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Insomnia during menopause — Ask Dr Jean

Ask Dr Jean 15 Oct 2018
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When it comes to women's health, there is no such thing as a silly question. Do you have a question you want answered, but have been too afraid or embarrassed to bring it up with your GP? Or you forgot to ask while you were in the doctor's surgery? Now, you can 'Ask Dr Jean'.


Answering your questions for this edition of 'Ask Dr Jean' is gynaecologist and Jean Hailes Medical Director, Dr Elizabeth Farrell AM

Question

About a year ago I was told that my hormone levels equated to me being postmenopausal (I am now 53). Because I'd had a total hysterectomy in 2009, but ovaries left in, I didn't know what was happening. I heard all these horror stories about night sweats and hot flushes, so when that didn't occur and I was told I was postmenopausal, I thought this was a great thing – until the sudden onset of terrible insomnia.

It is so debilitating it affects every aspect of my life. Despite it, I still exercise for an hour in the morning every day, only have caffeine in the morning, eat all the 'right' foods conducive to sleep, do all the right things, wear MHT oestrogen patch (100mg), have been prescribed Endep and Valium, but nothing works.

I really wish there was a forum that dealt with the debilitating effects of insomnia during menopause, rather than focusing on the night sweats and hot flushes. I hold a very senior position in my career and I just can't seem to focus, particularly after averaging two hours' sleep the last three nights. I have today been referred to a sleep specialist, but if there's any other advice I could get it would be great.

Dr Elizabeth Farrell

Answer

Insomnia seems to be maximal in women during the transition, or perimenopause, in about 50% of cases. As you have experienced, sleep disturbance can be a most distressing and impairing menopause symptom, having a negative effect on physical and psychological productivity and quality of life.

However, the mechanism of the relationship between insomnia and hormone changes in the perimenopause is poorly understood. Some studies have shown an association between poor sleep, chronic stress, heightened emotions, weight gain and hot flushes, but why is not understood. Midlife can be a stressful time of life and, in combination, may impact sleep patterns.

With differing personality traits, many different treatments and medications have been used. The best evidence is for cognitive behaviour therapy for insomnia.

Many more studies are needed to completely determine the association between the menopause and insomnia.