Circadian rhythm dysregulation in the elderly: shift work

The aim of this study was to investigate sleep disturbances in 46-yr-old women and their association with early-onset menopausal transition. The women of this cross-sectional birth cohort study were divided into climacteric (n = 359) and preclimacteric (n = 2,302) groups by their menopausal status, defined by follicle-stimulating hormone levels and menstrual history. Sleep disturbances were evaluated with Athens Insomnia Scale 5. We performed univariable and multivariable logistic regression models in which sleep parameters were dependent variables and climacteric status, hot flashes, smoking, and education level were independent variables. The use of hormone therapy was also evaluated in women suffering from sleeping disturbances. On the basis of the scale questions, climacteric women experienced significantly delayed sleep induction (12.2% vs 8.7%, P = 0.047), more problems with awakenings during the night (23.4% vs 14.6%, P < 0.001), earlier final awakening (13.8% vs 9.9%, P = 0.039), and more unsatisfying sleep quality (11.9% vs 7.9%, P = 0.023). Climacteric women who were experiencing hot flashes reported unsatisfactory sleep quality more frequently compared with climacteric women who did not experience hot flashes (17.0% vs 9.2%, P = 0.047). In the univariable and multivariable logistic regression models, being climacteric was independently associated with different impaired sleeping parameters. Most climacteric women who had a scale score of 4 or greater were not using hormone therapy, according to their medicine purchases over the past year. Being climacteric was associated with sleep disturbances in women in their mid-40s. However, this association seemed to be particularly driven by hot flashes. Most climacteric women with clinically significant sleeping disturbances were not using hormone therapy.

In recent years, light therapy has been tried for the treatment of depression and sleep in pregnancy or postnatal period women, but the results have been inconclusive. This meta-analysis is the first to systematically review the effects of light therapy on depression and sleep disturbances in women during pregnancy and the postnatal period. We searched for randomized controlled studies in PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, and Chinese Biomedical Database up to January 2023. The standardized mean difference (SMD) was used to assess the efficacy of the outcome indicators. Eight studies were eventually included in the analysis. The results showed that light therapy was more effective than the placebo group in terms of depression (SMD=.34, CI=.08-.61) and sleep (SMD=.64,95%CI=.28-1.00). Subgroup analysis could not explain the significant heterogeneity. There were no serious adverse effects in either the light therapy or placebo groups. Light therapy could be considered an effective treatment for depression and sleep disturbances in women during pregnancy and the postnatal period. However, future high-quality trials with larger sample sizes are still needed.

Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery

The menopause in a woman’s life is one of the most significant events indicating the large-scale changes in the hypothalamus-pituitary-ovarian axis function. Gonadal steroid hormones are actively involved in the central nervous system (CNS) growth, differentiation, physiology and ageing processes. Sleep provides restoration of the central nervous system, and also contributes to memory consolidation. Sleep influences the two primary effector systems, the hypothalamus-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS), which in turn regulate adaptive and innate immune responses. During sleep, blood levels of cortisol, adrenaline and norepinephrine drop, whereas the levels of neurotransmitters such as growth hormone, prolactin and melatonin show a steep increase. We get more and more facts showing the role of sleep in the processes of immunogenesis and metabolism, in particular fat metabolism. A systematic modern literature analysis on the prevalence and structure of sleep disturbances in women during pre-, peri- and postmenopause was carried out. The results of individual studies revealing the relationship between sleep disturbances and hormone levels including levels of sex steroids are presented. A review of current scientific evidence shows conclusively that the neuroendocrine system significantly determines the sleep quality. Sleep disturbances associated with RLS, COAC are highly prevalent, especially among postmenopausal women, due to declining ovarian function and deficiency of sex steroids. The results of conducted studies support the continued study and analysis of the relationships between gender, neuroendocrine factors, sleep disorders and the search for effective methods for their treatment. SonNorm Duo containing melatonin, peppermint leaf oil, and motherwort herb extract is one of the drugs used to manage sleep disturbances. SonNorm Duo is an adaptogenic sedative drug that is indicated for sleep disturbances, circadian rhythm sleep-wake disorders associated with rapid travel across multiple time zones.

To date many researchers have focused on depression as a discrete episode, attempting to relate its occurrence to a transition in menopausal stage or other factors that might account for its occurrence. Characterizing change over time requires consideration of pattern or trajectory, not merely discrete events. The purposes of this paper are to: 1) to explore methods for intraindividual and interindividual (group) analysis of patterns of depressed mood among midlife women 2) to identify challenges for analytic strategies for understanding depressed mood as it is experienced by midlife women, with special concern for its relationship to the menopausal transition. Data from the Seattle Midlife Women's Health Study were used to illustrate approaches to intraindividual and interindividual analysis of patterns of depressed mood. For most women, menopausal transition was not a time when there was a new episode of depression. Instead, a minority of women showed evidence of becoming depressed once the transition had begun. The most prevalent pattern was that of non-depressed mood across the years of the menopausal transition. Association of several factors with a pattern of depressed mood included life stressors, perceived poor health, and vasomotor symptoms.

Sleep disturbance is common during the menopausal transition, with numerous downstream consequences to health and functioning, including reduced quality of life, impaired mental health, and increased physical health morbidity. Insomnia affects approximately 50% of midlife women and is characterized by nocturnal symptoms of difficulties initiating or maintaining sleep (or both) and daytime symptoms that impair occupational, social, or other components of functioning. In addition, approximately 20% of midlife women develop sleep-disordered breathing during the menopausal transition. This commentary summarizes the prevalence, risk factors, and treatment options for each of these sleep disorders in midlife women, with specific focus on first-line treatments for insomnia (cognitive behavioral therapy for insomnia) and sleep-disordered breathing (continuous positive airway pressure) and unique considerations for treating sleep disorders in midlife women. Future directions are also discussed.

ABSTRACTThe transition due to immigration from one country to another country (referred to as immigration transition henceforth) is inherently stressful, placing an additional dimension of stress to midlife women in the menopausal transition. However, few studies have examined the association of immigration to sleep-related symptoms experienced by midlife women in the menopausal transition. The authors’ purpose for this study was to explore the associations of immigration to sleep-related symptoms among four major racial/ethnic groups of 1,054 midlife women in the United States. This was a secondary analysis of data from two national surveys that were collected from 2005 to 2013. The instruments included questions on background characteristics, health and menopausal status, immigration transition, and the Sleep Index for Midlife Women. The data were analyzed using t-tests, chi-square tests, correlation analyses, and hierarchical multiple regression analyses. Immigrants reported fewer total numbers of and lower total severity scores of sleep-related symptoms than non-immigrants (p < .01). Yet, when background characteristics and health and menopausal status were controlled, self-reported racial/ethnic identity was the only significant factor associated with sleep-related symptoms (ΔR2 = 0.02, p < .01). Health-care providers need to consider self-reported racial/ethnic identity as a factor significantly related to sleep-related symptoms during the menopausal transition.

BackgroundBiological aging is a heterogeneous process that varies across organs and systems. The dynamic hormonal changes during the menopausal transition may have profound and organ-specific impacts on biological aging. However, the relationship between the menopausal transition and both comprehensive and organ-specific biological aging remains poorly understood. This study aimed to investigate the associations between menopausal factors and both comprehensive and organ-specific biological aging, as well as the modifying role of reproductive history.MethodsThis study included 37,244 women from the China Multi-Ethnic Cohort (CMEC) and 140,479 from the UK Biobank (UKB). Menopausal factors included menopausal status, menopausal transition, and age at menopause. Comprehensive and organ-specific biological ages (BAs) were calculated using the Klemera-Doubal method and clinical biomarkers and have been shown to predict age-related health outcomes. Multiple linear regression and change-to-change models were applied, with stratified analyses based on reproductive history.ResultsCompared with pre-menopausal women, those who were peri- or post-menopausal or had undergone hysterectomy or oophorectomy exhibited greater acceleration in comprehensive, liver, metabolic, and kidney BA. In longitudinal change-to-change models, women undergoing menopausal transition showed greater increases in comprehensive BA (CMEC: β = 1.33, 95% CI = 0.89, 1.76; UKB: β = 2.60, 95% CI = 1.91, 3.30), as well as liver, metabolic, and kidney BAs compared to those remaining pre-menopausal. Earlier age at menopause was associated with accelerated comprehensive BA in UKB (< 40 years: β = 0.69, 95% CI = 0.39, 0.98; 40–44 years: β = 0.24, 95% CI = 0.09, 0.40). Across organ-specific BAs, liver BA showed the strongest associations with menopausal factors. Reproductive history like age at live birth and number of live births emerged as potential modifiers of these associations.ConclusionsMenopause, particularly the menopausal transition, was associated with accelerated comprehensive and organ-specific biological aging, with liver aging being most affected. These findings underscore the menopausal transition as a critical window for interventions to enhance women’s health and longevity.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04223-7.

Acupuncture relieves menopausal discomfort in breast cancer patients: A prospective, double blinded, randomized study

Introduction Sleep disturbance and clinical sleep conditions disrupt endocrine signals, energy expenditure and nutritional intake. Women with polycystic ovary syndrome (PCOS) are at higher risk of sleep disturbances and clinical conditions. It is possible that sleep may contribute to the exacerbation of PCOS. This review aims to explore the relationship between sleep and chronic disease, particularly in women with PCOS. Areas covered This review narratively explores what sleep is, how to measure sleep and the possible mechanisms that support the link between sleep in adipose tissue deposition, insulin resistance and the presentation of PCOS. Expert opinion Research shows that disturbed sleep and clinical sleep conditions disrupt energy expenditure. This may increase adipose tissue deposition and exacerbate insulin resistance which are known to worsen the presentation of PCOS. Further, sleep disturbance in women with PCOS may ameliorate any positive lifestyle changes made after diagnosis. Cognitive behavioural therapy interventions for sleep are a successful strategy for the management of sleep disturbances in the general population. However, such interventions are yet to be trialled in women with PCOS. Given the proposed implications, interventions to improve sleep could provide additional support for women with PCOS to successfully implement lifestyle strategies and should be further investigated.

Hot flashes: behavioral treatments, mechanisms, and relation to sleep

Whether changes in blood pressure (BP) over women's midlife are more driven by chronological aging or the menopause transition has been debated. We sought to determine whether women can be classified into distinct trajectory groups based on pattern and level of systolic BP (SBP), diastolic BP, pulse pressure (PP), and mean arterial pressure (MAP) over the menopause transition, and to assess whether menopause-related factors predict the group and level of BP measures. Participants were from the SWAN (Study of Women's Health Across the Nation). Group-based trajectory modeling was used to identify women who shared distinct BP trajectories over time relative to menopause onset and to assess associations of menopause-related factors with trajectory group and level of BP measures. An accelerated rise relative to menopause onset suggests a menopause contribution. The study included 3302 multiracial and multiethnic women with BP measures over 17 follow-up visits (baseline age [SD]: 46.3 [2.7]). Women were classified into either low, medium, or high trajectory group in each BP measure. The low SBP, PP, and MAP trajectories (in 35%, 53%, and 28% of the cohort, respectively) were rising slowly before menopause but showed a significant accelerated rise 1 year after menopause, indicating a menopause contribution. The remaining BP trajectories were rising up until menopause and either continued with the same rise or declined after menopause. A younger menopause age predicted the low SBP, PP, and MAP trajectories. A greater follicle-stimulating hormone level predicted lower SBP and PP levels, while vasomotor symptoms occurrence predicted higher SBP, PP, and MAP levels over time. Estradiol did not predict trajectory or level of any BP measure. Distinct BP trajectories over the menopause transition exist that revealed a group of women whose SBP, PP, and MAP trajectories are consistent with a menopause contribution. Our findings support frequent monitoring of BP during the menopause transition.

Despite the fact that ovarian volume is a marker of reproductive aging, there is little understanding of factors related to ovarian volume among aging women. The objective of this analysis was to examine the associations between body mass index (BMI), cigarette smoking, and alcohol intake with ovarian volume among midlife women. Data were analyzed from 771 women (45-54 years of age at baseline) enrolled in the Midlife Women's Health Study, a cohort study that was initiated in 2006. At annual clinic visits, height and weight were measured, a transvaginal ultrasound was performed to measure ovarian volume, blood was drawn to measure hormone concentrations, and a comprehensive questionnaire was administered. Generalized linear models and repeated measures mixed models were conducted to examine the associations between BMI, cigarette smoking, and alcohol intake with ovarian volume, adjusting for age and race. Age was significantly and negatively associated with ovarian volume. However, BMI, smoking, and alcohol use were not associated with ovarian volume either when stratified by menopausal status or when adjusting for age and race. Estradiol, but not progesterone or testosterone, was significantly and positively associated with ovarian volume overall and among both white and black participants (p < 0.05). This study provides insight into the associations between BMI, smoking, and alcohol use with ovarian volume among midlife women. The findings are somewhat consistent with the published literature and, thus, indicate that these factors may not be clinically important in terms of ovarian volume during the menopausal transition.

Challenges and Opportunities to Manage Depression During the Menopausal Transition and Beyond

We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.