Sleep quality and fatigue among women with premature ovarian insufficiency

By Dr. Ananya Mandal, MDJul 16 2019

There have been studies and anecdotal reports about worsening of sleep quality and increasing fatigue among women who are near menopause or have reached menopause. According to a new study sleep quality tends to be worse in women who have premature ovarian insufficiency (POI) and are on hormonal therapy for the same compared to women with normal ovarian function.

The study titled, “Sleep quality and fatigue in women with premature ovarian insufficiency receiving hormone therapy: a comparative study,” was published in the journal Menopause, the Journal of The North American Menopause Society (NAMS).

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The researchers explain that nearly half of all women achieving menopause or those nearing menopause suffer from sleep problems. These may include symptoms of insomnia, difficulty in falling asleep or staying asleep or waking up too early.  In addition there are symptoms of physical pain or mood disorders along with fatigue and reduced capacity for work. Some of these symptoms could be associated with menopause and its symptoms but not all sleep problems could be thus explained say the researchers.

Researchers from Brazil have looked at the sleep patterns and fatigue among women with primary ovarian insufficiency. Premature menopause signifies stopping of menstruation early and premature ovarian insufficiency refers to irregular and occasional periods over few years due to inadequate ovarian function. While women with premature menopause do not get pregnant, those with premature ovarian insufficiency have a small chance of getting pregnant.

The authors wrote, “[Primary] ovarian insufficiency causes physical and psychological effects resulting from hypoestrogenism, such as the loss of fertility, bone loss, an increased cardiovascular risk, psychological disturbances, altered sexuality, and even the risk of earlier mortality. The treatment must minimize such repercussions. One of the seemingly overlooked or unknown aspects is the repercussion of early hypoestrogenism on sleep quality and fatigue, and also the extent to which HT can act on these aspects.”

This latest study shows that Brazilian women with premature ovarian insufficiency who are also receiving hormonal therapy for treatment are more likely to have poor sleep quality and may take longer to fall asleep. They have high degree of fatigue, found the study by using tools such as the fatigue index. These women were more likely to use medications for sleep compared to women who were older and had complete ovarian function, the study researchers noted.

Dr. Stephanie Faubion, NAMS medical director, in a statement said, “This study shows that women with POI have poor sleep quality despite the use of hormone therapy. Another interesting finding from the study is that total sleep quality in women with POI was directly related to the number of children they had and overall was similar to sleep quality in women without POI. This speaks to the scope of the problem when it comes to sleep disturbances and the important and often under-recognized factors that contribute to sleep complaints being more common in women than in men.”

Authors of the study Cristina Benetti-Pinto, Camila Menezes, Daniela Yela and Tania Cardoso write that they included 61 women in their study with premature ovarian insufficiency who were on hormonal therapy and also 61 women with normal ovarian function. The second group was the control group. The participants from both groups were age matched so that they were less than 2 years apart in age. Average age of the women in the two groups was around 35 years.

To assess the quality of sleep the team used Pittsburgh Sleep Quality Index (PSQI) and to assess fatigue they used Chalder Fatigue Scale. Results showed that the sleep scores were overall similar in the two groups but there was a worse score for sleep latency among women with premature ovarian insufficiency. This meant that they took longer to fall asleep than women with normal ovarian function. In addition use of sleep medication was more likely in these women with ovarian insufficiency (scores were 1.28 and 0.85 in the POI and control groups respectively). Fatigue index revealed a higher fatigue score in women with ovarian insufficiency (5.25 compared to 3.49 among controls).

Authors wrote, “Our results show that women with POI receiving HT have poor sleep quality, but it is similar to that of women of the same age with preserved ovarian function; however, the former presented with a higher rate of fatigue. Variables directly related to ovarian insufficiency, such as the diagnosis time or treatment time, were not related to sleep; nevertheless, it was found that the greater the number of children, the worse the quality of sleep.” They add that all women evaluated for treatment of premature ovarian insufficiency should be asked about their sleep quality and fatigue and necessary measures to correct these should be adopted.