Estrogen Replacement and Its Effect on Sleep

Estrogen Replacement and Its Effect on Sleep

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Sleeping problems are common during menopause.

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When a woman reaches the end of her childbearing years and enters menopause, her body undergoes major hormonal and physiological changes that can affect many aspects of her life. Menopause sometimes causes insomnia or an inability to stay asleep, a problem that can interfere significantly with a woman's daily life. Replacing the estrogen the body no longer produces may help relieve these problems.

Estrogen and Sleep

When a woman enters menopause, her monthly period stops and her ovaries no longer make 2 important hormones: estrogen and progesterone. The National Sleep Foundation reports that up to 61 percent of postmenopausal women experience insomnia and other sleep disturbances.

Changes that occur in the normal balance between estrogen and progesterone after menopause are thought to be responsible for these sleep disturbances, although exactly why this happens is not fully understood. One possibility is that when a woman experiences menopausal flushing or a hot flash during the night, this could awaken her and cause a night sweat, explaining some of the difficulty with sleep that can accompany menopause.

Other Effects

When a woman stops ovulating and her estrogen level falls, other hormone-related symptoms may contribute to difficulty sleeping. For example, the North American Menopause Society reports that some women experience severe mood swings after entering menopause. In these women, menopausal symptoms can include extreme changes in mood, when intense feelings of happiness lead to periods of sadness and depression. The society also indicates that women prone to extreme symptoms of premenopausal syndrome or who had previously suffered from depression may be more likely to experience severe mood swings after menopause. Although replacing estrogen after menopause may not resolve all these issues, it might help alleviate sleeping problems in some women.

Replacing Estrogen

A substantial amount of research has examined the possible benefit of replacing estrogen on sleep disturbances in women after menopause. In a trial of hormone replacement therapy published in September 2003 in "Journal of Sleep Research," 51 postmenopausal women took either estrogen, estrogen and progesterone, or no replacement hormones for 2 months, while their wakefulness during the night and sense of being rested in the morning were evaluated. Both hormone treatments slightly improved general sleep patterns and also had significant positive effects on the subjects' sense of energy and having slept well in the morning compared to those who were not on hormone replacement therapy.

A larger study, published in the September-October 2005 issue of the journal "Menopause," enrolled about 8,000 postmenopausal women who had either never taken estrogen or had been taking estrogen, with or without added progesterone, to determine their sleep patterns. Women who did not take hormones reported sleeping less often, having difficulty falling or staying asleep significantly more often that those taking the hormones. Results of the Women's Health Initiative, published in May 2005 in "Obstetrics and Gynecology," concluded that replacing hormones after menopause helps alleviate many postmenopausal symptoms, but also advised the treatment may not be a good choice for all women.

Treatment and Recommendations

After menopause, a doctor might recommend taking an estrogen pill or wearing an estrogen-containing patch that delivers estrogen through the skin. Estrogen is not appropriate for everyone because it may cause some side effects or raise the risk of certain diseases in some groups of women. In a 2012 position statement, the North American Menopause Society recommended estrogen replacement, when appropriate, should be at the lowest possible dose and for no more than 3 to 5 years.

If you have questions about hormone replacement after menopause, talk with your doctor, who can advise you on the best course of action for your situation.