Tag Archives: menopause

What happened to my sleep?

Difficulty sleeping is one of the most common problems brought up by women who come to see me. It can be one of the earliest symptoms women notice in the perimenopause, affecting roughly half of us. Women are more likely to experience insomnia than men. Why this should be is not well understood. The times in a woman’s life when she is most likely to experience insomnia are premenstrually, in the third trimester of pregnancy and in menopause. Mood disorders can contribute to insomnia, and persistent insomnia increases the occurrence of depression. Chronic insomnia is also common in women with breast cancer.

What to do about sleep problems? The first recommendation in any discussion of the topic is to apply the principles of sleep hygiene. These include going to bed and getting up at the same time every day (including weekends), avoiding caffeine and alcohol in the evening, avoid exercising close to bedtime, keeping the bedroom quiet and cool, and using the bedroom only for sleeping and sex. Vasomotor symptoms (VMS), hot flashes and night sweats, are notorious for disrupting sleep. Hormone therapy in low doses has been shown to be effective for many women with VMS, and any related sleep problem. Cognitive behavioral therapy has been shown to be helpful in cases of chronic insomnia and is preferable to medications as a first-line treatment. If the access to a therapist is limited, there are books and DVDs available that teach relaxation techniques and meditation that may be helpful to sleep. For insomnia related to depression and/or anxiety, an anti-depressant medication may help sleep and the mood symptoms. Sleeping pills may be helpful in the short term, but their use should be limited due to the risks of developing a tolerance to them or a dependence on them.

Our approach to sleep problems should be built around sleep hygiene and relaxation techniques first, hormones and medications if needed later.

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What is Menopause?

What is menopause?  Many women are unaware there is an agreed-upon definition, set by the STRAW and STRAW+10, the Stages of Reproductive Aging Workshop in 2001 and STRAW+10: Addressing the Unfinished Agenda of Staging Reproductive Aging in 2011, respectively.  This was done to standardize research and discussions about women’s health, so that everyone was on the same page as to what stage they were discussing.  Menopause, by definition, occurs once a woman has gone 12 months without a period, after which she is considered postmenopausal.  Being a retrospective definition, though, presents problems as women don’t know which menstrual period is their last at the time.  Perimenopause and/or  the Menopausal Transition are defined as beginning with changing cycles of variable length; there is no concrete marker, as FSH may be raised but is often variable up until 3 or more years after the final menstrual period.  Contrary to popular belief, estrogen levels in perimenopause may be higher instead of lower, and are often chaotically up and down.  Progesterone levels go down.  The FSH level being variable makes it an unreliable marker of menopause.  Vasomotor symptoms, hot flashes and night sweats, are most likely to be problematic in the one to three years prior to the final menstrual period (FMP) until two years after.  The work of defining the stages of reproduction in women is ongoing, as the 2011 meeting identified seven areas of research priorities.

In a nutshell, the answer to the question is that there is no actual point in time that is menopause. A woman is premenopausal throughout her reproductive years until her periods start to change in frequency or amount of bleeding, at which time she becomes perimenopausal. Perimenopause lasts until a year after the final menstrual period (FMP), when a woman is regarded as postmenopausal. Many changes occur to us over this time, and they affect all the systems of the body. This is menopause.

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