Aetiology and treatment of sleep disturbances during perimenopause and postmenopause

The sudden and predictable cessation of ovarian endocrinological function a t menopause results in a marked decrease of endogenous estrogen and progest ogen secretion. In addition to cessation of menstruation, a wide range of b iological functions, including sleep, are affected. Sleep disturbances are more common in women than in men and their incidence increases with age. Th ere are 2 distinct mechanisms by which menopause is known to affect sleep q uality. One is menopausal insomnia, which can be considered as part of the symptomatology of the climacterium. Another is sleep-disordered breathing, where impairment of sleep quality is secondary to sleep apnoea or partial u pper airway obstruction during sleep. The former is effectively controlled with conventional estrogen replacement therapy, whereas the latter could po tentially be improved with progestogens. Many age-related conditions withou t a direct link with the menopause should also be considered when treating postmenopausal sleep disorders.