by Zoom Heaton
The biggest complaint from women going through “the change” is the inability to sleep. Without restful sleep, our bodies cannot heal properly increasing our risk for dangerous medical conditions like heart disease and cancers. There are many reasons in present-day society why we cannot sleep — such as stress, emotional turmoil, and environmental factors. However, for women approaching menopause, sleep disturbances are likely to be caused by hormonal imbalances.
Hormones Involved In Maintaining Sleep
Estrogen is a sleep-maintaining hormone. An upset in estrogen balance is common during perimenopause and menopause, resulting in one’s inability to get a full night’s sleep. Progesterone plays a role in maintaining and calming the nervous system. It is a natural anti-depressant and has protective qualities for the brain. It stimulates the new formation of bone and restores a normal sleep pattern. Testosterone can be indirectly converted to estrogen, which can help to relieve hot flashes and sleep disturbances. Low testosterone levels can also contribute to insomnia by making it difficult to achieve deep sleep. Low levels of testosterone are linked with snoring and sleep apnea. Both low and high levels of thyroid hormones can result in a variety of sleep disturbances and be a hidden cause of insomnia. An imbalance in cortisol, an adrenal hormone, can cause fatigue, lethargy, anxiety or insomnia.
Hormone Fluctuations During Perimenopause and Menopause
During perimenopause, progesterone levels begin to decrease first, especially when women are stressed. Both age and stress decrease the amount of progesterone produced by the ovaries. This creates an imbalance between progesterone and estrogen.
When estrogen levels are higher than progesterone for any reason (including perimenopause), the menstrual cycle becomes irregular. Symptoms known as premenstrual syndrome (PMS) include mood changes, bloating, breast tenderness, and water retention, which become more likely due to this irregularity. This condition where estrogen levels are higher than progesterone levels, known as estrogen dominance, can cause menstrual cramping, fibroids, polyps, and heavy bleeding.
There are three main forms of estrogen: estrone (the strongest form, that’s been linked to breast cancer); estradiol (the most prevalent form in menstruating women); and estriol (the weakest form of estrogen, yet the most protective). All forms of estrogen are metabolized by the liver. Each of us has a unique ability to break down (metabolize) estrogen in two phases. The efficiency with which we do this is determined by our genetics. If your body is not as able to metabolize estrogen, it will remain in your body longer in more toxic forms, increasing the risk of PMS and fibroids, as well as breast cancer and other estrogen-related health issues.
Eventually, as perimenopause progresses, the ovaries also start to make less estrogen. Hence, both progesterone and estrogen levels begin to decrease gradually. However, estrogen often doesn’t decrease gradually but tends to dip, sometimes fluctuating from high to low within minutes. Every time estrogen shifts, it sends signals through your body that triggers many of the symptoms associated with perimenopause and menopause, such as insomnia, night sweats, hot flashes, migraines, and mood changes.
Ultimately, when ovulation ceases altogether, estrogen and progesterone levels stop cycling from low to high and instead remain low. At this point, women often experience vaginal dryness, urinary infections, joint pain, and weight gain, all of which can cause sleep disruption.
Estrogen Dominance Affecting Thyroid Function Can Affect Sleep
At estrogen dominance thyroid function becomes suppressed, and low levels of thyroid hormones can cause mild hypothyroidism and result in insomnia, especially in women around menopause. Women with hypothyroidism frequently have increased insensitivity of progesterone receptors resulting in low progesterone levels.
Mild hypothyroidism can cause people to sleep lightly and/or experience difficulties falling and staying asleep. When hypothyroidism is undiagnosed or undertreated, adrenal glands start to work more intensively and produce an excessive amount of adrenaline in order to compensate for the low thyroid function. The effect of adrenaline is hardly noticeable during the day but in the evening sleep is elusive due to continuous thoughts, worrying, planning, or anxiety.
Balancing estrogen by adjusting progesterone levels with bioidentical hormone therapy can help restore thyroid function and sleep. Also, optimizing thyroid hormones in women with underachieving thyroid function can support adequate progesterone production and healthy sleep patterns.
Cortisol Imbalances Can Lead To Insomnia
The adrenal hormones are essential for energy production but an imbalance can cause restlessness and an inability to sleep. Cortisol, aldosterone, adrenaline and epinephrine are hormones produced by the adrenal glands.
During times of chronic stress, continual elevated levels of cortisol and adrenaline negatively affect thyroid function, suppress the immune system, and cause sleep disturbances and insomnia, particularly in women. Adrenals and the thyroid gland are closely connected and during times of adrenal fatigue, the thyroid gland slows down the production of thyroid hormones as well.
What To Do
- If you are between the ages of 35-55, get tested to get a baseline of your hormone levels. This includes estradiol, progesterone, testosterone, DHEA, cortisol, thyroid. Testing can be done through blood, saliva, and urine.
- Reduce stress through meditation, gentle exercise (i.e., yoga, pilates); removing or turning off stimuli such as phones, television, computers, lights, etc.; reducing your “to do” list to where you can finish comfortably without excess worrying and guilt.
- Change your sleeping habits by getting into a healthy routine of going to bed around the same time each night.
- Avoid stimulants such as coffee, diet pills, alcohol, cigarettes, recreational drugs, sugar and caffeinated drinks. Inappropriate use of immune support and thyroid boosters can cause insomnia in women mainly due to high cortisol and the stimulating effects of adrenaline.
- Change your diet by eliminating simple carbohydrates and processed foods. To support healthy adrenals, cut back or eliminate foods high in refined sugars and saturated fats.
- Support your adrenal glands with adaptogenic herbs, vitamins and minerals
- Help your body detoxify and break down accumulated unwanted estrogen metabolites lingering in your liver by taking supplements like meta-I-3C and DIM
- If supplementation of hormones is necessary as determined by your doctor, bio-identical hormone replacement therapy is an alternative option to conventional medications.
Testing for hormones is available at TLC Medical Centre Pharmacy. Compounding for bio-identical hormone replacement is available in our compounding lab Custom Prescription Compounders, LLC.. We work closely with you and your doctor to customize a hormone treatment that fits you individually for optimum balance and health. Call 648-7800 for your free 15-minute consultation to get started.
Zoom Heaton is the owner of TLC Medical Centre Inc., an Independent Community Pharmacy and Medical Equipment facility located at 190 Crepe Myrtle Drive off Silver Bluff Road. A pharmacist, she is a graduate of the University of South Carolina. She is a Certified Diabetes Educator and is certified in Immunization; she is also the chief compounding pharmacist at Custom Prescription Compounders, LLC, inside TLC Medical Centre, Inc., specializing in Bio-Identical Hormone Replacement Therapy and Women’s Health. Call 803.648.7800 or visit nooneshoerx.com for more information.