The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review

Haufe, Annika; Baker, Fiona C.; Leeners, Brigitte

doi:10.1016/j.smrv.2022.101710

Cited by 9 publications

(5 citation statements)

References 111 publications

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“…A recent systematic review [ 141 ] demonstrated that estrogen-only therapy, progesterone-only therapy, combined hormone therapy, selective estrogen receptor modulators, and selective tissue estrogenic activity regulators were all effective in alleviating sleep complaints. Oral estrogen-only therapy reduced insomnia and improved subjective sleep disturbances [ 101‐135 ].…”

Section: Resultsmentioning

confidence: 99%

“…Whereas giving hormones to perimenopausal women, where the prevalence of sleep disturbances is much higher, results in an effect as there is room for improvement in this group of women. Perimenopausal estrogen therapy alleviates symptoms of insomnia by directly targeting the estrogen deficiency associated with sleep disturbances as well as other causes of sleep disturbances, such as vasomotor symptoms [ 141 ]. In younger cycling women the data were inconclusive, and in pregnant women other mechanical and physiological factors such as nocturnal micturition or gastroesophageal reflux appear to be more responsible for sleep disruption during pregnancy [ 78 ] than the absolute change in hormone level.…”

Section: Discussionmentioning

confidence: 99%

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Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?

Haufe

Leeners

2023

Journal of the Endocrine Society

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Fluctuations of reproductive hormones are associated with various forms of sleep disturbances and specific sleep disorders, e.g. insomnia or sleep-disordered breathing, across different stages of reproductive ageing. During the menstrual cycle, sleep is particularly disrupted during the late luteal phase as demonstrated by both objective and subjective measurements of sleep. Progesterone and its metabolites generally have sleep promoting effects. A steep decline in progesterone, e.g. during the late luteal phase, is associated with sleep disruption. Endogenous estrogen shows no clear correlation with sleep alterations in relation to the menstrual cycle. During pregnancy, sleep disruption is not associated with changes in estrogen or progesterone but rather with changing physiological factors, e.g. nocturnal micturition, gastroesophageal reflux or musculoskeletal discomfort, all substantial factors that most likely mask any effect of hormones. Both endogenous and exogenous estrogen, as well as progesterone, are positively associated with sleep during the menopausal transition. A marked improvement of sleep disturbances is observed with perimenopausal hormone therapy. As this effect is not seen in younger women receiving contraceptive therapy, other causes of sleep disturbances, e.g. ageing and related changes in metabolism of stress hormones, secondary effects of vasomotor symptoms or depression, must be considered. Gonadotropins are less associated with sleep disturbances than ovarian hormones, except for during the menopausal transition where follicle-stimulating hormone (FSH) is related to sleep disruption. Further, hyperandrogenism, as seen in women with polycystic ovary syndrome (PCOS), is associated with sleep disturbances and specific sleep disorders, e.g. obstructive sleep apnea (OSA).

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?

Haufe

Leeners

2023

Journal of the Endocrine Society

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“…The symptoms most classically associated with menopause are hot flashes and profuse sweating. Hot flushes, especially if very frequent, are associated with irritability, difficulty concentrating, and frequent nocturnal awakenings, conditions that cause a reduction in quality of life [39]. These symptoms can last from 6 months to >10 years and range from nonexistent to severe.…”

Section: Menopause-associated Symptoms and Diseasesmentioning

confidence: 99%

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Comparetto,

Borruto

2023

OBM Geriatr

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In the United States (US), menopause occurs at an average age of 52. Menopausal symptoms tend to be maximal during the few years before and the year after menopause (during perimenopause), except for symptomatic vulvovaginal atrophy, which may worsen over time. Up to 20% of bone density loss occurs during the first 5 years after menopause, followed by an age-related bone loss rate similar to that in men. Menopause should be considered confirmed if an age-appropriate woman who is not pregnant has not had a menstrual period for 12 months. Regarding treatment, for vaginal dryness or dyspareunia due to menopause, vaginal stimulation and vaginal lubricants and moisturizers are recommended, and if these are ineffective, low-dose vaginal estrogen, in the form of creams, tablets, suppositories, or rings should be considered; other options include oral ospemifene or intravaginal dehydroepiandrosterone (DEHA) suppositories. Before prescribing hormone replacement therapy (HRT) and periodically while therapy continues, women should be informed of risks (e.g., deep vein thrombosis [DVT], pulmonary embolism [PE], stroke, breast cancer, gallbladder disease, and urinary incontinence); potential harms are greatest for women who start HRT after 60 years of age or who are 10-20 years past menopause onset. If women choose HRT to relieve hot flushes, estrogen plus, a progestin or conjugated estrogen/bazedoxifene could be prescribed for women who still have the uterus. Treatment with HRT should be tailored to maximize benefits and minimize harms, and periodically benefits and harms should be reassessed; low-dose transdermal HRT may lead to a lower risk of DVT and stroke. Selective serotonin reuptakereuptake inhibitors (SSRIs), selective serotonin-nor-epinephrine reuptake inhibitors (SNRIs), and gabapentin could be considered as less effective alternatives to HRT for relieving hot flushes; paroxetine 7.5 milligrams (mg) is the only non-hormonal drug approved in the US for the relief of hot flushes. Effective non-drug options include cognitive behavioral therapy and hypnosis.

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“…Dentre as principais manifestações clínicas decorrentes da queda hormonal típica do período menopausal, podemos observar: distúrbios do sono, risco de sintomas depressivos, envelhecimento da pele e sintomas geniturinários (Pivazyan et al, 2023;Tseng et al, 2023;Haufe;Baker;Leeners, 2022;Christmas et al, 2023). Esse conjunto de sintomas produzem um quadro denominado de síndrome climatérica, impactando diretamente sobre a qualidade de vida da mulher na menopausa.…”

Section: Introductionunclassified

Hormone Therapy During Menopause: Benefits and Indications

Batista,

Aguiar,

Cervo

et al. 2024

PBPC

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Descrever os benefícios e as principais indicações para o tratamento de reposição de hormônios durante a menopausa. Métodos: O presente estudo foi realizado mediante uma revisão sistemática da literatura, que aborda os benefícios da terapia hormonal na menopausa, por meio das bases de dados EMBASE e MEDLINE, através dos descritores DeCS/MeSH “Hormone Replacement Therapy” e “Menopause”utilizando o operador booleano “and” entre os descritores, como representado a seguir: “Hormone Replacement Therapy” and “Menopause”. Resultados/Discussão: Após as etapas descritas na metodologia do estudo, foram selecionados 14 artigos mediante busca selecionada e direcionada nas bases de dados EMBASE e MEDLINE. Os estudos selecionados passaram, a posteriori, por um processo de leitura e análise crítica de forma a determinar o objetivo do presente estudo, que seria apresentar os benefícios e indicações para o tratamento hormonal na menopausa. Considerações Finais: A terapia hormonal é um tratamento eficaz para os sintomas provenientes da menopausa, contribuindo como, por exemplo, com efeitos protetores sobre os sistemas cardiovascular e músculo-esquelético.

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The role of ovarian hormones in the pathophysiology of perimenopausal sleep disturbances: A systematic review

Cited by 9 publications

References 111 publications

Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?

Sleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?

Treatments and Management of Menopausal Symptoms: Current Status and Future Challenges

Hormone Therapy During Menopause: Benefits and Indications

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