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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 -- 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, 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 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
What Alternative Treatments Are Available to Treat Hot Flashes?
Alternative treatments for treating hot flashes and improve sleep 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.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
Menopause Guide
VIVELLE-DOT (estradiol transdermal system) IS AVAILABLE BY PRESCRPTION ONLY.
INDICATION
Vivelle-Dot is used after menopause to: reduce moderate to severe hot flashes; treat moderate to severe dryness, itching and burning in or around the vagina; help reduce your chances of getting osteoporosis (thin weak bones); and treat certain conditions in which a young woman's ovaries do not produce enough estrogens naturally. Vivelle-Dot 0.025 mg/day is only used to prevent osteoporosis from menopause. If you use Vivelle-Dot only to treat your dryness, itching, and burning in and around your vagina or if you use Vivelle-Dot only to prevent osteoporosis from menopause, talk with your healthcare professional about whether a different treatment or medicine without estrogens might be better for you.
IMPORTANT SAFETY INFORMATION
Estrogens increase the chances of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are taking estrogens. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb).
Do not use estrogens with or without progestins to prevent heart disease, heart attacks, or strokes. Using estrogens with or without progestins may increase your chances of getting heart attacks, strokes, breast cancer, and blood clots. Using estrogens with progestins may increase your risk of dementia (decline in memory and thinking skills).
Vivelle-Dot should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past (for example, in the past year); currently have or have had blood clots; currently have or have had liver problems; or think you may be, or know that you are, pregnant.
The most common side effects that may occur with Vivelle-Dot are headache, breast tenderness, and back pain.
You and your healthcare professional should talk regularly about whether you still need treatment with Vivelle-Dot.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Full Prescribing Information for Vivelle-Dot.
Ob-Gyn Laura Corio talks about the importance of exercise during menopause.
