The menopause is associated with many symptoms, but surveys have shown that bot flushes, insomnia, and psychological symptoms are especially common in the perimenopausal years. Menopausal symptoms are often treated by hormone replacement therapy because the menopause is associated with changeing hormone levels, but the value of treatment has not been conclusively proven.
The aim of my study was to determine the effect of oestrogen treatment on sleep, mood, anxiety, and hot flushes in perimenopausal women. Patients in the study were women aged 45-55, with at least three months amenorrhoea and symptoms of insomnia, depression, anxiety, and hot flushes. The study was 4 ouble blind and controlled, with half of the patients receiving six weeks placebo followed by eight weeks piperazine oestrone sulphate 3 m·g/day, and half remaining on placebo throughout the study. Sleep was recorded electrophysiologically on one night per week, the first two nights being for adaptation purposes only, the next four in the baseline placebo period, the next four in the first treatment month, and the remaining four in the second treatment month. Patients rated their sleep quality, mood, anxiety levels, and hot flush :severity daily using visual analogue scales, and recorded their daily hot flush count. Hamilton observer rating scales of depression and anxiety were completed at intervals during the study.
There were 17 patients in each group, and the two groups were similar in terms of age and duration of amenorrhoea. Electrophysiological sleep recording showed that during the first month of active treatment, the amount of wakefulness interrupting periods of sleep decreased more in the oestrone group than the placebo group. In the second treatment month, the oestrone group showed a further decrease in the amount of intervening wakefulness, a decrease in the frequency of waking, and an increase in their amount of REM sleep, all of which were significant when compared with the changes shown by the placebo group. The less sensitive visual analogue scales failed to differentiate between the groups. Mood and anxiety improved, and the number and severity of hot flushes decreased to a similar extent in the two groups.
Six patients in each group attended on two extra nights, when blood samples were taken at 20 min intervals while recording sleep to investigate their nocturnal plasma hormone levels. In all oases, plasma oestrone and oestradiol concentrations fluctuated rapidly and widely, but the mean levels of both hormones ware low on placebo. The four patients studied after four weeks of oestrogen treatment showed an increase in their mean oestrone levels, but only two bad higher mean oestradiol levels. Prolactin secretion increased after sleep onset in all cases, and oestrogen treatment bad no consistent effect on prolactin secretion. Free and total plasma tryptophan levels were measured in three patients on placebo, and in each case a highly significant correlation was found between total plasma oestrogen concentration and both concentration and % free plasma tryptophan.
