Sleep Symptoms During the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women's Health Study

Overview

Journal Sleep

Publisher Oxford University Press

Specialty Psychiatry

Date 2010 Apr 17

PMID 20394324

Citations 70

Authors

Nancy Fugate Woods

Ellen Sullivan Mitchell

Affiliations

Soon will be listed here.

Abstract

Study Objectives: Describe the severity of getting to sleep, nighttime awakening, and early morning awakening across the menopausal transition (MT) and early postmenopause (PM) and their relationship to age, menopausal transition factors, symptoms, stress-related factors, and health related factors.

Design: Cohort.

Setting: community.

Participants: 286 women from the Seattle Midlife Women's Health Study cohort.

Measurements: Participants completed annual menstrual calendars for MT staging, diaries in which they rated their symptoms, stress levels, and perceived health multiple times per year from 1990-2007 and provided first morning urine samples assayed for E1G, FSH, cortisol, and catecholamines. Multilevel modeling (R program) was used for data analysis.

Results: Severity of self-reported problems going to sleep was associated with all symptoms, perceived stress, history of sexual abuse, perceived health (-), alcohol use (-) (all P < 0.001), and lower cortisol (P = 0.009), but not E1G or FSH. Severity of nighttime awakening was significantly associated with age, late MT stage, and early PM, FSH, E1G (-), hot flashes, depressed mood, anxiety, joint pain, backache, perceived stress, history of sexual abuse, perceived health (-), and alcohol use (-) (all P < 0.001, except E1G for which P = 0.030). Severity of early morning awakening was significantly associated with age, hot flashes, depressed mood anxiety, joint pain, backache, perceived stress, history of sexual abuse, perceived health (-) (all P < or = 0.001, except E1G for which P = 0.02 and epinephrine (P = 0.038), but not MT stages or FSH. Multivariate models for each symptom included hot flashes, depressed mood, and perceived health.

Conclusion: Sleep symptoms during the MT may be amenable to symptom management strategies that take into account the symptom clusters and promote women's general health rather than focusing only on the MT.

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References

Denari J, Farinati Z, Casas P, Oliva A . Determination of ovarian function using first morning urine steroid assays. Obstet Gynecol. 1981; 58(1):5-9. View

Heim C, Newport D, Heit S, Graham Y, Wilcox M, Bonsall R . Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA. 2000; 284(5):592-7. DOI: 10.1001/jama.284.5.592. View

Shaver J, Johnston S, Lentz M, Landis C . Stress exposure, psychological distress, and physiological stress activation in midlife women with insomnia. Psychosom Med. 2002; 64(5):793-802. DOI: 10.1097/01.psy.0000024235.11538.9a. View

Ensrud K, Stone K, Blackwell T, Sawaya G, Tagliaferri M, Diem S . Frequency and severity of hot flashes and sleep disturbance in postmenopausal women with hot flashes. Menopause. 2008; 16(2):286-92. DOI: 10.1097/gme.0b013e31818c0485. View

Cheek R, Shaver J, Lentz M . Variations in sleep hygiene practices of women with and without insomnia. Res Nurs Health. 2004; 27(4):225-36. DOI: 10.1002/nur.20025. View

Woods N, Mitchell E, Percival D, Smith-DiJulio K . Is the menopausal transition stressful? Observations of perceived stress from the Seattle Midlife Women's Health Study. Menopause. 2008; 16(1):90-7. PMC: 3842691. DOI: 10.1097/gme.0b013e31817ed261. View

Woods N, Smith-DiJulio K, Percival D, Tao E, Taylor H, Mitchell E . Symptoms during the menopausal transition and early postmenopause and their relation to endocrine levels over time: observations from the Seattle Midlife Women's Health Study. J Womens Health (Larchmt). 2007; 16(5):667-77. DOI: 10.1089/jwh.2006.0138. View

Shaver J, Giblin E, Paulsen V . Sleep quality subtypes in midlife women. Sleep. 1991; 14(1):18-23. DOI: 10.1093/sleep/14.1.18. View

Gold E, Sternfeld B, Kelsey J, Brown C, Mouton C, Reame N . Relation of demographic and lifestyle factors to symptoms in a multi-racial/ethnic population of women 40-55 years of age. Am J Epidemiol. 2000; 152(5):463-73. DOI: 10.1093/aje/152.5.463. View

10.

Krakow B, Melendrez D, Johnston L, Warner T, Clark J, Pacheco M . Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors. J Nerv Ment Dis. 2002; 190(7):442-52. DOI: 10.1097/00005053-200207000-00004. View

11.

Harlow S, Crawford S, Dennerstein L, Burger H, Mitchell E, Sowers M . Recommendations from a multi-study evaluation of proposed criteria for staging reproductive aging. Climacteric. 2007; 10(2):112-9. DOI: 10.1080/13697130701258838. View

12.

Kravitz H, Zhao X, Bromberger J, Gold E, Hall M, Matthews K . Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008; 31(7):979-90. PMC: 2491500. View

13.

OConnor K, Brindle E, Holman D, Klein N, Soules M, Campbell K . Urinary estrone conjugate and pregnanediol 3-glucuronide enzyme immunoassays for population research. Clin Chem. 2003; 49(7):1139-48. DOI: 10.1373/49.7.1139. View

14.

Harlow S, Cain K, Crawford S, Dennerstein L, Little R, Mitchell E . Evaluation of four proposed bleeding criteria for the onset of late menopausal transition. J Clin Endocrinol Metab. 2006; 91(9):3432-8. PMC: 1950694. DOI: 10.1210/jc.2005-2810. View

15.

Kravitz H, Ganz P, Bromberger J, Powell L, Sutton-Tyrrell K, Meyer P . Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause. 2003; 10(1):19-28. DOI: 10.1097/00042192-200310010-00005. View

16.

Backhaus J, Junghanns K, Hohagen F . Sleep disturbances are correlated with decreased morning awakening salivary cortisol. Psychoneuroendocrinology. 2004; 29(9):1184-91. DOI: 10.1016/j.psyneuen.2004.01.010. View

17.

Utian W, Boggs P . The North American Menopause Society 1998 Menopause Survey. Part I: Postmenopausal women's perceptions about menopause and midlife. Menopause. 1999; 6(2):122-8. View

18.

Paulsen V, Shaver J . Stress, support, psychological states and sleep. Soc Sci Med. 1991; 32(11):1237-43. DOI: 10.1016/0277-9536(91)90038-e. View

19.

Soules M, Sherman S, Parrott E, Rebar R, Santoro N, Utian W . Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril. 2001; 76(5):874-8. DOI: 10.1016/s0015-0282(01)02909-0. View

20.

Mitchell E, Woods N, Mariella A . Three stages of the menopausal transition from the Seattle Midlife Women's Health Study: toward a more precise definition. Menopause. 2000; 7(5):334-49. DOI: 10.1097/00042192-200007050-00008. View