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Area of Science:

  • Reproductive Endocrinology
  • Sleep Medicine
  • Gerontology

Background:

  • Sleep disturbances are common in menopausal transition and postmenopause.
  • Insomnia correlates with declining estradiol, vasomotor symptoms (VMS), depression, and anxiety.
  • Other factors like pain and sleep-disordered breathing contribute to menopausal insomnia.

Purpose of the Study:

  • To review the mechanisms and management of sleep disturbances during menopausal transition.
  • To integrate epidemiological, mechanistic, and treatment data for individualized care.
  • To identify future research directions for targeted therapies.

Main Methods:

  • Literature review integrating epidemiological findings, mechanistic insights, and treatment data.
  • Analysis of randomized trials for pharmacological and non-pharmacological interventions.
  • Synthesis of current understanding of menopausal insomnia contributors.

Main Results:

  • Insomnia prevalence rises during midlife with decreasing estradiol and increasing VMS, depression, and anxiety.
  • Menopausal hormone therapy offers inconsistent sleep benefits; non-benzodiazepines and dual orexin receptor antagonists show efficacy.
  • Traditional herbal formulas may benefit select women, but evidence is limited.

Conclusions:

  • Menopausal insomnia is multifactorial, requiring individualized treatment plans based on symptom profile and patient preference.
  • Future research should focus on objective sleep measures and elucidating biological pathways.
  • Targeted therapies for neuroendocrine, circadian, orexin, and inflammatory pathways are needed.