Several processes in our bodies slow down with age. Some even come to a standstill, like women’s reproductive process. As they age, women experience menopause, a stage where they no longer menstruate.
Ways to deal with menopause refers to the time when a woman has not had a menstrual period for 12 months. With an average age of onset being 51, menopause occurs between the ages of 45 and 55. It isn’t a sudden event and the term is often confused with menopausal transition or perimenopause.
Menopausal transition refers to the years leading up to this point. During this period, women experience symptoms such as hot flashes, irregular periods, changes in mood, etc. They also experience sleep disruption, mood fluctuations, cold sweats and other vasomotor symptoms (relating to actions which alter the diameter of blood vessels).
“The hot flashes started at 42 and I entered menopause at 52,” says Kamala, 60, a homemaker. “Even now, my hot flashes haven’t stopped.”
So, what causes these changes? The ovaries (organs that produce egg cells) stop making progesterone and oestrogen, the female hormones responsible for fertility and regulating menstrual cycles.
As women approach their fifties, their ovaries get smaller. At this stage, hormones are produced at irregular intervals, causing unpredictable menstrual cycles and other symptoms. Gradually, the eggs stored in the ovaries decrease to a level that periods stop occurring at all.
Hot flashes stay for a median duration of around 7.4 years. They occur round the clock and are often found to disrupt sleep. A study on sleep problems in perimenopausal and menopausal women found that women in their middle age rank higher on the scale of insomnia severity.
Kamala wakes up unrested and with low energy every morning because hot flashes disrupt her sleep. “If I fall asleep at around 11pm, the hot flash wakes me up at 1am, then at around three and again at around 5.30 or 6 in the morning. I used to get them throughout the day earlier. But now they start from the evening and last throughout the night.” She naps in the afternoon to catch up on her rest.
Other than oestrogen (regulates the menstrual cycle) and progesterone (prepares the uterus for pregnancy), the production of follicle-stimulating hormone (stimulates the ovaries to produce eggs), luteinizing hormone (triggers ovulation) as well as testosterone (male hormone released in small amounts in the female body to maintain muscle mass and energy, and affects libido) also reduces during menopause, Stephanie S. Faubion writes in The Menopause Solution – Mayo Clinic.
An estimated 40% to 60% of menopausal women have a poor quality of sleep and around 25% meet the criteria for an insomnia disorder, according to a study. With symptoms of menopause playing havoc on women’s sleep cycle, research has also found that fragmented sleep adversely affects cognitive performance.
“Hormonal changes, reduced calcium metabolism and lowering of progesterone, estrogen and vitamin D3 lead to sleep deprivation,” says Dr Rama Shankarnarayan, a gynaecologist and IVF specialist in Bengaluru. “In menopause, women are deprived of their hormones, making them irritable — which also contributes to the disruption of sleep.”
Reproductive hormones such as oestrogen and progesterone also affect neurotransmitters (chemicals in the brain) that promote sleep. As the production of these hormones decreases, falling and staying asleep may become a tough task.
Studies have also found that with advancing age, sleep problems become more common in people regardless of their sex. Since menopause is a phase in reproductive ageing, women’s physical age also plays a role in disrupting their sleep-wake cycle (circadian rhythm).
Menopause is not a disease or a disorder, but a phase in every woman’s life and occurs with age. It does not require treatment. However, there are ways to deal with menopause and manage solutions for menopause-related symptoms without medication too.
“Exercise makes the body release endorphins (feel-good neurotransmitters), which reduces mood variation. Taking vitamin D3 and calcium tablets along with calcium-rich foods helps improve sleep during menopause,” Dr Shankarnarayan says, when asked about how sleep during menopause could be improved. “Eating early and giving a gap of three hours before bedtime reduces pressure on the intestines and improves sleep quality. Artificial light affects the pituitary gland, indirectly reducing sleep.”
As far as sleep disruption is concerned, the following simple steps can make a big difference in hot flashes treatment:
- Exercise: Physical activity is known to improve sleep quality. Exercising 4-5 hours before bedtime helps improve sleep; exercising too close to bedtime, however, might keep you awake. Practising yoga may have a positive effect on sleep.
- Meditation: Evidence shows that mindful meditation promotes sleep quality. Breathing exercises and other meditation techniques also play a role in alleviating anxiety.
- Caffeine: The intake of caffeine causes problems in sleep. Although caffeine may help in avoiding daytime sleepiness, research suggests that it also has a negative impact on sleep at night. Maintaining sleep hygiene goes a long way in avoiding any potential health risks.
- Food: Avoid snacking or drinking fluids before bedtime. It may cause digestion problems and keep you awake at night.
- Electronic devices: Exposure to artificial light before bedtime suppresses the production of melatonin, the hormone that controls the sleep-wake cycle (circadian rhythm). It also leads to arousal, stimulating the brain and disrupting sleep. Putting away devices at least half an hour before bedtime is a part of good sleep hygiene.
With medical advancement, the average life expectancy of people has also increased. Today, women spend more than a third of their lives in menopause. They can find remedies for menopause by understanding reproductive ageing along with its causes and consequences. And by taking measures to cushion its impact, women can transition well into the next phase of their lives.