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Sleep problems are frequently encountered during the menopausal transition, which have been related to various factors and can impair female quality of life [1]; however, direct relation with hormonal changes of the menopausal transition is still unclear. Recently Coborn et al. [2] reported a study that aimed at determining the association between female reproductive hormones and sleep discontinuity independent of night vasomotor symptoms (VMS) and depressive symptoms (DepS) in perimenopausal women. For this, daily sleep and VMS diaries, as well as weekly serum measurements of female reproductive hormones were obtained for 8 consecutive weeks among 45 perimenopausal women with night VMS and mild DepS. Women with primary sleep problems were excluded. Estimating equations were used to examine associations of estradiol, progesterone, and FSH with the mean number of nightly awakenings, wakefulness after sleep onset (WASO) and sleep-onset latency (SOL), adjusting for night VMS and DepS. The authors found that sleep disruption was common (awakenings/night, WASO and SOL). In adjusted models, a higher rate of awakenings was associated with postmenopausal estradiol levels and higher FSH levels, but not with progesterone. Female reproductive hormones were not associated with WASO or SOL. The authors conclude that the relationship of more awakenings with lower estradiol and higher FSH levels gives support for sleep discontinuity in the perimenopause linked with female reproductive hormone changes, independent of night VMS and DepSx.


Nocturnal VMS, DepS, and female reproductive hormone changes observed during the perimenopausal phase are associated to disruption in sleep continuity. It is known that hormonal changes underlie both VMS and DepS; however, their association with sleep continuity parameters resulting in sleep disruption during the perimenopausal stage is still a question of debate. This is because sleep disorders are multifactorial and VMS, age-related changes of normal circadian rhythm, and increases in comorbid conditions such as DepS and sleep-disordered breathing (SDB) might be relevant confounders [3]. In addition, perceived sleep changes should be confirmed by polysomnographic (PSG) measures that not always have been shown to reflect self-report sleep quality [4]. By controlling for VMS and DepS, Coborn et al. [2] corroborate early reports of the Study of Women’s Health Across the Nation (SWAN) [5] that have shown the association of increasing FSH levels with greater odds of waking up several times. However, in the SWAN decreasing estrogen was associated with higher odds of difficulty in falling and staying asleep [5]. Further longitudinal studies are needed to understand the multifactorial nature of sleep difficulties in women approaching the menopause in order to establish appropriate evidence-based treatments [6].

Rossella E. Nappi
Reproductive Medicine, GyneEndo & Menopause,
IRCCS San Matteo, University of Pavia, Pavia, Italy
President Elect, International Menopause Society (IMS)



  1. Blümel JE, Cano A, Mezones-Holguín E, et al. A multinational study of sleep disorders during female mid-life. Maturitas. 2012;72(4):359-66.
  2. Coborn J, de Wit A, Crawford S, et al. Disruption of Sleep Continuity During the Perimenopause: Associations with Female Reproductive Hormone Profiles. J Clin Endocrinol Metab. 2022;107(10):e4144-e4153.
  3. Pengo MF, Won CH, Bourjeily G. Sleep in Women Across the Life Span. Chest. 2018;154(1):196-206.
  4. Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018;13(3):443-456.
  5. Kravitz HM, Zhao X, Bromberger JT, et al. Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women. Sleep. 2008;31(7):979-90.
  6. Proserpio P, Marra S, Campana C, et al. Insomnia and menopause: a narrative review on mechanisms and treatments. Climacteric. 2020;23(6):539-549.


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