Thank you for your recent piece on how to reduce insomnia [ “Sleepless in Asheville: Insomniacs Share Strategies for Finding Rest,” Nov. 22, Xpress], because this is such a huge problem, particularly among midlife women. I was especially glad that the article specifically highlighted menopause as a major driver of sleeping problems in women. As a menopause specialist working in health care, I spend a lot of time educating women and providers alike about perimenopausal changes and how hormone changes impact well-being in midlife. There is a lot of misinformation around menopause in health care, and as a result, many women’s health providers remain uneducated about the benefits of hormone replacement therapy.
Many people don’t realize the cost of women not treating these temporary but often debilitating symptoms. The perimenopause transition begins on average seven-10 years before a woman reaches full menopause. The average age that women reach menopause in the U.S. is 51, which means that hormonal shifts begin on average around ages 41-45, and sometimes even earlier. The most common hormonal problems that contribute to disrupted sleep and altered circadian rhythms in midlife women are waning progesterone levels, erratic estrogen levels and sometimes depleted levels of testosterone.
In addition to causing multiple nighttime wake-ups and sometimes increased difficulty falling asleep, early menopause symptoms like anxiety, fatigue and decreased resilience can start years earlier than hot flashes for some women. In addition, as a woman gets closer to her menopause transition, hot flashes and feeling increasingly uncomfortable and wakeful when hot at night (“night sweats”) are the most common driver of sleep disruption. Together with hormonal weight gain and increased risk of sleep apnea (as the article also mentions), midlife women really suffer as a result of not sleeping well. Sometimes several nights per week of sleep are affected, over a period of nearly a decade.
Over 80% of women report sleep difficulties during their menopause transition, but only 12% or less are offered hormone replacement therapy, or HRT. Despite what many people have been misled to believe, modern body-identical HRT is safe and affordable, and offers highly effective treatment for hot flashes and sleep disruption with the most long-term benefits (namely, reducing osteoporosis, diabetes and heart disease). Women and providers can get more education about ways to treat menopause symptoms safely and effectively by reading the Menopause Society guidelines at [avl.mx/d7w].
— Jill Gustafson
Certified menopause specialist and nurse-midwife
Asheville
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