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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