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HT improves sleep quality during menopause

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August 25, 2017

Virginia Miller
Virginia M. Miller

Menopausal women may have improved sleep quality when using hormone therapy, which may lessen severity of vasomotor symptoms, particularly hot flashes and night sweats, study data show.

Virginia M. Miller, PhD, professor of surgery and physiology at Mayo Clinic in Rochester, Minnesota, and colleagues evaluated data from the Kronos Early Estrogen Prevention Study (KEEPS) on 727 menopausal women randomly assigned to 0.45 mg per day of oral conjugated equine estrogens (Premarin, Pfizer) plus a placebo transdermal patch (n = 230), 50 µg per day of a transdermal 17beta-estradiol patch (Climara, Bayer) plus a placebo pill (n = 222), or placebo pills and placebo patch (n = 275). Researchers sought to determine the effect of HT on sleep quality. Participants received the treatment for 4 years, and all were invited to complete the Pittsburgh Sleep Quality Index (PSQI) at baseline and the 6-, 18-, 36- and 48-month study visits.

Poor sleep quality was reported by 24% of all participants at study entry. Average PSQI score showed similar reductions but improvement were greater in the oral conjugated equine estrogen group (P = .001) and the transdermal 17beta-estradiol patch group (P = .002) compared with placebo. The percentage of participants with poor sleep quality (PSQI global score > 8) decreased in all groups from 21% to 9% in the estradiol group (P < .001), 28% to 16% in the conjugated equine estrogen group (P < .001) and 22% to 17% in the placebo group (P = .06).

Three of the six sleep domains (sleep satisfaction, sleep latency and sleep disturbances) improved in both HT groups compared with placebo (P < .001). No significant differences were observed for sleep efficiency, sleep duration or daytime dysfunction between the groups.

Compared with placebo, both HT formulations led to reduced severity scores for hot flashes and night sweats (P < .001 for both). Average change in global PSQI scores and average changes in severity of hot flashes and night sweats were positively associated (P < .001 for both).

“This study provides evidence that some sleep disturbances are related to hot flashes and night sweats,” Miller told Endocrine Today. “If sleep disturbances persist when hot flashes and night sweats decline with hormone treatment, other sleep assessments for obstructive sleep apnea should be considered. Basic research is needed to better understand the neurological association of changes in temperature regulation and sleep. Clinically, studies are needed to quantify vasomotor dysfunction in women in conjunction with sleep assessments for respiratory function and in general stratifying and quantifying changes in autonomic function in menopausal women.” – by Amber Cox

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Virginia M. Miller, PhD, can be reached at

Disclosures: The authors report no relevant financial disclosures.

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