MENOPAUSE, SLEEP AND OBESITY

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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.

Sleep Tips During Menopause

Eat healthy. Avoid large meals, especially before bedtime. Maintain

a regular, normal weight. Some foods that are spicy or acidic may

trigger hot flashes. Try foods rich in soy as they might minimize

hot flashes.

Avoid nicotine, caffeine and alcohol, especially before bedtime.

Dress in lightweight clothes to improve sleep efficiency. Avoid

heavy, insulating blankets and consider using a fan or air

conditioning to cool the air and increase circulation.

Reduce stress and worry as much as possible. Try relaxation

techniques, massage and exercise. Talk to a behavioral health

professional if you are depressed, anxious or having problems.