Figure 1. Hormone changes during the average 28-day menstrual cycle without a fertilization event. FSH is Follicle Stimulating Hormone and LH is Luteinizing Hormone. Shaded gray area is the Ovulation phase, which represents when you are most fertile. 

 

Menstruation 

During menstruation, women often experience specific changes in their sleep patterns due to a combination of physical discomfort and hormonal shifts. Common issues include increased sleep disturbances, such as frequent awakenings and difficulty falling asleep, primarily caused by menstrual pain, cramps, bloating, headaches and fatigue. Additionally, hormonal fluctuations during this phase can lead to mood changes, such as irritability and anxiety, which further contribute to sleep disruptions. Some women also report experiencing more vivid dreams and nightmares during menstruation. Understanding these patterns can aid in developing better sleep management strategies during this time [5]. 

 

How is sleep affected during pregnancy?  

During pregnancy, sleep patterns shift significantly across each trimester [6, 7]: 

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• First Trimester: increased levels of progesterone can cause excessive daytime sleepiness and frequent awakenings at night due to nausea and increased urination. 

 

• Second Trimester: sleep generally improves as hormone levels stabilize, although some women may still experience disruptions. 

 

• Third Trimester: sleep disturbances often increase again due to physical discomfort, frequent urination, and hormonal changes. 

 

Sleep Changes During Menopause 

Sleep changes during the menopause transition (e.g., perimenopause, menopause, and post-menopause) are significant due to hormonal fluctuations. During perimenopause, declining estrogen and progesterone levels can cause hot flashes, night sweats, and mood swings, leading to insomnia and fragmented sleep. Menopause intensifies these symptoms, further disrupting sleep and increasing the risk of sleep disorders such as sleep apnea and restless legs syndrome.  

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In menopausal women, Hormone Replacement Therapy (HRT) can help alleviate sleep disturbances by stabilizing hormone levels. However, HRT is not suitable for everyone and should be considered carefully with medical guidance. 

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In post-menopause, while some symptoms may stabilize, many women continue to experience sleep disturbances due to persistent hot flashes, increased anxiety, and other health changes [6, 7]. 

 

How Women’s Sleep and Hormones Impact Memory 

Sleep plays a crucial role in cognitive functions, including memory consolidation, which is the process of transforming short-term memories into long-term ones. For women, hormonal changes throughout their reproductive lives can significantly impact sleep quality and, consequently, memory [6]. 

 

Estrogen 

Estrogen has been shown to have neuroprotective effects, which can enhance cognitive functions, including memory. It promotes the growth and survival of neurons, enhances synaptic plasticity, and increases neurotransmitter levels. 

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As estrogen levels decline during menopause, many women report difficulties with memory and other cognitive functions. HRT has been found to mitigate some of these cognitive declines, although its use must be carefully considered due to other health risks. 

 

Progesterone 

Progesterone's impact on memory is more complex and can vary. Some studies suggest it may impair certain types of memory, particularly verbal and spatial memory, while others indicate it might support memory consolidation during sleep. High levels of progesterone during the luteal phase can sometimes lead to difficulties in memory and concentration, often referred to as "brain fog." 

 

Research Insights on Estrogen and Progesterone Effects on Memory 

Recent research highlights that estradiol (a form of estrogen) strengthens brain cell mechanisms crucial for memory formation and retrieval. Estradiol can induce rapid changes in brain cells within minutes to hours, essential for enhancing memory consolidation. This demonstrates estradiol's powerful and swift impact on the brain. Estrogen's memory-enhancing ability suggests potential for treating cognitive decline associated with aging and neurodegenerative diseases [8]. In addition, new findings reveal progesterone's rapid inhibitory role on memory during navigational tasks [9]. 

 

Strategies for Improving the Sleep Quality 

Improving sleep quality is important for overall health and well-being. Here are some practices that women can adopt to get better sleep [6, 7]: 

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• Establish a consistent sleep schedule – going to bed and waking up at the same time every day, even on weekends, helps regulate your body’s internal clock. 

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• Create a relaxing bedtime routine by engaging in calming activities like reading. Avoid screens (phones, tablets, computers, TV) at least an hour before bedtime as the blue light can interfere with melatonin production. 

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• Avoid heavy meals before bed as they a can cause discomfort and interfere with sleep

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• Limit caffeine and alcohol intake. 

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• Manage your stress by practicing relaxation techniques such as medication, breathing exercises to help calm the mind. 

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• Regular physical activity can promote better sleep. Aim for at least 30 minutes of moderate exercise most days of the week but avoid vigorous exercise close to bedtime. 

 

For women suffering from chronic insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) may be beneficial. CBT-I includes components such as sleep hygiene education, stimulus control, sleep restriction, and cognitive restructuring. Unlike sleeping pills, CBT-I has long-lasting effects without the risk of side effects. If medication is necessary, options like benzodiazepines and melatonin receptor agonists are available but should be used short-term to avoid potential dependency [10]. In addition, medications such as dopamine agonists and anti-seizure drugs can be used to treat specific disorders like Restless Legs Syndrome. 

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If sleep problems persist, it may be helpful to consult a healthcare provider or a sleep specialist to rule out sleep disorders and to find the best treatment solution for you.