Self-reported sleep problems are common especially during the menopausal transition
Guthrie et al. (Sleep, 2018) combined data from multiple studies to describe the efficacy of interventions on severe insomnia symptoms in women with menopause associated vasomotor symptoms (VMS)
Pooling of data from 4 MsFLASH RCTs (Menopausal Strategies: Finding Lasting Answers to Symptoms and Health)
Common eligibility criteria
In the menopause transition, defined as amenorrhea ≥ 60 days in the past year OR postmenopausal, defined as ≥12 months since last menstrual period or bi-lateral oophorectomy) OR had a hysterectomy with one or both ovaries remaining and FSH >20 mIU/mL and estradiol ≤50 pg/mL
In good health based on history, physical exam and basic lab tests
Adjustments made for differences between studies
Analyzed pooled individual-level data from 546 peri- and postmenopausal women with Insomnia Severity Index (ISI) ≥ 12, and ≥14 bothersome VMS/week
ISI assesses difficulty falling asleep | difficulty staying asleep |problems with early awakening, satisfaction with current sleep pattern | interference of sleep problem with daily functioning | noticeability of impairment attributed to the sleep problem | degree of distress caused by the sleep problem
Each item scored from 0-4
Interventions included the following
escitalopram 10–20 mg/day
8 g/day omega-3 fatty acids
oral 17-beta-estradiol 0.5-mg/day
venlafaxine XR 75-mg/day
cognitive behavioral therapy for insomnia (CBT-I), which includes
Stimulus control (e.g., not eating too close to bedtime)
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