Did you know? Sex differences in sleep often begin as early as puberty, and women are more prone to poorer sleep quality and insomnia than men. Last International Women’s Day, we explored how biological and psychosocial factors contribute to this complicated relationship between women and sleep.
This year, we look at the two major female hormones — oestrogen and progesterone — and how they affect not just sleep, but a woman’s overall wellbeing.
In a silo, oestrogen and progesterone technically enhance sleep! Progesterone has been shown to be a natural sedative and sleep stabiliser because of its calming and relaxing effects.¹ Oestrogen also improves sleep quality by reducing the time taken to fall asleep and increasing the amount of Rapid Eye Movement (REM) sleep.²
However, women experience constantly shifting hormonal levels due to biological processes like menstruation, pregnancy, and menopause. This results in disrupted sleep patterns — and not in a good way.
Oestrogen and progesterone can cause uncomfortable physical symptoms that commonly manifest in Premenstrual Syndrome (PMS). Occurring about a week or two before menstruation, PMS has been shown to afflict over 90% of women with symptoms like headaches, bloating, and cramps.³ The rise in progesterone levels during the ovulation phase of the menstrual cycle can also raise body temperatures, causing abrupt awakenings in the night due to warmth. In fact, according to Australia’s Sleep Health Foundation, up to seven in ten women say their sleep changes just before their period.
Similarly, women going through menopause are often left tossing and turning due to symptoms like hot flashes, night sweats, chills, and incontinence. They are also most likely to sleep less than seven hours on average, as compared to their premenopausal and postmenopausal counterparts.⁴
As frustrating as it is when sleep doesn’t come at night, it is arguably more frustrating when it comes unexpectedly in the day, which is what happens during pregnancy. Skyrocketing levels of oestrogen and progesterone, especially during the first trimester of pregnancy, induces daytime drowsiness and more napping. Although hormonal levels even out by the third trimester, other pregnancy-related symptoms like frequent urination and sleep apnea can make it hard to get a good night’s sleep. The steep decrease in both hormones after delivery can unfortunately be insomnia-inducing too, and sleep disruptions may not normalise until three to six months post-partum.⁵
Do you experience PMS symptoms like irritability and moodiness? Studies have discovered that high levels of progesterone may have a depressing effect in some women.⁷
The hormonal changes that accompany puberty, postpartum, and menopause can contribute to the onset of more serious depressive disorders too — postpartum depression (PPD), for instance, is believed to affect up to 15% of mothers⁹, and nearly 20% of women experience depression at some point during menopause.¹⁰
Note: The above is based on an average 28-day cycle, but individual menstrual cycles can vary. The use of a period tracker can help you better understand yours!
Fluctuations in oestrogen and progesterone can bring about shifting energy levels, especially during the menstrual cycle — oestrogen can help you feel more energetic,¹² while progesterone can make you feel sluggish.¹³ With the help of period trackers like phone apps, you may be able to leverage on these hormonal and energy shifts to get the most out of your daily activities!
Unfortunately, these cyclical changes in energy levels often begin to temper with the onset of menopause, where falling levels of oestrogen in particular has been associated with feelings of fatigue and fat gain¹⁴.
Build habits that support quality sleep. Apart from general ones like maintaining a regular sleep routine, try tailoring your practices to the physical symptoms that are keeping you awake. To combat hot flashes and higher body temperatures, for instance, keep your bedroom a degree or two cooler and wear lightweight clothing to sleep.
Stress can cause hormonal havoc in your body. Although stress management may be easier said than done, incorporating relaxation techniques like meditation and yoga into your daily routine is worth a try! Therapy has also been found to be an effective treatment option for those experiencing debilitating levels of stress and emotional changes.¹⁵
Apart from the physical benefits, exercise can also lift your mood by increasing happy hormones like serotonin and endorphins, and reducing the effects of stress on the brain.¹⁶
Unfortunately, beyond external coping strategies, there may be little we can do to alter the internal fluctuations of oestrogen and progesterone levels. The resulting challenges to rest and wellbeing may make you feel that you are in for a tough journey ahead, but it is also one that many women will inevitably walk. Instead of traversing solo, we’d like to use this opportunity to start conversations on your experiences — hopefully it might bring you some solace, new insights, or a simple avenue to get things off your chest. So if you have a story to share, feel free to leave a comment or drop us a DM on our Instagram. We always love to hear from you!
Citations:
1. Scott, L. A., M.D. (2018, May 1). Progesterone and Sleep. Retrieved from https://www.leighannscottmd.com/progesterone-sleep.
2. Estrogen Treatment Restores Normal Sleep Patterns in Menopausal Women. (2000, March 17). Retrieved from https://www.webmd.com/menopause/news/20000317/estrogen-treatment-restores-normal-sleep-patterns-in-menopausal-women.
3. Winer, S. A., Rapkin, A. J. (2006). Premenstrual disorders: prevalence, etiology and impact. Journal of Reproductive Medicine; 51(4 Suppl):339-347.
4. Vahratian, Anjel. “Sleep Duration and Quality Among Women Aged 40–59, by Menopausal Status.” Centers for Disease Control and Prevention, Sept. 2017, www.cdc.gov/nchs/products/databriefs/db286.htm#.
5. Nowakowski, Sara et al. “Sleep and Women's Health.” Sleep medicine research vol. 4,1 (2013): 1-22. doi:10.17241/smr.2013.4.1.1
6. Bechard, Elizabeth. “Workout Flow for the Ladies: Syncing Exercise With Your Cycle.” Duke Integrative Medicine, 18 June 2017, dukeintegrativemedicine.org/DHWBlog/workout-flow-ladies-syncing-exercise-cycle.
7. Werber, Cassie. “Your Brain on PMS Is like Your Brain on Alcohol and Depressants.” Quartz, 21 Dec. 2016, qz.com/847871/this-is-what-happens-to-womens-brains-when-theyre-having-pms.
8. Schiller, Crystal Edler et al. “The role of reproductive hormones in postpartum depression.” CNS spectrums vol. 20,1 (2015): 48-59.
9. Pearlstein, Teri et al. “Postpartum depression.” American journal of obstetrics and gynecology vol. 200,4 (2009): 357-64.
10. Bhatt, Nita V. “What Is the Prevalence of Depression in Menopause?” Medscape, 30 Jan. 2019, www.medscape.com/answers/295382-172975/what-is-the-prevalence-of-depression-in-menopause.
11. Chen C P, Cheng D Z, Luo Yue-Jia. Estrogen Impacts on Emotion: Psychological, Neuroscience and Endocrine Studies. SCI CHINA Life Sci, 2011, 41(11).
12. “How Hormones Impact Your Energy and Mood.” Proov, 3 Dec. 2013, proovtest.com/blogs/blog/hormones-energy.
13. Gottesmann, Claude. “GABA mechanisms and sleep.” Neuroscience vol. 111,2 (2002): 231-9. doi:10.1016/s0306-4522(02)00034-9
14. Melanson, Edward L et al. “Regulation of energy expenditure by estradiol in premenopausal women.” Journal of applied physiology (Bethesda, Md. : 1985) vol. 119,9 (2015): 975-81.
15. Sheehan, Jan. “Mood Swings: PMS and Your Emotional Health.” Everyday Health, 16 Feb. 2010, www.everydayhealth.com/pms/mood-swings.aspx.
16. “Exercise and Mood.” Better Health Channel, www.betterhealth.vic.gov.au/health/HealthyLiving/exercise-and-mood.
