Sleep problems may be worse when menopause is hastened by surgery

Women who have surgery to remove their ovaries go through menopause abruptly, and a new study suggests this comes with an increased risk for the kinds of sleep troubles many women experience when they go through menopause gradually. 

Women typically go through menopause between ages 45 and 55. As the ovaries curb production of the hormones oestrogen and progesterone, women can experience symptoms ranging from vaginal dryness to mood swings, joint pain and insomnia. 

Women who have their ovaries surgically removed, however, are thrust into menopause virtually overnight. This kind of procedure may be done to treat cancer or reduce the risk of tumours for women with a genetic risk for breast and ovarian malignancies. Surgery may also be done to remove cysts or treat endometriosis, or painful scarring in the reproductive tract. 

In the current study, women who underwent surgical menopause were more than twice as likely to experience insomnia and reported lower quality sleep compared with women who went through natural menopause. 

“Menopause is a difficult transition for many women, both psychologically and physically, and is often not well-discussed in psychiatric or medical settings,” said senior study author Sooyeon Suh of Sungshin Women’s University in Seoul. 

“Many women bear the burden of going through this phase feeling isolated and frustrated, without much information or education,” Suh said by e-mail. “The results of this study show that women who have surgery and experience menopause may be especially more vulnerable to sleep difficulties compared to women who transition naturally.” 

The study included 429 women who went through menopause naturally and another 97 women who had menopause induced by surgery. All were from Korea and were in their 50s and 60s. On average, those who had surgery were about seven years younger when they entered menopause than the women who had natural menopause. 

About 8 per cent of women with surgical menopause and 4 per cent of women with natural menopause used hormone therapy to ease symptoms. 

With surgical menopause, women reported more difficulty with falling asleep and staying asleep, and more nighttime awakenings, researchers report in Menopause. 

Women who had surgery were also more likely to have habits that can contribute to sleep troubles, such as drinking coffee, eating large meals at night or napping during the day. 

The study cannot prove whether or how surgical menopause has a different impact on sleep than natural menopause. 

Even so, it makes sense that a sudden loss of all hormone production with surgical removal of the ovaries would produce more pronounced symptoms than natural menopause, when the ovaries slow down but do not entirely stop hormone production, said Susan Davis, president of the International Menopause Society and chair of women’s health at Monash University Melbourne in Australia. 

“Disturbed sleep is a common, possibly the most common, menopausal symptom as it is experienced by women who do not have flushes or sweats,” Davis, who was not involved in the study, said by e-mail. 

One thing that may help women get more rest after menopause is to focus on sleep hygiene: habits designed to make it easier to fall asleep and remain asleep, Davis said. That can include reducing caffeine, eating right, exercising regularly and having a consistent bedtime routine. 

While hormones may not be safe for women who have their ovaries removed because of cancer, most women who have ovaries removed to lower their risk of cancer or to treat other conditions can take hormones, said Dr Mary Jane Minkin, a professor of obstetrics, gynaecology and reproductive sciences at Yale Medical School in New Haven, Connecticut, who was not involved in the study. 

“I am certain that the vast majority of women who had surgical menopause did not have it for cancer, but I’ll bet the majority of women just had their ovaries out as part of a hysterectomy for fibroids or some other benign disease,” Minkin said by e-mail. 

“Because they had their ovaries out for benign disease, there is no reason that they couldn’t have received hormone therapy,” Minkin added.