In This article
- Sleep disturbance is highly prevalent in peri- and postmenopausal women in both the US and Europe, with or without vasomotor symptoms.
- About 40% of women without vasomotor symptoms report clinically relevant sleep disturbance during the menopausal transition.
- Sleep disturbance is independently associated with worse health-related quality of life and higher depression and anxiety scores, regardless of VMS status.
- Women with both sleep disturbance and VMS have the highest levels of anxiety and depression, but those with sleep problems alone still experience substantial impairment.
- There are currently no treatments specifically indicated for menopause-related sleep disturbance, highlighting an unmet need and a target for future research and clinical care.
Beyond Hot Flashes: The Hidden Toll of Menopausal Sleep Disturbance on Well-Being
Vasomotor symptoms (VMS) and sleep disturbances are among the most commonly experienced and bothersome symptoms reported by women during their perimenopausal and postmenopausal years. Epidemiologic studies have shown that both VMS and sleep problems are associated with reduced quality of life (QoL). Although these two symptoms commonly co-exist, they often appear independently, and we have little data on their associated burden when one occurs in the absence of the other.
In this study, researchers analyzed data from peri- and postmenopausal women between the ages of 40 and 65 who participated in the National Health and Wellness Study. Data were derived from the 2019 and 2021 surveys for US respondents (N=27,621) and from the 2017 and 2020 surveys for respondents from Europe (France, Germany, Italy, Spain, and the United Kingdom; N=20,220). Participants completing surveys reported on health-related quality of life (HRQoL), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). Generalized multivariable linear regression was used to identify associations between self-reported sleep disturbance and/or VMS and quality of life, anxiety, and depression.
In perimenopausal women:
- VMS were reported by 60.1% (US) and 60.3% (Europe) of women.
- Sleep disturbance was reported by 53.8% (US) and 51.3% (Europe) of women.
- In women with VMS: 61.7% (US) and 60.6% (Europe) reported sleep disturbance.
- In women without VMS: 38.0% (US) and 40.8% (Europe) reported sleep disturbance.
In postmenopausal women:
- VMS were reported by 43.4% (United States) and 44.0% (Europe) of women.
- Sleep disturbance was reported by 54.2% (United States) and 50.8% (Europe) of women.
- In women with VMS: 66.7% (US) and 63.4% (Europe) reported sleep disturbance.
- In women without VMS: 44.5% (US) and 40.9% (Europe) reported sleep disturbance.
Compared to women with no sleep disturbance, peri- and postmenopausal women with sleep disturbance had worse HRQoL and higher levels of depression and anxiety, regardless of whether or not they had vasomotor symptoms. The subgroup with both sleep disturbance and VMS had the highest proportion of women with moderate-to-severe anxiety and depression.
Among postmenopausal women, those with sleep disturbance alone had worse HRQoL and higher depression and anxiety scores than those with VMS alone.
Clinical implications
While sleep disturbance and vasomotor symptoms often occur together and are common among peri- and postmenopausal women, this large-scale study, including nearly 50,000 peri- and postmenopausal women, indicates that, even in women without VMS, sleep disturbance is very common, affecting about 40% of peri- and postmenopausal women. Furthermore, sleep disturbance was independently associated with negative effects on HRQoL, depression, and anxiety. Although the prevalence of moderate-to-severe depression and/or anxiety was the highest in those with both VMS and sleep disturbance, women with sleep disturbance alone still had substantially elevated symptom burden.
This study builds upon the existing literature documenting the negative impact of sleep disturbance and VMS on quality of life in peri- and postmenopausal women reported in smaller studies. In addition, this body of research demonstrates a clear link between sleep disturbance and worse mental health during the menopausal transition.
While treatment in this population is often focused on the management of vasomotor symptoms, this study indicates that up to 40% of women have sleep disturbance but do not have VMS. Thus, they may not receive specific treatment, although sleep disturbance (even in the absence of VMS) may negatively impact quality of life and may significantly increase vulnerability to depression and anxiety.
Given that the menopausal transition may last up to 10 years in some women, these symptoms have significant public health implications. The study reveals a clear unmet need among menopausal women experiencing sleep disturbance; not only does sleep disturbance have a significant impact on quality of life and mental health, there are currently no pharmacological treatments specifically indicated for menopause-related sleep disturbance. Because the menopausal transition is associated with such a wide array of symptoms, further study to identify effective treatment options for specific symptoms, including sleep disturbance in menopausal women, is needed to mitigate the associated burden and improve well-being.
—Ruta Nonacs, MD PhD
