The menopausal transition is associated with increasing
sleep disorders including sleep apnoea and
restless leg syndrome.
Insomnia is the most common and is recognised as a core symptom of the menopause. Guidelines to support decision making for women with sleep problems during the menopausal transition are lacking. Sleep problems are associated with negative impacts on healthcare utilisation, quality of life and work productivity.
Sleep deprivation is a risk factor for
cardiovascular disease, diabetes,
obesity and neurobehavioral dysfunction. Declining oestrogen is implicated as a cause of menopausal sleep disruption. Vasomotor symptoms (VMS) and menopausal mood disturbance are also factors in the complex aetiology. VMS commonly precipitate
insomnia and, due to their prolonged duration, they often perpetuate the condition.
Insomnia in the general population is most effectively treated with cognitive behavioural
therapy (CBT) (also effective in the menopausal transition.) The associations of menopausal sleep disturbance with VMS and depression mean that other treatment options must be considered. Existing guidelines outline effectiveness of
hormone replacement therapy (HRT), CBT and
antidepressants. HRT may indirectly help with sleep disturbance by treating VMS and also via beneficial effect on mood symptoms. The evidence base underpinning menopausal
insomnia often references risks associated with HRT that are not in line with current international menopause guidelines. This may influence clinicians managing
sleep disorders, leading to hesitation in offering HRT, despite evidence of effectiveness. Viewing sleep symptoms on an axis of menopausal symptoms - towards vasomotor symptoms or towards mood symptoms may help tailor treatment options towards the symptom profile.