Sleep symptoms signaling the menopausal transition.

STUDY OBJECTIVES: To describe changes in sleep quality and associated sleep symptoms as women begin menopausal transition compared to pre-menopausal controls.

METHODS: In a repeated measures design, we analyzed data collected every 2-6 months from a community-based sample of 223 women 40-50 (45.6±2.3) years old over a two-year period. Each 6-month visit included urinary follicle stimulating hormone (FSH) as a marker of ovarian function, Pittsburgh Sleep Quality Index (PSQI) and other questionnaires (Center for Epidemiological Studies-Depression Scale; Perceived Stress Scale). Menstrual cycle and vasomotor symptoms (Seattle Women's Health Symptom Checklist) were tracked every 2 months by phone. For women entering menopausal transition (n=68) we used data from the two consecutive visits prior to their FSH rise and the next two visits. Data from the last four consecutive visits were used for controls remaining pre-menopausal (n=155).

RESULTS: The transition group did not differ from controls on age, vasomotor symptoms (hot flashes/night sweats), stress or depression but did have a higher BMI. Measures were stable over time for controls. However, the transition group experienced an increase in PSQI scores (initial PSQI=5.7±3.2 and final PSQI 6.3±3.8, p=.030) and frequency of trouble sleeping because of feeling too hot (p=.016) that lagged the FSH rise by 6 months with no notable change in report of hot flashes/night sweats.

CONCLUSIONS: Trouble sleeping because of feeling too hot, distinct from awareness of vasomotor symptoms, was the only uniform contribution to higher PSQI scores after the initial FSH increase and may signal onset of the menopausal transition.