Sleep checks could unlock better menopause care, poll suggests

Women aged 50 to 80 with menopause symptoms were more likely to report sleep problems than those without in a US national poll.

In a cross-sectional analysis of 1,202 US women, investigators found that 56.4 per cent reported sleep problems overall.

Among women with menopause-related symptoms, 75 per cent reported sleep problems, compared with 49.8 per cent of those without such symptoms.

The findings add to existing evidence that sleep disturbances are common during the menopause transition and may be closely tied to active symptom burden.

The Menopause Society has noted that women with vasomotor symptoms during the menopause transition are more likely to report disrupted sleep, and its 2022 hormone therapy position statement says hormone therapy improves sleep in women with bothersome night sweats and hot flushes that disrupt sleep.

Sleep problems in midlife and older women are clinically important because they may affect quality of life, daytime function, cardiometabolic health and long-term wellbeing.

Reviews of sleep disorders during menopause have identified several possible contributors, including vasomotor symptoms, ovarian hormone changes, restless legs syndrome, periodic limb movement disorder and obstructive sleep apnoea.

The findings underscore the importance of asking about sleep when evaluating menopause symptoms and, conversely, considering menopause-related symptom burden when women in midlife and older adulthood present with insomnia, fragmented sleep or poor sleep quality.

“Integrating screening and evidence-based interventions for sleep disturbances into menopause management may improve overall health, quality of life, and long-term outcomes,” Joseph R. White, MD, MS, and colleagues wrote in the study abstract.

White and colleagues analysed survey data from Wave 10 of the National Poll on Healthy Aging, a nationally representative household survey of US adults aged 50 years and older conducted from 21 January to 7 February 2022 to assess timely issues related to health, health care and health policy.

Respondents in the current analysis were stratified and weighted to reflect the US Census. Investigators used chi-square testing to evaluate associations between sleep problems and menopause symptoms.

Among the 1,202 respondents, 65 women were premenopausal with no symptoms, accounting for 7.3 per cent of the weighted sample.

Thirty-seven women were perimenopausal with some symptoms, accounting for 3 per cent, 40 were menopausal within the past year with regular symptoms, accounting for 3.3 per cent, and 35 were menopausal within the past year without regular symptoms, also accounting for 3.3 per cent.

Most respondents were postmenopausal.

A total of 243 women were postmenopausal with symptoms, accounting for 20.8 per cent of the weighted sample, and 765 were postmenopausal without symptoms, accounting for 61.2 per cent.

Overall, 677 respondents reported sleep problems. Women with any menopause-related symptoms were significantly more likely to report sleep problems than women without menopause-related symptoms.

The current findings suggest that sleep assessment may be an important component of that individualised approach.

In primary care, screening may include questions about sleep duration, sleep latency, nighttime awakenings, early-morning awakening, daytime impairment, snoring or witnessed apnoeas, restless legs symptoms, mood symptoms, medication use, alcohol use, and the timing and severity of hot flushes or night sweats.

Investigators did not identify which specific menopause symptoms were most strongly associated with sleep problems.

However, earlier research has shown that greater vasomotor symptom severity is associated with more sleep disturbance, greater sleep-related impairment, worse sleep quality, and greater impairment in daytime activities and work productivity.

Limitations of the analysis include the fact that it was cross-sectional, that sleep problems and menopause symptoms were self-reported, and that it does not specify whether respondents had diagnosed sleep disorders or whether other contributors, such as depression, anxiety, chronic pain, cardiometabolic disease, or medication use, were assessed.

Still, the large, nationally representative sample provides clinically relevant insight into the overlap between menopause-related symptoms and sleep complaints among US women aged 50 to 80 years.

The authors said the findings support routine sleep screening as part of menopause evaluation and follow-up, particularly among women reporting active symptoms.