The association of vasomotor symptoms with fracture risk and bone mineral density in postmenopausal women: a systematic review and meta-analysis of observational studies.

BACKGROUND/AIMS: Vasomotor symptoms (VMS) adversely affect postmenopausal quality of life. However, their association with bone health has not been elucidated. This study aimed to systematically review and meta-analyze the evidence regarding the association of VMS with fracture risk and bone mineral density (BMD) in peri- and postmenopausal women. METHODS: A literature search was conducted in PubMed, Scopus and Cochrane databases until 31 August 2023. Fracture, low BMD (osteoporosis/osteopenia) and mean change in lumbar spine (LS) and femoral neck (FN) BMD were assessed. The results are presented as odds ratio (OR) and mean difference (MD), respectively, with a 95% confidence interval (95% CI). The I2 index quantified heterogeneity. RESULTS: Twenty studies were included in the qualitative and 12 in the quantitative analysis (n=49,659). No difference in fractures between women with and without VMS was found (n=5, OR 1.04, 95% CI 0.93-1.16, I2 16%). However, VMS were associated with low BMD (n=5, OR 1.54, 95% CI 1.42-1.67, I2 0%). This difference was evident for LS (MD -0.019 g/cm2, 95% CI -0.03 to -0.008, I2 85.2%), but not for FN BMD (MD -0.010 g/cm2, 95% CI -0.021 to 0.001, I2 78.2%). These results were independent of VMS severity, age and study design. When the analysis was confined to studies that excluded menopausal hormone therapy use, the association with BMD remained significant. CONCLUSIONS: The presence of VMS is associated with low BMD in postmenopausal women, although it does not seem to increase fracture risk.

Optimizing sleep across the menopausal transition.

Women frequently experience sleep disturbances, particularly night-time awakenings, as they transition menopause and enter postmenopause. Sleep is essential for optimal functioning and health. Persistent and distressing sleep disturbances across menopause can negatively impact daytime functioning and productivity, and increase risk for mental and physical health conditions. While multiple factors can disturb sleep, two unique factors in the context of menopause are vasomotor symptoms and the changing reproductive hormone environment. Vasomotor symptoms are associated with sleep disturbances and contribute significantly to awakenings and amount of time spent awake during the night. Even after accounting for vasomotor and depressive symptoms, lower estradiol and higher follicle stimulating hormone levels, indicative of menopause, are associated with sleep disturbance, particularly awakenings, suggesting that the hormone environment may directly affect sleep. Management strategies for clinically significant menopausal sleep disturbances include cognitive behavioral therapy for insomnia, which is effective and durable in treating menopausal insomnia. Hormone therapy alleviates sleep disturbances, particularly in the presence of disruptive vasomotor symptoms. Sleep disturbances have a significant impact on women's functioning and health, and there is a need for further research of the underlying mechanisms to advance effective preventative and treatment strategies that ensure optimal health and well-being of midlife women.

Vasomotor symptoms of menopause, autonomic dysfunction, and cardiovascular disease.

Cardiovascular disease (CVD), the leading cause of death among US adults, is more prevalent in menopausal females compared with age-matched males. Vasomotor symptoms of menopause (VMS; hot flashes/flushes and night sweats) are common among females undergoing menopausal transition and have been associated with elevated blood pressure (BP) and increased CVD risk. Autonomic dysregulation of BP has been posited as a contributing factor to the elevated CVD risk in menopausal females with VMS. This review includes 1) a brief overview of the relationship between VMS and CVD, 2) mechanisms of hot flushes and their potential impact on short- and long-term BP regulation, and 3) how the disruption of autonomic function associated with VMS might provide a mechanistic pathway to CVD development. Finally, this review will highlight knowledge gaps and future directions toward better understanding of hot flush physiology and VMS contributions to CVD.

The association between severe menopausal symptoms and engagement with HIV care and treatment in women living with HIV.

Using data from the PRIME Study, an observational study of the menopause in women living with HIV in England, we explored the association between menopausal symptoms and: (i) antiretroviral therapy (ART) adherence and (ii) HIV clinic attendance. We measured menopausal symptom severity with the Menopause Rating Scale (MRS, score ≥17 indicating severe symptoms), adherence with the CPCRA Antiretroviral Medication Adherence Self-Report Form, and ascertained HIV clinic attendance via self-report. Odds ratios were obtained using logistic regression. Women who reported severe menopausal symptoms had greater odds of suboptimal ART adherence (adjusted odds ratio (AOR) 2.22; 95% CI 1.13, 4.35) and suboptimal clinic attendance (AOR 1.52; 95% CI 1.01, 2.29). When psychological, somatic and urogenital domains of the MRS were analysed individually there was no association between adherence and severe symptoms (all p > 0.1), however there was an association between suboptimal HIV clinic attendance and severe somatic (AOR 1.98; 95% CI 1.24, 3.16) and psychological (AOR 1.76; 95% CI 1.17, 2.65) symptoms. Severe menopausal symptoms were significantly associated with sub-optimal ART adherence and HIV clinic attendance, however we cannot infer causality, highlighting the need for longitudinal data.

Relationship between vasomotor symptoms and metabolic syndrome in Chinese middle-aged women.

PURPOSE: This study aimed to find the associations between vasomotor symptoms (VMS) and metabolic syndrome (MetS) in Chinese middle-aged women in a cross-sectional study. METHODS: A total of 675 participants were recruited from an urban Chinese community. MetS was defined by the 2009 criteria of the Joint Interim Statement. VMS including hot flashes and sweats, blood pressure, weight, height, waist circumference (WC), serum glucose, triglycerides, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), estradiol, and follicle-stimulating hormone (FSH) were collected. RESULTS: The presence of hot flashes was independently associated with the risk of MetS after adjusting for age, menopausal status, FSHlog, estradiollog, and physical activity (odds ratio: 1.98, 95% confidence interval: 1.21-3.24, p = 0.006). Both hot flashes and sweats were also independently associated with WC (for hot flashes, p = 0.016; and for sweats, p = 0.007) and triglycerides (for hot flashes, p = 0.041; and for sweats, p = 0.014) significantly. However, VMS were not significantly associated with blood pressure, glucose, HDL, and LDL. CONCLUSION: Women with hot flashes had a higher risk of MetS. Both hot flashes and sweats were related to a higher amount of central fat indicated by WC and higher triglycerides, but were not related to blood pressure, glucose, and HDL in Chinese women.

Effects of forehead cooling and supportive care on menopause-related sleep difficulties, hot flashes and menopausal symptoms: a pilot study.

OBJECTIVE/BACKGROUND: This pilot study explored the efficacy of a novel forehead cooling device for perceived sleep difficulties and hot flashes in menopausal-age women. PARTICIPANTS: 20 women (55.1 ± 4.2 years; 19 post-menopausal) with insomnia symptoms and self-reported two or more hot flashes per day. METHODS: Participants completed daily assessments of sleep and hot flashes (via diaries) across 1 baseline week and 4 weeks of open-label, in-home, nightly treatment with a forehead cooling device (15-18°C) along with sleep hygiene instructions. They also completed ratings of insomnia and menopausal symptoms using standardized questionnaires. RESULTS: Women reported reductions in sleep onset latency (SOL), wakefulness after sleep onset (WASO), and nocturnal hot flash severity during the first week of treatment (SOL: 25.7 ± 18.4 min; WASO: 36.3 ± 27.3 min; hot flash severity: 3.0 ± 2.8) compared with baseline (SOL: 38 ± 26.3 min; WASO: 52.2 ± 35.6 min; hot flash severity: 6.8 ± 3.7), with further improvements after 2-4 weeks of use (p < .001). There were also clinically meaningful reductions in insomnia severity and hot flash-related daily interference and lower psychological and physical symptom scores on the Greene climacteric scale after treatment (all p's<0.001). CONCLUSIONS: This exploratory, naturalistic, pilot study shows that nightly use of a forehead cooling device produces improvements in self-reported sleep and reductions in insomnia, hot flash, and other menopausal, symptoms. Controlled studies are warranted to determine the role of this therapy in the management of sleep difficulties and menopausal symptoms in women. Further mechanistic studies are needed to understand the physiological impact of forehead cooling on sleep and menopausal symptoms.

Menopausal symptoms are associated with non-adherence to highly active antiretroviral therapy in human immunodeficiency virus-infected middle-aged women.

Objective: This study aimed to evaluate the association between the intensity of menopausal symptoms and highly active antiretroviral therapy (HAART) adherence in middle-aged women with human immunodeficiency virus (HIV) infection.Methods: In this cross-sectional study, 313 Peruvian women with HIV infection (age 40-59 years) were surveyed and classified as adherent or non-adherent to HAART based on the Antiretroviral Treatment Adherence Evaluation Questionnaire. The intensity of menopausal symptoms was assessed with the Menopause Rating Scale, and categorized as none, mild, moderate, and/or severe. Age, sexual orientation, used HAART scheme, time since HIV diagnosis, menopausal status, risk of depression, and presence of comorbidities were also assessed. Poisson generalized linear models with robust variance were performed in order to estimate crude prevalence ratios (PRs) and adjusted PRs using statistical (a1PR) and epidemiological criteria (a2PR).Results: A total of 19.9%, 32.6%, and 15.0% of all women presented mild, moderate, and severe menopausal symptoms, respectively. Overall, 70.6% women were non-adherent to HAART. The probability of non-adherence was higher in women with mild, moderate, and severe symptoms as compared to asymptomatic women in the non-adjusted model (PR: 1.79, 95% confidence interval [CI]: 1.39-2.29; PR: 1.76, 95% CI: 1.38-2.23; and PR: 2.07, 95% CI: 1.64-2.61, respectively) and the adjusted model.Conclusion: The severity of menopausal symptoms was associated with HAART non-adherence in HIV-infected middle-aged women.

Associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan Province, China.

Objective: This study aimed to determine the associations among menopausal status, menopausal symptoms, and depressive symptoms in midlife women in Hunan, China.Methods: A secondary analysis involving 3199 women aged 40-55 years was performed based on data from the Women Health Needs Survey 2018 in Hunan Province, central south China. The depressive symptoms were determined using the 9-item Patient Health Questionnaire. The menopausal symptoms were assessed using the Kupperman Menopausal Index. Demographic characteristics and menopausal status were measured using self-administered questionnaires.Results: The prevalence of depressive symptoms was 19.3%. The three most common menopausal symptoms were insomnia (48.0%), fatigue (42.7%), and mood swing (39.8%). The increase in depressive symptoms was significantly associated with menopausal status and menopausal symptoms. After controlling for demographic variables, multivariate logistic regression showed that menopausal transition (odds ratio [OR] = 1.14, 95% confidence interval [95% CI] = 1.12-1.86), postmenopause (OR =1.52, 95% CI = 1.09-2.11), and four menopausal symptoms including mood swing (OR = 1.32, 95% CI = 1.03-1.70), depressive mood (OR = 2.28, 95% CI = 1.79-2.91), palpitations (OR = 1.37, 95% CI = 1.06-1.77), and urinary tract infection (OR = 1.49, 95% CI = 1.16-1.92) were associated with depressive symptoms.Conclusions: Independent of demographic variables, menopausal transition, postmenopause, and four menopausal symptoms (mood swing, depressive mood, palpitations, and urinary tract infection) increase the risk of depressive symptoms.

The relationship between sleep quality and lifestyle in postmenopausal Iranian women: a cross-sectional study.

One of the most frequent symptoms in postmenopausal women is sleep disturbance. This study aimed to determine the relationship between sleep quality and lifestyle factors in postmenopausal women. Postmenopausal women (n = 252) in Ahvaz, Iran with an age range of 45-55 years, were enrolled from April to December 2015. The study tools included the Lifestyle Questionnaire (LSQ) and Pittsburgh Sleep Quality Index. The LSQ contains 10 lifestyle factors: physical health, physical activity, weight control and nutrition, psychological health, spiritual health, social health, medications and narcotics avoidance, illness prevention, accident prevention, and environmental health. Data were analyzed using, chi-square, Pearson correlation coefficients, analysis of variance, and multiple linear regressions. In unadjusted analyses, physical health, physical activity, nutrition, mental health, spiritual health, social health, and medication and narcotics avoidance scores were significantly higher in women without sleep disruption than in those with light and moderate sleep disruption (p < .001). Adjusting for confounding factors, sleep disruption was directly related to duration since the final menstrual period (p < .001), and inversely related to physical health (p = .04) and spiritual health (p = .028). Lifestyle factors were related to sleep disruption in postmenopausal women. Policymakers should consider education on healthy lifestyles for women.

Effect of soy lecithin on fatigue and menopausal symptoms in middle-aged women: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Lecithin is a complex mixture of phospholipids which compose lipid bilayer cell membranes. Lipid replacement therapy, or administration of phospholipids for the purpose of repairing the dmaged cell membranes, had been shown to alleviate fatigue. The present study aimed to investigate the effect of soy lecithin on fatigue in middle-aged women, as well as other menopausal symptoms and various health parameters. METHODS: This randomized, double-blind, placebo-controlled study included 96 women aged 40 to 60 years who complained of fatigue. The participants were randomized to receive active tablets containing high-dose (1200 mg/day; n = 32) or low-dose (600 mg/day; n = 32) soy lecithin, or placebo (n = 32), for 8 weeks. The following parameters were evaluated: age, menopausal status, lifestyle factors, physical and psychological symptoms of menopause, subjective symptoms of insomnia and fatigue, body composition, cardiovascular parameters, and physical activities and objective sleep states obtained from actigraphy before and 4 and 8 weeks after treatment. Fatigue was evaluated using the Profile of Mood States (POMS)-brief, Menopausal Health-Related Quality of Life questionnaire, Chalder Fatigue Scale, and Brief Fatigue Inventory. RESULTS: Eighty-nine women completed the study. There were no significant differences in the changes in Chalder Fatigue Scale score (placebo vs low-dose vs high-dose groups: -2.9 ± 1.1, -3.2 ± 1.1, and -3.5 ± 1.0; P = 0.79). On the other hand, the improvements were greater in the high-dose group compared with the placebo group concerning vigor scores in the POMS-brief (1.9 ± 0.7 vs 0.2 ± 0.6; P = 0.02), diastolic blood pressure (-4.1 ± 1.8 vs 1.2 ± 1.9; P = 0.05), and cardio-ankle vascular index (-0.4 ± 0.2 vs 0.07 ± 0.1; P = 0.03) after 8 weeks of treatment. CONCLUSIONS: High-dose (1200 mg/day) soy lecithin not only increases vigor, but also lowers the diastolic blood pressure and cardio-ankle vascular index in middle-aged women who present with fatigue. TRIAL REGISTRATION: UMIN-CTR UMIN000017127 .

Climacteric women at work: What lurks behind poor occupational quality of life?

Physical and psychological changes during menopausal transition may affect various aspects of everyday functioning including women's work ability and work productivity. Presence of menopausal symptoms has been well-acknowledged to negatively affect quality of life (QOL). However, data on factors associated with occupational QOL among women at this period of life are lacking. The authors' purpose in this study was to evaluate factors affecting occupational QOL in a sample of employed mid-life women who are experiencing menopause. The authors performed a cross-sectional study among 335 employed women aged 40 to 65 years from Serbia. Socio-demographic questionnaire, Utian's Quality of Life Scale, and Beck's Depression Inventory were used in data collection. Women's average monthly household income and educational level were positively correlated, while having uterine prolapse was negatively associated with occupational QOL. Significant regression models assessing impact of gynecological illnesses and menopause-specific symptoms on occupational QOL (direct value and categories-below vs. above mean) showed that having insomnia, uterine prolapse, and genital inflammations may differentiate "good" from "poor" occupational QOL. Uterine prolapse, genital inflammation, and insomnia were associated with worse occupational QOL among working women in menopausal transition.

Acupuncture for Menopausal Hot Flashes: A Randomized Trial.

BACKGROUND: Hot flashes (HFs) affect up to 75% of menopausal women and pose a considerable health and financial burden. Evidence of acupuncture efficacy as an HF treatment is conflicting. OBJECTIVE: To assess the efficacy of Chinese medicine acupuncture against sham acupuncture for menopausal HFs. DESIGN: Stratified, blind (participants, outcome assessors, and investigators, but not treating acupuncturists), parallel, randomized, sham-controlled trial with equal allocation. (Australia New Zealand Clinical Trials Registry: ACTRN12611000393954). SETTING: Community in Australia. PARTICIPANTS: Women older than 40 years in the late menopausal transition or postmenopause with at least 7 moderate HFs daily, meeting criteria for Chinese medicine diagnosis of kidney yin deficiency. INTERVENTIONS: 10 treatments over 8 weeks of either standardized Chinese medicine needle acupuncture designed to treat kidney yin deficiency or noninsertive sham acupuncture. MEASUREMENTS: The primary outcome was HF score at the end of treatment. Secondary outcomes included quality of life, anxiety, depression, and adverse events. Participants were assessed at 4 weeks, the end of treatment, and then 3 and 6 months after the end of treatment. Intention-to-treat analysis was conducted with linear mixed-effects models. RESULTS: 327 women were randomly assigned to acupuncture (n = 163) or sham acupuncture (n = 164). At the end of treatment, 16% of participants in the acupuncture group and 13% in the sham group were lost to follow-up. Mean HF scores at the end of treatment were 15.36 in the acupuncture group and 15.04 in the sham group (mean difference, 0.33 [95% CI, -1.87 to 2.52]; P = 0.77). No serious adverse events were reported. LIMITATION: Participants were predominantly Caucasian and did not have breast cancer or surgical menopause. CONCLUSION: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs. PRIMARY FUNDING SOURCE: National Health and Medical Research Council.

[PHYTOESTROGENS: MECHANISMS OF CORRECTION OF CARDIOVASCULAR COMPLICATIONS OF CLIMACTERIC SYNDROME.]

The pharmacodynamics of phytoestrogens representing nonsteroidal compounds of plant origin with variable affinity to estrogen receptor subtypes has been studied. Clinical and experimental data on the mechanisms of action of phytoestrogens of the isoflavone and lignan classes are presented and their effects ca- pable of reducing the risk of cardiovascular disease development in women with climacteric syndrome and in experimental hypoestrogenemia are considered.

Role of paroxetine in the management of hot flashes in gynecological cancer survivors: Results of the first randomized single-center controlled trial.

OBJECTIVES: To examine the effects of paroxetine supplementation on hot flashes and sleep in gynecological cancer survivors. METHODS: In a randomized, double-blind, placebo-controlled study, postmenopausal women with a prior history of stage 0-III gynecological cancer who had completed active cancer treatment (including hormonal therapy) were randomly assigned 1:1 to either 7.5mg oral paroxetine or placebo daily for 16weeks. Sleep and hot flashes were assessed at baseline, week 4 and week 16. RESULTS: Eighty women (91%) completed the study. We found out a statistically significant difference in weekly reductions in VMS frequency and severity for paroxetine 7.5mg than for placebo on week 4 and 16. Regarding sleep characteristics, the analysis of data through week 16 reported a statistically significant reduction in the number of nighttime awakenings attributed to VMS among participants receiving paroxetine than among participants receiving placebo on baseline and weeks. The duration of sleep per night increased significantly more among participants receiving paroxetine than among those receiving placebo at all post baseline time points. No significant differences in sleep-onset latency were noted between the two treatment arms during the course of the study. Paroxetine was well-tolerated with a high level of compliance. In our cohort of patients, no serious adverse events have been reported. CONCLUSIONS: This is the first randomized placebo-controlled study in gynecological cancer survivors that demonstrates that paroxetine significantly reduces hot flashes in weekly frequency and severity and the number of nighttime awakenings attributed to vasomotor symptoms, increasing sleep duration.

Exploring Sleep Quality and Related Factors in Chinese Midlife Women.

We investigated the percentage of women with poor sleep quality and its related factors among mainland Chinese women. Sleep quality and menopausal status were self-reported. We explored the contribution of possible risk factors, including sociodemographic characteristics, comorbidities, lifestyle, psychological status, stressful life events, and vasomotor symptoms. We found that 38.6% of midlife Chinese women were poor sleepers. This percentage was higher in comparison with women from other Asian countries. Our multiple logistic regression showed that anxiety, comorbidities, perceived stress, and vasomotor symptoms were risk factors for poor sleep quality.

[Correlation between intensity of menopausal symptoms and cognitive domain assessed with CNS-VS tests]. / Nasilenie objawów menopauzalnych a funkcje poznawcze oceniane bateria testów CNS-VS.

INTRODUCTION: Numerous publications suggest that many cognitive domains deteriorate with age. As far as postmenopausal women are concerned, the question remains whether the process is caused only by an ageing brain or also by the menopause. The objective of this research was to analyze a possible correlation between intensity and duration of menopausal symptoms and the level of cognitive domains measured with CNS-VS tests among post-menopausal women. METHODOLOGY: The group under examination included 383 postmenopausal women (at least 2 years after their last menstruation) from South-Eastern Poland. The following inclusion criteria were used: age 50-65, good overall health status, at least primary level of education, and FSH>30 mlU/ml. Cognitive domains were assessed using the CNS - VitalSigns diagnostic device. The intensity of menopausal symptoms was measured with the Kupperman Index and the Greene Scale. The statistical analysis was conducted with the use of the Statistica software. RESULTS: There were no significant relations between age at last menstruation and cognitive domains. BMI was oositively correlated with the Neurocognitive index (NCI) and memory visual memory processing speed, and executive functions. The intensity of menopausal symptoms measured with the Greene Scale was negatively correlated with NCI and most of the cognitive domains, whereas symptoms measured with the Kupperman Index were negatively correlated with NCI and visual memory CONCLUSIONS: Our findings suggest a correlation of the intensity and duration of menopausal symptoms with the revel of cognitive domain among menopausal women. The most significant consequences resulting from changes in the cognitive domains included psychological and vasomotor symptoms, as well as - to a lesser extent - somatic symptoms.

[Doctor, I'm hot! Managing the effects of menopause in patients with breast cancer]. / Docteur, j'ai chaud! Gestion des effets de la menopause chez les patientes atteintes d'un cancer du sein.

The incidence of breast cancer is rising up, but the mortality rate is decreasing, leading to a growing number of survivors. Most of these women are postmenopausal at diagnosis or will reach menopause following anti-cancer treatments. Most of them have hormone-sensitive tumors and will receive an anti-hormonal treatment. Endocrine therapy is associated with many adverse effects, including a worsening of climacteric symptoms with a negative impact on quality of life and therefore a suboptimal therapeutic adherence. Some supportive therapies can alleviate these adverse effects and should be offered to patients.

Menopausal age, related factors and climacteric symptoms in Libyan women.

OBJECTIVE: Studies of the menopause have received much attention recently as fluctuating hormone levels are known to influence a woman's mood and well-being. The present study aimed to evaluate the onset of natural menopause in Libyan women together with the prevalence of postmenopause-related symptoms experienced. METHOD: A cross-sectional survey was conducted in Tripoli city, from October 2008 to June 2009; 91 women were recruited from urban and rural areas. Data were collected using a structured questionnaire and included a number of lifestyle variables. RESULTS: The mean age of participants was 53 years, and the median age at menopause for postmenopausal women was 47 years. Out of 20 possible symptoms, the mean number of symptoms was 8.36. The most frequent symptoms were hot flushes and aching in muscles and joints (74.4%). Increasing level of education was positively associated with more symptoms, and increased tea or coffee consumption resulted in fewer symptoms. Of the total subjects, 8.1% reported no symptoms. In the four domains, 87.2% reported physical symptoms, 83.7% reported psychosocial symptoms, 76.6% reported vasomotor symptoms and 48.8% reported sexual symptoms. Our data showed that the most common disease associated with the frequency of menopausal symptoms was osteoarthritis, followed by hypertension, heart diseases and diabetes mellitus. CONCLUSION: The age of menopause in Libyan women, as in other developing countries, is less than the median age reported for Western women. The menopausal women experienced various symptoms and morbidities as part of a normal life stage, and their quality of life was negatively affected by these symptoms.

Does self-compassion explain variance in sleep quality in women experiencing hot flushes?

OBJECTIVES: With poor sleep highly prevalent during the menopause transition, there is a need to better understand modifiable psychological resources that may be associated with improved sleep. Hence, we investigated whether self-compassion can explain variance in self-reported sleep quality in midlife women, over and above vasomotor symptoms. METHODS: This cross-sectional study (N = 274) used questionnaire data from self-report measures of sleep, hot flushes and night sweats, hot flush interference, and self-compassion, with analyses conducted using sequential (hierarchical) regression. RESULTS: Poor sleep, as measured by the Pittsburgh Sleep Quality Index, was prevalent and significantly worse in the subsample of women with hot flushes and night sweats, g = 0.28, 95 % CI [0.04, 0.53]. The interference of hot flushes in everyday life (ß = 0.35, p < .01), but not their frequency, predicted self-reported sleep quality. Once self-compassion was added to the model it was the only predictor of poor sleep (ß = -0.32, p < .01). When positive self-compassion and self-coldness were considered separately, the effect on sleep quality appeared to be attributable to self-coldness scores alone (ß = 0.29, p < .05). CONCLUSIONS: Self-compassion may have a stronger relationship with self-reported sleep quality in midlife women than vasomotor symptoms. Future intervention-based research could test the efficacy of self-compassion training for midlife women experiencing sleep disturbances, as this may be an important and modifiable psychological resilience factor.

Sleep disturbances in women with early-onset menopausal transition: a population-based study.

OBJECTIVE: The aim of this study was to investigate sleep disturbances in 46-yr-old women and their association with early-onset menopausal transition. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.