One of the main issues that I come across is sleep issues. Falling asleep, staying asleep and having a restful nights’ sleep is a complex issue – there is a great deal involved. Sleep problems are quite common amongst menopausal women and I would expect most of my patients to have some sort of sleep issue (6 out of every 10 menopausal women). Sometimes it is quite straight forward to pin point the cause such as hot-flushes and night sweats. Hot flushes are normally preceded by the body temperature rising causing awakening. Obviously being drenched in sweat at night and requiring changes of nightwear is quite disturbing. Waking up to change nightwear is very disruptive but there are often more esoteric induced sleep problems such as relationship hiccups and concerns about children and work. There are lots of reasons that contribute to poor sleeping and so it’s important to have a good diet but essential to follow a good bedtime routine. We all tend to use our smart phones and screens late into the day. Try switching off a few hours before bed time and engaging in reading a book or meditation will slow the body down. We all know that a dark room with no distractions is ideal to initiate good sleep, but like many people, I find this difficult to do. It’s not only the in hormonal levels that will affect sleep quality in menopausal women (and relatively straightforward to remedy by replacement therapy), but the additional stresses of life which suddenly manifest at this life stage; notably children leaving home as well as re-appraising partner/ parent/ personal relationships. Sadly, these are often much more difficult to address than hormone levels.
How can hormone replacement help?
From a hormonal point of view, the presence of hot flushes, night sweats (called vasomotor symptoms) and irritability will cause sleep problems and these can be addressed with low dose oestrogen. Progesterones (e.g. Utrogestan) are good at helping a woman drift off to sleep. Even comparatively low doses of progesterone cream can be beneficial. Here is the medical bit…. When progesterone is metabolised (broken down) a new hormone is produced called Allopregnanolone. This new hormone affects a different hormone framework in the brain called the GABA system. Mild stimulation of the GABA system results in relaxation, decrease in anxiety and sedation. There are many facets to improving sleep issues and low dose hormonal replacement has an important role.