Analysis of the long-term beneficial effects of menopausal hormone therapy on sleep quality and menopausal symptoms

A large number of menopausal women report sleep disturbances along with psychological, somatic and urogenital menopausal symptoms. The aim of this study was to evaluate the efficacy of menopausal hormonal therapy (MHT) in improving subjective sleep quality and the severity of menopausal symptoms. An institutional ethics committee approved this retrospective chart review of 342 women treated with MHT for menopausal symptoms. Standard 28-day MHT consisted of the oral administration of 2 mg estradiol daily for 14 days, followed by 2 mg estradiol and 10 mg dydrogesterone daily for the remaining 14 days. A subgroup of 14 participants with a family history of cancer and mammography scores of 3 and above, received only tibolone 2.5 mg daily. Perceived sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI), while the assessment of menopausal symptoms was performed using the Kupperman Menopause Index (KMI) and menopause rating scale (MRS). Of the 342 patients, 79 were followed-up for 3 years. Compared to the baseline scores, the mean decrease in PSQI scores was 1.53 +/- 0.29 points (P<0.0001) at 1 month, 2.21 +/- 0.187 points (P<0.0001) at 2 months and 2.26 +/- 0.6 points (P<0.0001) after 3 years of MHT. The KMI scores also decreased by a mean of 6.37 +/- 1.59 points (P<0.0001) at 1 month and by 8.73 +/- 1.92 points after 3 years (P<0.0001). The MRS scores decreased by a mean of 3.56 +/- 1.05 points (P<0.0001) at 1 month and by 4.28 +/- 2.01 points (P<0.0001) after 3 years, as compared to the baseline scores. Patients receiving tibolone MHT did not report any improvement in sleep quality (P=0.956). On the whole, the findings of this study indicate that conventional MHT has a rapid and prolonged beneficial effect on self-reported sleep quality and menopausal symptoms in women. However, further clinical studies are warranted to compare the effects of different MHT regimens.