Sleep and Menopause

Menopause is a stage in a woman's life when her ovaries stop producing the hormones estrogen and progesterone and she stops having her monthly menstrual cycle (her period). It is a normal part of aging and marks the end of a woman's reproductive years. Menopause typically occurs in a woman's late 40's to early 50's. It can also lead to sleep problems.

When the ovaries no longer produce adequate amounts of estrogen and progesterone (as in menopause), the loss of these hormones can bring about various symptoms including hot flashes (a sudden feeling of warmth that spreads over the body) and sweating (which is related to hot flashes).

Approximately 75-85% of menopausal women experience hot flashes, which can last for five years. Hot flashes and sweating can make it difficult to sleep. According to the National Sleep Foundation, approximately 61% of menopausal women have sleep problems. Sleeping difficulties can lead to other problems, such as daytime drowsiness.

How Can I Treat Sleep Problems Related to Menopause?

The traditional treatment for the symptoms related to menopause has been hormone replacement therapy (HRT). HRT consists of estrogen given as a pill, patch, or vaginal cream, either alone or combined with progesterone (for women who still have their uterus). However, results from a large study, the Women's Health Initiative, showed that long term use of estrogen-progesterone combination therapy caused an increased risk of breast cancer, heart disease, blood clots, and stroke. Estrogen alone did not increase breast cancer or heart disease, but the study also found that therapy with estrogen alone increases the risk of blood clots and stroke.

The latest recommendation for use of HRT for severe menopause symptoms is to use the lowest possible dose for the shortest possible time, with regular follow-up with your doctor.

If you are not a candidate for HRT, if your symptoms are not severe, or if you simply decide not to use HRT, the following tips might keep you cooler at night and help you sleep better without the use of hormones.

• Wear loose clothing to bed.
• Keep your bedroom cool and well-ventilated.
• Avoid certain foods that may cause sweating (such as spicy foods), especially right before bed.

Other practices that may ease sleep problems include:

• Maintain a regular bedtime schedule, including going to bed at the same time every night
• Exercise regularly but not right before sleep
• Avoid excessive caffeine
• Avoid naps during the day, which can prevent you from sleeping well at night
• Talk to your doctor about prescription medications that can help you sleep

What Alternative Treatments Are Available to Treat Hot Flashes?

Alternative treatments for treating hot flashes have included soy products such as tofu and soybeans. Soy products contain a plant hormone called phytoestrogen that acts as a weak estrogen. Studies in general do not show significant hot flash reduction with soy products.

Black cohosh, a perennial plant that is a member of the buttercup family, has also been used to treat hot flashes. In several studies, menopausal women who took black cohosh experienced relief from hot flashes and sweating, although most of these studies have been short-term, and used varying amounts of black cohosh from different sources. More studies are underway to determine if black cohosh reduces the frequency of hot flashes and other menopausal symptoms.

Keep in mind that alternative treatment products are not regulated or controlled by the Food and Drug Administration, and the long-term benefits and risks of these therapies are unknown. Talk to your doctor before you take any of these products.

Reviewed by a doctor in The Department of Obstetrics and Gynecology at The Cleveland Clinic.