The sleep of men and women is different. Not to mention sleep and menstrual cycle. There are many theories about gender differences, but the main reason is hormonal changes. During the month, women experience an increase and decrease in the concentration of sex hormones depending on the phase of the menstrual cycle. In men, the concentration of their main sex hormone, testosterone, is more stable during the month.
The National Sleep Foundation in the United States reports that 30% of women experience sleep disturbances during menstruation, as well as 23% the week before. Insomnia is also more common during pregnancy and perimenopause.
What hormones affect sleep and menstrual cycle?
Melatonin is a well-known sleep hormone that is produced in the pineal gland, or the so-called pineal body. Melatonin provides adaptation to environmental conditions by regulating physiological rhythms of sleep and active period. The functions of melatonin also include the regulation of fat and carbohydrate metabolism, psycho-emotional and cognitive functions (memory), as well as pronounced antidepressant, anticarcinogenic, antioxidant, immunomodulatory and reproductive effects.
Melatonin begins to be produced at nine o’clock in the evening, peaks at about 23:00 and decreases in concentration by four o’clock in the morning. The main condition for melatonin synthesis is darkness. During artificial light of the white or blue spectrum, the production of the hormone is suppressed and falling asleep occurs on average 1.5 hours later. That is why I ask each of my patients to fall asleep before 23:00 and constantly emphasize this time as the key to the prevention of women’s health disorders.
The female reproductive system, although it has its own rhythms, depends on the environmental rhythms transmitted by melatonin. Therefore, sex hormones and pineal hormone interact with each other.
For example, research presented at the Associated Professional Sleep Societies (APSS) meeting shows that women with delayed sleep phase syndrome are twice as likely to report irregular menstrual cycles and premenstrual symptoms compared to women without sleep disorders. That is, sleep and menstrual disorders are interrelated.
Steroid hormone produced in both sexes by the adrenal glands, as well as the corpus luteum of the ovaries and placenta in women. The functions of progesterone are very diverse. The quality of sleep is directly influenced by progesterone derivatives such as pregnenolone or allopregnanolone, which are neurotransmitters and act directly on brain cells. Back in the 60s, a study found that high doses of progesterone induce a deep sleep in humans, from which it is impossible to bring sound stimuli, but only a sharp tactile stimulation. Progesterone improves sleep and falling asleep also by eliminating anxiety and calming effect.
Progesterone also correlates with the level of melatonin, which can be traced during the menstrual cycle. That is why you should not be afraid to be prescribed progesterone by your gynecologist in the second phase of the cycle. Unfortunately, I can state that chronic lack of progesterone leads to the development of emotional lability and nervousness, which I regularly see in my patients.
After menstruation, estrogen and progesterone levels gradually increase until the luteal phase. At this time, a lengthening of the deep sleep phase can be observed. Then, during the depletion of the corpus luteum, progesterone levels drop, so women may experience sleep disturbances a few days before or during menstruation.
With age, progesterone levels in humans gradually decrease. Therefore, most people begin to experience problems with sleep. Women are especially sensitive to such changes during and after menopause. This is manifested by prolonged falling asleep or waking up at four or five o’clock in the morning. This may be followed by a couple more hours of sleep, difficult waking up and feeling tired and powerless at 10-11 am.
Obstructive sleep apnea syndrome (OSAS), which occurs in postmenopausal women, is partly associated with weight gain during menopause. But it is also linked to hormones. It seems that estrogen helps protect women from OSA. Also, obstructive sleep apnea is more common in women diagnosed with PCOS (polycystic ovary syndrome).
Affects not only the mammary glands and lactation, but also the pancreas and thyroid gland, adrenal glands, ovaries. I want to draw your attention to the fact that high prolactin levels outside of pregnancy and lactation are the cause of the development of benign tumors in the mammary gland.
Increased prolactin levels suppress ovulation and cause menstrual irregularities. In addition, there is a decrease in libido, achieving orgasm is difficult.
Increased prolactin in the blood, i.e. hyperprolactinemia, is directly related to sleep. Night vigil leads to an increase in the level of the hormone.
Approximately a quarter of women in Canada work in shifts. Shift workers experience a mismatch between their endogenous circadian rhythms and their sleep-wake cycles, which can lead to a variety of health problems, including sleep disorders, cardiovascular and gastrointestinal disorders, and psycho-emotional disturbances. Women who work in shifts are also particularly at risk of menstrual disorders, reproductive health problems and breast cancer.
In patients suffering from hypothyroidism, melatonin decreases faster than in healthy people, which leads to sleep disturbances. Plus, the production of hormones that regulate the thyroid gland (TSH – thyroid-stimulating hormone) is in balance with the level of prolactin and gonadotropic hormones (i.e. those that regulate the production of sex hormones). For example, if a woman does not sleep at night for a long time, the level of prolactin will increase, and thyroid hormones will decrease, and provoke menstrual irregularities.
Following healthy sleeping habits can help improve your daily well-being. However, all of us women face many potential obstacles, including adverse life events, depression, illness, and medications that can disrupt sleep.
Check out the tips from the American Academy of Sleep Medicine (AASM) to help yourself improve your sleep quality. I have added my recommendations from a gynecologist-endocrinologist to these tips:
- Make your bedroom a comfortable and safe place. Reduce noise and extreme temperatures that can bother you. Snoring partner? Feel free to sleep with earplugs!
- Go to bed and get up at the same time every day, including weekends and holidays.
- Use light and comfortable bedding and clothes, movements during sleep should not be constrained by uncomfortable pajamas. Ideally, if you sleep naked. If this is not possible, sleep without underwear!
- Go to bed only when you feel sleepy, and use the bed only for sleep and sex.
- Relaxation. Implement rituals to help you relax before bed, such as lying down for 20-30 minutes in a soothing bath with magnesium salt.
- If you need to take a nap during the day, lie down for 15-30 minutes.
- Drink caffeinated beverages only in the morning and avoid alcohol and tobacco at the end of the day.
- Avoid fatty and spicy foods that can cause stomach upset or heartburn. Also exclude fast carbohydrates for dinner, but add “healthy” fat. You should not wake up hungry.
- Increase the amount of vitamin E in your diet, or talk to your gynecologist or family doctor about taking vitamin E supplements.
- Hormone replacement therapy can help menopausal women sleep better by reducing symptoms such as hot flashes. So please, do not support the myths and stereotypes that hormones cause cancer. Cancer is caused by many factors, including uncontrolled use of hormones.
- Use sleeping pills or supplements that affect sleep only under the supervision of a doctor.
- Those who suspect they may have a sleep disorder are advised to consult their doctor or a sleep specialist.
Take care of your body, because during sleep restorative processes are rocking in your body, as well as the transfer of information to long-term memory. Your sleep and menstrual cycle are connected – do not forget about it.
Be healthy mentally, physically, sexually and reproductively.
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To all 💗, your Natalia Silina!
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