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Grand Rounds

Meta-Analysis: Does Menopausal Hormone Therapy Improve Sleep Quality?

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BACKGROUND AND PURPOSE:

  • It is unclear whether hormone therapy (HT) can improve sleep quality for menopausal women
  • Pan et al. (Menopause, 2022) performed a systematic review and meta-analysis to assess the effects of different HT regimens on menopausal sleep quality

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • Double blinded RCTs
    • Studies that examined the effects of menopausal HT on sleep disturbances
    • Menopause (including perimenopause and postmenopause)
    • Minimal 4 week intervention
    • Sleep quality outcomes: Measured with polysomnography or self-reported questionnaires
  • Study design
    • Standardized mean difference (SMD) was estimated using random-effects models
    • GRADE criteria used for determining study quality
  • Primary outcome
    • Sleep quality

RESULTS:

  • 15 studies
  • Compared with placebo, HT improved self-reported sleep outcomes
    • SMD –0.13 (95% CI, –0.18 to -0.080); P<0.00001
  • HT did not improve sleep parameters using polysomnography
  • In subgroup analyses by regimen of HT, the following were found to improve sleep quality
    • 17β-estradiol
      • SMD –0.34 (95% CI, –0.51 to -0.17); P<0.0001
    • Conjugated equine estrogens
      • SMD –0.10 (95% CI, −0.12 to −0.07); P<0.00001
  • Transdermal administration was more beneficial than oral administration
    • Transdermal
      • SMD −0.35 (95% CI, −0.64 to −0.06); P=0.02
    • Oral
      • SMD −0.10 (95% CI, −0.14 to −0.07); P<0.00001
  • The combination of estrogen and progesterone had a positive effect on sleep disturbance, while estrogen monotherapy did not
    • Combination
      • SMD −0.10 (95% CI, −0.13 to −0.07); P<0.00001
  • The following could alleviate sleep disturbance
    • Estrogen/micronized progesterone
      • SMD −0.22 (95% CI, −0.37 to −0.06); P=0.007
    • Estrogen/medroxyprogesterone acetate
      • SMD −0.10 (95% CI, −0.13 to −0.07); P<0.00001

CONCLUSION:

  • Menopausal hormone therapy can improve self-reported sleep outcomes
  • Mode of administration and regimen of hormone therapy likely impact outcomes
  • The authors state that while more RCTs with larger sample sizes are required

Our findings from indirect evidence support the use of transdermal 17β-estradiol combined with micronized progesterone for at least 6 months in menopausal women with sleep disturbance

Learn More – Primary Sources:

Different regimens of menopausal hormone therapy for improving sleep quality: a systematic review and meta-analysis

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Related ObG Topics:

Which Menopausal Hormone Therapies Improve Sleep Quality? 
Insomnia in Menopause: How do Treatments Compare?
Is Treatment for Urinary Incontinence Associated with Improved Sleep Quality?

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