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One of the most common complaints from the women I see in my practice is a lack of sleep. Trouble getting to sleep, trouble staying asleep, never enough sleep, and the result is total exhaustion. Women feel run down and stressed out from a lack of sleep. Sleep is very valuable! The amount of sleep and the quality of that sleep affect your energy levels and mood. On average, a person should get at least 7 hours of sleep a night. Unfortunately, as women age the quality and quantity of their sleep can suffer.

Hormones impact sleep and during menopause and the years leading up to menopause, a woman’s sleep cycle can be disrupted. For example, have you ever found yourself tossing and turning after you turn out the lights? Or, even worse, you wake up several times during the night. The most frustrating disruption is waking up at 3 or 4 a.m. and not being able to get back to sleep. You wind tired and unable to face the day being your best self. As many as 40-60 percent of women experience major sleep issues with perimenopause (8-10 years leading up to the last period) and/or at menopause (time when you stop having menstruation: bleeding cycles).

Estrogen and progesterone play a major role in the sleep cycle for women. Sleep disruptions occur frequently during menstruation (monthly bleeding cycle), pregnancy, menopause, and the years leading up to menopause (perimenopause). The typical medical response is to prescribe a sleep agent, unfortunately, most sleep agents have been studied in men, even though women have more sleep disruptions then men. Go figure! In fact, big pharma companies have had to adjust sleep medications dosages to reflect a woman’s physical needs.

Bio-identical hormone replacement therapy (BHRT), more specifically progesterone and estradiol reduce sleep disturbance in addition to providing relief from other major issues such as mood changes, vaginal dryness, and hot flashes to name a few. For some women, hot flashes and night sweats are a major issue, with some women complaining of having to get up to change their night gown or even their sheets during their sleep. A lot of women sleep with the window open and/or leave a fan on in the bedroom all year round to help with this important sleep issue.

Another sleep disruptor is cortisol. We don’t hear enough about cortisol from medicine, but in fact, cortisol plays a significant role in weight control, sleep, and mood. Cortisol levels are affected by decreasing estrogen and testosterone levels experienced in menopause. As such, cortisol, often called “the stress hormone” can rise by more than 20 percent over baseline during sleep for menopausal women. This increase can further disrupt sleep by interfering with the normal daily rhythm of hormones.

There are many sleep supplement options, Melatonin, Benadryl, Unisom, and Valerian, to name a few. Some people also turn to cannabis for sleep. But the question is, ‘Do these work?’ Some work for some people, but it typically isn’t something that you want to become dependent on. These treat the symptom not the root cause.

Women are more likely than men to have sleep issues, higher rates of restless leg syndrome, and overall lower sleep satisfaction. So, the next time your husband asks, “why are you always so tired”, you can tell him that he sleeps much longer and much better than you do!

If you are a woman sleepless in Sydney or anywhere else on this small but mighty island, it is likely related to your hormones. As I noted in the first sentence, many women that I see in my practice complain of not being able to sleep. But there is promise when women start BHRT, they often tell me that the first thing to improve was their sleep. This improvement led to several other improvements!

Be sleepless no longer.

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