Melatonin is a hormone which is normally secreted by the pineal gland; its levels rise at night when it is dark and fall during the morning hours in response to daylight.  Melatonin is involved in regulating normal sleep-wake cycles but recent research has shown that melatonin may have other important beneficial effects.

Melatonin is sold over the counter as a dietary supplement and is a popular natural remedy for sleep problems.  The data regarding the effectiveness of melatonin is somewhat mixed. Not everybody seems to respond to melatonin; not surprisingly, it seems to be more effective for those with disruptions in circadian rhythms, such as those who have delayed sleep phase syndrome.

Because melatonin levels normally decrease with age and because sleep problems are so common in perimenopausal women, it seems that melatonin may be a reasonable option for the treatment of sleep disturbance in this population of women, especially in those women who are not good candidates for hormone replacement therapy.  

Studies exploring the use of melatonin in perimenopausal women are sparse and have yielded mixed results.  Women reporting sleep disturbance do seem to benefit from melatonin supplementation, especially those with problems falling asleep.  

Melatonin may have other benefits in perimenopausal women.  Melatonin appears to play a role in the prevention of postmenopausal bone loss; it is hypothesized that this effect may be mediated through melatonin’s inhibition of oxidative stress and decreasing bone turnover.  

While there is not, at least at the present time, a large body of data to support the use of melatonin in peri- and post-menopausal women, a trial of melatonin supplementation may be considered in perimenopausal women with sleep disturbance.  Exogenous melatonin supplementation is well tolerated and has no obvious short- or long-term adverse effects. 

Before initiating treatment with melatonin, other causes of sleep disturbance must be considered.  Sleep disorders, such as obstructive sleep apnea, are more common in midlife women and must be ruled out or treated. At the same time it is important to consider the presence of other perimenopausal symptoms.  Women with prominent vasomotor symptoms, in addition to sleep disturbance, may do better with gabapentin or hormone replacement therapy. Women with comorbid depression and anxiety may benefit from treatment with an antidepressant or a benzodiazepine.  

Ruta Nonacs, MD PhD

 

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