One of the most common symptoms I hear women complain of starting in perimenopause is insomnia. Either they have difficulty falling asleep or frequent awakenings due to hot flashes or nightsweats and have difficulty falling back asleep. If left untreated, these symptoms will persist after menopause as well. I will let you know what the best sleep aids are.
1. If you are experiencing insomnia related to a hormone imbalance here is the first step you need to take to get a good nights sleep.
Estradiol, progesterone and testosterone levels start to fluctuate as women approach menopause. As a result of these fluctuations the women’s natural circadian rhythm can become disrupted leading to insomnia. The first step you need to take is to get your hormone levels checked by a doctor who specializes in bio-identical hormone replacement (BHRT). I recommend that you have your levels checked in the blood vs urine or saliva because blood levels are always the most accurate. Typically what you will find is that your follicle stimulating hormone is starting to go up and progesterone levels are declining. Estradiol levels can range from 12 all the way up to 500 depending on where you are in the menstrual cycle.
Once you have your hormone levels in hand you can then go and meet with a qualified anti-aging physician and he or she will review you complete medical history. He or she will rule out any other obvious reasons for your insomnia and then recommend the best sleep aid. Some of the typical reasons I see for insomnia not caused by a hormone imbalance are too much caffeine and high levels of stress (which increases cortisol).
Here is a link to a great article on natural ways to treat insomnia: http://www.lifeextension.com//Magazine/2006/12/atd/Page-01
2. What is the best sleep aid for treating insomnia as a result of a hormone imbalance
If your insomnia is a result of peimenopause or menopause then the best treatment is to take progesterone in a capsule form before bed. The dose is going to depend on how symptomatic you are and where your hormone levels are but the range is 50mg to as high as 300mg. In order for progesterone to be sedating it has to be given in a capsule form. Progesterone creams and oral rapid dissolved tablets will not cause sedation because they bypass the liver when being absorbed. Most women will tell me that the progesterone is a “miracle” for their sleep.
If the progesterone doesn’t work by itself then I will generally add compounded sustained released melatonin in a capsule. We will start women on 1mg and have them titrate up by 1mg each night until it works. They average women will require 9-12mg per night (some as high as 50mg). It is really important that you use a compound pharmacy for melatonin versus over the counter melatonin. The over the counter melatonin is typically 1mg and is not sustained release. You will get much better results if you use a sustained release capsule in much higher doses. If that doesn’t work than I like a product called Cerenity PM by Ortho Molecular.
3. What about insomnia after menopause?
Often women come to my office years after they went through menopause and have difficulty sleeping. These patients are the easiest to treat because we can safely use high doses of progesterone in a capsule form and they generally feel amazing. Just like in perimenopause we can add SR melatonin and Cerenity PM. Rarely will I prescribe medications like trazodone, ambien or lunesta. 95% of women will do amazing with bio-identical progesterone. Here is a link to how bio-identical progesterone helped one women sleep through the night: http://www.healthline.com/health-blogs/hold-that-pause/fda-approved-bioidentical-prometrium-for-insomnia-it-works-for-me
The bottom line is that insomnia is a very common complaint in perimenopause, menopause and after menopause. The goal is for patients to achieve 8-9 hours in uninterrupted each night. Doctors who specialize in anti-aging medicine and have experience prescribing bio-identical hormones can easily treat this using bio-identical progesterone in a capsule form.
If you would like to schedule a consult with Dr. Sean Breen simply give us a call at 877-721-0047 and visit us on the web at www.DoctorBreen.com