Counting Sheep After Discontinuing HRT

Hormone replacement therapy often impacts sleeping

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Lack of sleep can take one's vitality for life away. With slower schedules and hormone shifts, sleeping can get really slippery for older women.

A recent study review indicates that women trying to quit taking their hormone replacement therapy (HRT) can have an increase of sleep problems.

"Ask your internist for sleeping suggestions if your on HRT."

Sarah E. Tom, Ph.D., Interdisciplinary Women’s Health Research Scholar at the University of Texas Medical School, and colleagues suggest that the hot flashes and night sweats that occur after stopping HRT may be causing subsequent sleeping difficulties.

Overall, women who experienced a significant resurgence of night sweats and hot flashes were also more likely to experience higher sleep quality index scores.

The scientists also acknowledged the potential effects of estrogen and progesterone found in some HRTs on sleep: Progesterone has been shown to have a sedative-like effect while estrogen can decrease the time needed to fall asleep.

Additionally, sex steroids can also influence the process of sleeping through their general effects on thermoregulation and central nervous system.

Regardless of the exact cause or causes, Dr. Tom and her colleagues recommend caregivers be aware of this and understand that women may need medication assistance with getting enough sleep after suspension of HRT.

Researchers conducted a secondary analysis by using already recorded data from the Radiological Evaluation and Breast Density (READ) trial. READ included 1,405 women that were an average of 60 years old. All women were randomly assigned to one of three groups: 518 women continued hormone therapy, 452 women suspended the hormone therapy for one month and 435 quit the therapy for a period of two months.

All the women completed baseline and follow-up questionnaires about sleeping patterns. A General Sleep Disturbance Scale was applied to evaluate issues like waking too early, poorly sleeping, waking up tired and other sleeping problems associated with menopause.

At baseline, all three groups reported low menopausal symptoms and similar patterns of sleep disturbance. The most predominant complaint was waking while sleeping. This occurred an average of 4.5 times weekly. Most women didn’t use medications to assist in sleeping.

After the study, women in both therapy suspension groups self-reported more sleeping complaints than the women who continued their HRT. Sleeping complaints were also greater in the group that ceased their HRT for two months over the one-month group. 

Complaints in the cessation group included not feeling rested after sleep, poor sleeping quality, waking while sleeping, and difficulty falling asleep. The researchers also found that age, the type of HRT and duration of HRT did not affect sleep outcomes.

These study results were published in the July issue of Menopause.

Reviewed by: 
Review Date: 
September 13, 2011
Last Updated:
September 15, 2011