CommunityMenopausePerspectivesSleepWomen's Health


By: Wulf Utian MD PhD

There are a number of links between sleep, mood, and memory. Menopause
has a major influence on all!

SLEEP: Almost half of women over 50 experience sleep disturbances, suffering
more frequent insomnia, and nighttime awakenings, being twice as likely as
younger women to use prescription drugs for sleep. Poor sleep or disrupted
sleep in turn is associated with symptoms like morning fatigue, irritability,
lethargy, inability to concentrate, a perceived loss of memory, difficulty in
performing tasks, and lack of motivation. The million-dollar question is
whether nighttime hot flashes (night sweats) are responsible for the sleep
disruption, and what is called the “snow-ball
” of triggering all or some of the above symptoms.

Quality of sleep does vary during the night. Estrogen has been
demonstrated to positively influence the good-quality sleep called rapid
eye-movement (REM) sleep, which tends to occur during the second half of the

There is evidence that after menopause, more women experience
sleep-disordered breathing (SDB, or sleep apnea/hypopnea syndrome). This
can manifest with loud snoring, sleep arousals, and episodes of reduced
breathing (hypopnea) or even no breathing (apnea) and reduction in circulating

MOOD: The impact of menopause and hormones on sense of well-being and mood has
been a subject of my own intense research interest since my days as a young
investigator. My initial studies demonstrated a direct effect between ovarian
function, hormones, and mood. I am not referring to a major depression, but
what we describe as “blue moods” (technically referred to as dysphoria). Studies over the years have
confirmed these findings, and this mood-elevating effect of estrogen appears to
go beyond the snowball effect of eliminating night sweats and disrupted sleep.
In addition, compared with women before menopause, perimenopausal women who
seek help for mood changes have been found to be less healthy, have more hot
flashes and psychosomatic complaints, and even to have suffered more from premenstrual syndrome (PMS).

MEMORY: Women around the age of menopause, when surveyed for their greatest
health concern, overwhelmingly say breast cancer. However, women over 60
overwhelmingly worry more about memory loss and eventually succumbing to
Alzheimer’s disease. I guess it is what you see among your direct peers that
influences thinking most. But memory 
(cognition) is a concern for
most people as they age (I know it bothers me!).

This word cognition has deep
meaning, incorporating multiple brain skills including memory, learning
ability, powers of concentration, language, spatial abilities, and judgment.
There are many factors that can influence each and any of these domains,
including physical health, stress, mood, fatigue, drugs and medications,
alcohol, and the list is almost endless. As a result it is extremely difficult
to determine the role of menopause and hormones for their true effect on
cognition. Fortunately, some great minds in the research world are
concentrating their efforts into this extremely relevant area of quality of

The steroid hormones – and remember this includes estrogen,
progesterone, testosterone, and the adrenal hormone cortisone – directly influence brain function through receptors in
many specific areas of the brain. At this time, there is no firm evidence that
menopause negatively affects any of the cognitive skills. Some weak
associations have been shown, but these are more likely to be related to mood
or aging than to menopause itself.

What about that form of advanced cognition loss called dementia in which there is such a
disruption of intellectual abilities that usual daily activities become
substantially impaired? This sad state may be preceded by a time of moderate
cognitive difficulty called mild
cognitive impairment
. Alzheimer’s accounts for half of all dementia, with
more women affected than men. But that may be because women live longer than
men, meaning there are more older women than men.
Vascular disease is also a major cause of dementia. Ovarian function does have
an impact on vascular health or disease. But at this time we do not have enough
evidence to confirm a role of menopause itself as a cause of Alzheimer’s

Next week I will address sex after menopause.

Have a great week

Wulf Utian MD PhD

Author; CHANGE YOUR MENOPAUSE – Why one size does not fit all.


The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

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