Elsevier

Sleep Medicine Clinics

Volume 13, Issue 3, September 2018, Pages 283-294
Sleep Medicine Clinics

Menstrual Cycle Effects on Sleep

https://doi.org/10.1016/j.jsmc.2018.04.002Get rights and content

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Key points

  • Self-reported sleep disturbance increases during premenstrual and menstruation phases of the menstrual cycle, particularly in women with premenstrual symptoms or painful menstrual cramps (dysmenorrhea).

  • Sleep spindles increase in the luteal phase relative to the follicular phase, possibly due to an effect of progesterone and/or its metabolites.

  • Women with polycystic ovary syndrome, particularly if obese, are at risk of sleep disordered breathing, partly due to hyperandrogenism that characterizes

Definitions and menstrual cycle physiology

Most women have menstrual cycle lengths between 21 and 30 days, with menses lasting less than 7 days.1 The menstrual cycle is divided into a preovulatory follicular phase and postovulatory luteal phase, with the onset of menstrual flow marking the beginning of a new cycle (day 1) (Fig. 1).

During the follicular phase, follicle-stimulating hormone and luteinizing hormone (LH) are released from the anterior pituitary and act on the ovaries to initiate development of several primary follicles,

Self-Reported Sleep Quality

Collectively, studies show that sleep disturbances are more commonly reported by women around the time of menstruation, encompassing the last few premenstrual days (late luteal phase) and the first few days of menstrual bleeding (early follicular phase).6, 7, 8, 9 However, not all studies find a menstrual cycle effect on sleep quality10 or find only small effects,11 possibly reflecting between-individual variability in the relationship between sleep and menstrual cycle phase. Van Reen and

Prevalence, Cause, and Symptoms

The most common endocrine disorder for reproductive-age women is polycystic ovary syndrome (PCOS). PCOS affects 5% to 20% of women, depending on age, type of epidemiologic survey, and diagnostic criteria. There are likely different phenotypes for this syndrome; because polycystic ovaries may or may not be present, discussion about the misleading label of PCOS is leaning toward 3 types: androgen excess with ovarian dysfunction, androgen excess with polycystic ovary morphology, and ovarian

Prevalence, Cause, and Symptoms

Premenstrual syndrome (PMS) is characterized by emotional, behavioral, and physical symptoms that manifest almost exclusively in the late-luteal (premenstrual) phase, with resolution soon after onset of menses. Although many women experience some symptoms premenstrually, up to 18% have severe symptoms that impact daily function.48 Premenstrual dysphoric disorder (PMDD) is a severe form of PMS evident in 3% to 8% and classified as a depressive disorder in the American Psychiatric Association’s

Sleep and dysmenorrhea

Dysmenorrhea, defined as painful menstrual cramps of uterine origin, is either primary (menstrual pain without organic disease that typically emerges in adolescence) or secondary (associated with conditions such as endometriosis and pelvic inflammatory disease). The relationship between primary dysmenorrhea and sleep is detailed elsewhere in this special issue (Joan L. Shaver and Stella Iacovides’ article, “Sleep in Women with Chronic Pain and Autoimmune Conditions: A Narrative Review,” in this

Sleep and hormonal contraceptives

Combined oral contraceptives (OCs) contain ethinyl estradiol and a synthetic progestin taken for 21 days and a placebo taken for 7 days. During the 21-day period, hypothalamic pituitary ovarian axis activity is suppressed and endogenous estradiol and progesterone levels are low, similar to levels in the follicular phase for nonusers.73 Across most of the 7-day placebo period, estrogen levels remain suppressed. New formulations contain the minimum steroid doses necessary to inhibit ovulation.74

Impact of sleep on reproductive function

Not only does the reproductive cycle influence sleep but sleep can also influence reproductive function.79 Sleep duration, timing, and quality can influence the reproductive system, with effects depending on reproductive maturity. During puberty, LH is released in a pulsatile fashion during N3, playing a critical role in reproductive regulation.80, 81 In adulthood, direction of the relationship changes in the early follicular phase, with sleep inhibiting pulsatile LH secretion, thought to be

Summary

Sleep and circadian rhythms are altered in association with the hormonal changes of the menstrual cycle and in the presence of menstrual-associated disorders. The magnitude of effect varies, particularly for self-reported sleep quality, which worsens in some, but not all, women when premenstrual symptoms emerge. Importantly, women with PCOS have an increased risk for SDB, which should be treated to mitigate health impacts. Potential menstrual cycle variability in sleep quality as well as upper

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    Disclosure statement: F.C. Baker has received funding unrelated to this work from Ebb Therapeutics Inc, Fitbit Inc, and International Flavors & Fragrances Inc. K.A. Lee has nothing to disclose.

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