Sleep and menstrual cycle

The sleep of men and women is different. There are many theories about gender dissimilarities, but the main reason is hormonal change. So how are sleep and the menstrual cycle connected? 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 of 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.

Which Hormones Affect Sleep And Menstrual Cycle?

Melatonin is a well-known sleep hormone that is produced in the pineal gland. 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 production starts at 9 PM, peaks at about 11 PM and starts decreasing at 4 AM. The main condition for melatonin synthesis is darkness. Artificial light of the white or blue spectrum suppresses the production of the hormone and so you fall asleep about 1.5 hours later. That is why I ask each of my patients to fall asleep before 11 PM and constantly emphasize this time is crucial for preventing women’s health disorders.

The female reproductive system, although it has its 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.

Progesterone

It is a steroid hormone produced in both sexes by the adrenal glands, and 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, impossible to break with sound, only through tactile stimulation. Progesterone improves sleep and falling asleep also by eliminating anxiety and causing a 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 when your gynecologist prescribes progesterone in the second phase of the cycle. Unfortunately, chronic lack of progesterone leads to the 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 sleep problems. Women are especially sensitive to such changes during and after menopause. It takes more time for them to fall asleep, or they might wake up at 4-5 AM. This may be followed by a couple more hours of sleep, difficult waking up and feeling tired and powerless at 10-11 AM.

Estrogen

Obstructive sleep apnea syndrome (OSAS), which occurs in postmenopausal women, is partly associated with weight gain. But there is also hormones’ impact. It appears that estrogen helps protect women from OSAS. Plus, obstructive sleep apnea is more common in women diagnosed with PCOS (polycystic ovary syndrome).

Prolactin

This hormone affects not only the mammary glands and lactation, but also the pancreas and thyroid gland, adrenal glands, ovaries. I want to emphasize that high prolactin levels when you’re not pregnant or breastfeeding are causing benign tumors in the mammary gland.

Increased prolactin levels suppress ovulation and cause menstrual irregularities. In addition, there is a decrease in libido, and getting an orgasm is harder.

Increased prolactin, i.e., hyperprolactinemia, is directly related to sleep. Staying awake at night leads to an increase in the level of this hormone.

Approximately a quarter of women in Canada work in shifts. They experience a mismatch between their endogenous circadian rhythms and their sleep-wake cycles, which can lead to various 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 issues and breast cancer.

Thyroid hormones

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 balanced 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.

The Ways to Improve Your Sleep

Take a look at the tips from the American Academy of Sleep Medicine (AASM) to help yourself improve your sleep quality. I have added my recommendations as a gynecologist-endocrinologist:

Make your bedroom a comfortable and safe place. Reduce noise and extreme temperatures that can bother you. Snoring partner? Please don’t hesitate 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 inconvenient pajamas. Ideally, sleep naked. If it is impossible, 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, like taking a soothing bath with magnesium salt for 20–30 minutes.
If you need to take a nap during the day, take it 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 ache or burning sensations. Also exclude fast carbohydrates for dinner, but add “healthy” fat. Hunger should not disrupt your sleep.
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 believe in 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 medical supervision.
If you suspect having a sleep disorder, consult your doctor or a sleep specialist.

Take care of your body, since during sleep restorative processes are rocking, and information transfers to your long-term memory. Your sleep and menstrual cycle are connected – do not forget about it.

Be healthy mentally, physically, sexually and reproductively.

Please share this article on your social networks, let as many people as possible know the simple things that save life and enhance it, and therefore make it happier!

More about your health and body is in the courses: A girl becomes a woman, All about you. What it’s like to be a Woman, All about you 35+.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com

You can always choose your doctor at the Lior Medical Center.

My 💗 to everybody!
Sincerely, Natalia Silina

Sources:

1. JR Thorpe. How Does The Menstrual Cycle Affect Sleep?; Sleep Review, July 26, 2019
2. Fiona C Baker, Kathryn Aldrich Lee. Menstrual Cycle Effects on Sleep; Sleep Medicine Clinics, September 2018
3. Fiona C Baker, Helen S Driver. Circadian rhythms, sleep, and the menstrual cycle; Sleep Medicine Clinics, September 2007
4. Ari Shechter, B.Sc., Francine O. James, PhD, Circadian Rhythms and Shift Working Women; Sleep Medicine Clinics, March 2008
5. А.Ю. Беспятых, В.Я. Бродский. Мелатонин: теория и практика; Медпрактика, 2009