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 menstruating. 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 on average 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 -- like hot flashes and insomnia -- 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, medications originally used as antidepressants may help relieve hot flashes. These include low doses of fluoxetine (Prozac), paroxetine (Paxil), venlafaxine (Effexor)), and many other SSRI’s. And two other drugs -- the anti-seizure drug gabapentin and the blood pressure medication clonidine -- also may be effective for menopausal symptoms.

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Also, the drugs Brisdelle and Duavee are made specifically for hot flashes.

In addition to medication, the following tips might keep you cooler at night and help you sleep better without the use of hormones:

  • Wear loose clothing to bed. Clothing made of natural fibers, like cotton, is usually best.
  • 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 during menopause 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.
  • Make sure you empty your bladder before bed.

Can Alternative Treatments Treat Hot Flashes and Help Me Sleep?

Alternative treatments for treating hot flashes and improving sleep have included soy products such as tofu and soybeans. Soy products contain a plant hormone called phytoestrogen that acts as a weak estrogen. In general, research has not shown 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 and sweating. Despite some positive results, studies that have investigated the role of black cohosh in reducing menopausal symptoms have been flawed.

Keep in mind that dietary supplements are not regulated or controlled by the FDA like medications. Talk to your doctor before you take any of these products.

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