Sleep quality and surgical versus natural menopause

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Women who undergo surgical menopause have lower sleep quality than those whose menopause occurs naturally, according to results of a first-of-its-kind comparison of menopause in context of sleep-interfering behavior. Published in Menopause, the research was done by Korean investigators.

“Often women who experience surgical menopause are not aware they are more vulnerable to sleep problems, and engaging in sleep-interfering behavior that can exacerbate sleep disturbance,” said senior author Sooyeon Suh, PhD, Department of Psychology, Sungshin University, Republic of Korea.

In the cross-sectional study, Suh and colleagues used data from a subsample of the Korean Genome and Epidemiology study, a population-based cohort to identify gene-environment factors and their interactions in common chronic diseases, to compare sleep quality, insomnia, and sleep-interfering behaviors between women who underwent surgical menopause those whose menopause was natural. 

The study enrolled 536 women, 429 (81.6%) who reported going through natural menopause and 97 (18.4%) who reported undergoing surgical menopause. The women in the latter group were older at menopause than those in the former group (50.14 vs 42.94 years, respectively; P≤0.001), used less hormonal medication (4.4% vs 8.3%, P= 0.02), and had a shorter transition into menopause (10.13 vs 16.22 years, P< 0.001). The groups were otherwise evenly matched. 

Based on the Pittsburgh Sleep Quality Index (PSQI) that measures self-reported sleep quality and disturbances, women who underwent surgical menopause had significantly worse total sleep quality than those who went through natural menopause (5.85 vs 4.75, P= 0.007) as well as shorter sleep duration (1.54 vs 1.17, P= 0.001) and worse habitual sleep efficiency (0.76 vs 0.44, P= 0.01).  Overall, women who underwent surgical menopause had 2.13 times higher odds of experiencing clinical levels of insomnia symptoms. 

Women who underwent surgical menopause also were also more negatively affected by sleep-interfering behaviors than those who went through natural menopause. Using the Sleep Behavior Scale (SBS), a self-report questionnaire on sleep-interfering behaviors before bed such as alcohol or caffeine use, eating heavy meals, or engaging in activity, the study found that sleep-interfering behavior reported by women who underwent surgical menopause was associated with more insomnia symptoms than women who went through natural menopause who reported similar sleep-interfering behaviors.

These results underscore the importance of assessing sleep quality in women, particularly those who undergo surgical menopause, and educating them prior to surgery on the effects of sleep and after surgery on behavioral interventions that may help improve sleep.

“Although low sleep quality and insomnia symptoms in women who transition into menopause through surgery are quite common, they are often overlooked in clinical settings and education or treatment are generally not tailored to women based on type of menopause,” said Dr. Suh.