Women who are going through menopause frequently complain of sleep complaints and depressive symptoms in addition to other typical symptoms such as hot flashes and night sweats. Two of the most common ways of becoming menopausal are through natural menopause and surgical menopause. While natural menopause is usually experienced in the course of aging, surgical menopause is usually induced by OBGYN surgery such as bilateral oopherectomy, often as a result of illnesses such as ovarian cancer.
Many studies have found that women who experience surgical menopause often experience more psychological and physical difficulties compared to women who transition through menopause naturally due to a more acute drop in estrogen following surgery. Unfortunately, in clinical settings, women who undergo surgical menopause are not provided with additional psychoeducation or customized treatment to address these issues.
The main findings of these studies support these issues. In 526 postmenopausal women, women who went through surgical menopause reported significantly worse sleep quality an shorter sleep duration. Additionally, they had a 2.13 times higher likelihood of having insomnia that warranted treatment.
Finally, even though women who went through surgical menopause engaged in the same sleep-interfering behaviors (e.g., drinking caffeine, drinking alcohol before bed, watching TV in bed, etc) as women who went through menopause naturally, their sleep was impacted more negatively.
Menopausal is a difficult transition for many women, both psychologically and physically, and this study showed that women who have surgery and experience menopause may be especially more vulnerable. For clinicians, it is important to address sleep and psychological issues in clinical settings and educate women who are experiencing surgical menopause about behaviors that may interfere with their sleep.
For women experiencing surgical menopause, it will be important to avoid behaviors that are not conducive to sleep, such as drinking alcohol or caffeine, having heavy meals or engaging in activities in bed, or taking a long nap during the day. If sleep has become a problem, you should consider seeing a sleep expert and receiving non-pharmacological treatments such as cognitive-behavioral therapy for insomnia.
Because of the nature of the women we are studying, it is often difficult to tease apart the physical and psychological factors that contribute to sleep and psychological problems. I believe future studies can utilize objective measures of menopausal symptoms (e.g., follicle-stimulating hormone levels) and sleep (e.g., polysomnography) to provide more information about differences and mechanisms about why women who undergo surgical menopause experience more sleep difficulties compared to women who transition into menopause naturally.
Menopause is not a very well-discussed or well-researched topic, especially in psychiatric or medical settings. Many women bear the burden of going through this phase feeling isolated without much information or education. More studies and interest in this topic are definitely needed to help half of the world population who will inevitably go through this transition.
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