), sleep efficiency (p=0.01) and wakefulness after sleep onset (WASO) (p=0.01). Women with insomnia had, on average, 43.5 minutes less PSG-measured sleep time (p<0.001). There was little evidence of cortical EEG hyperarousal in insomniacs apart from elevated beta EEG power during REM sleep. Estradiol and follicle stimulating hormone levels were unrelated to beta EEG power but were associated with the frequency of hot flashes. Insomniacs were more likely to have physiological hot flashes, and the presence of hot flashes predicted the number of PSG-awakenings per hour of sleep (p=0.03). From diaries, women with insomnia reported more WASO (p=0.002), more night-to-night variability in WASO (p<0.002) and more hot flashes (p=0.012) compared with controls. Women who develop insomnia in the approach to menopause have a measurable sleep deficit, with almost 50% of the sample having less than 6 hours of sleep. Compromised sleep that develops in the context of the menopause transition should be addressed, taking into account unique aspects of menopause like hot flashes, to avoid the known negative health consequences associated with insufficient sleep and insomnia in midlife women.

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Section: Discussionmentioning

confidence: 99%

Insomnia in women approaching menopause: Beyond perception

Baker

Willoughby

Sassoon

et al. 2015

Psychoneuroendocrinology

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“…Few studies of antidepressants by menopausal women have considered sleep as an independent outcome measure. However, in a study of 600 menopausal women with moderate / severe VMS, paroxetine 7.5 mg induced a significant reduction in associated awakenings and a significant increase in total sleep time [24]. Of note, paroxetine is approved for the management of VMS by the FDA but not in Europe.…”

Section: Insomniamentioning

confidence: 99%

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

et al. 2019

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Insomnia, vasomotor symptoms (VMS) and depression often co-occur after the menopause, with consequent health problems and reductions in quality of life. The aim of this position statement is to provide evidence-based advice on the management of postmenopausal sleep disorders derived from a systematic review of the literature. The latter yielded results on VMS, insomnia, circadian rhythm disorders, obstructive sleep apnea (OSA) and restless leg syndrome (RLS). Overall, the studies show that menopausal hormone therapy (MHT) improves VMS, insomnia, and mood. Several antidepressants can improve insomnia, either on their own or in association with MHT; these include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and mirtazapine. Long-term benefits for postmenopausal insomnia may also be achieved with non-drug strategies such as cognitive behavioral therapy (CBT) and aerobic exercise. Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) both reduce blood pressure and cortisol levels in postmenopausal women suffering from OSA. However, the data regarding MHT on postmenopausal restless legs syndrome are conflicting.

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“…Sleep disorders are usually shared among midlife women. Studies have shown that 7.5 mg of paroxetine/day, administered for the alleviation of vascular symptoms, also reduced the number of awakenings significantly during the night and prolonged the sleeping period [38].…”

Section: The Management Of Vasomotor Disordersmentioning

confidence: 99%

Management Strategies of The Symptomatology and Pathology Associated with Menopause – An Overview

Bălan¹,

Dima²,

I³

et al. 2019

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Menopause is a physiological period, considered to be installed after at least 12 months without menstruation. The mean age at menopause is 51 years. This condition is the consequence of hormonal imbalance that produces a series of general manifestations, which have become increasingly important and in most of the cases require treatment to improve. This paper aims to analyze all the therapeutical strategies applied for the improvement of the menopausal symptomatology. After a review of the last five years literature, we identified epidemiological studies, clinical cases, guidelines, and meta-analysis regarding the proper management strategies for the symptoms and pathologies associated with menopause. Fifty-three studies have been included in this paper that provides an overview of the impact of various menopause therapies. Vasomotor symptoms (VMS), hormonal replacement therapy (HRT), consisting of the administration of estrogen, alone or combined with progesterone, have been demonstrated to reduce their frequency and severity. Also, systemic estrogen therapy has shown its efficiency in depression, genito-urinary syndrome, cognitive disorders, and postmenopausal migraine syndrome. Non-hormonal treatments, including alimentary supplements, proved their efficacy with low rates of adverse effects. Among nonhormonal therapeutical alternatives, antidepressants such as venlafaxine, paroxetine, or fluoxetine (selective serotonin reuptake inhibitors-SSRI), and the anticonvulsant gabapentin have shown their utility for treating depressive disorders and vasomotor symptoms.

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Low-dose paroxetine (7.5 mg) improves sleep in women with vasomotor symptoms associated with menopause

Cited by 36 publications

References 43 publications

Insomnia in women approaching menopause: Beyond perception

Insomnia in women approaching menopause: Beyond perception

Italian Association of Sleep Medicine (AIMS) position statement and guideline on the treatment of menopausal sleep disorders

Management Strategies of The Symptomatology and Pathology Associated with Menopause – An Overview

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