The effect of estrogen plus progestin treatment on sleep: a randomized, placebo-controlled, double-blind trial in premenopausal and late postmenopausal women

Objective In this prospective randomized, place bo-controlled and double-blind study, the objective was to investigate the effects of estrogen-progestin treatment (EPT) on sleep in pre- and postmenopausal women. Design Seventeen premenopausal (aged 45-51 years) and 18 postmenopausal (aged 58-70 years) women were studied in a sleep laboratory for two nights (one night for adaptation and one study night) before and after 6 months of treatment with EPT or placebo. During the treatment period, premenopausal women received cyclic EPT or placebo and the postmenopausal women continuous EPT or placebo. Polysomnography and questionnaires were used to evaluate sleep and well-being. Results At the end of the treatment period, premenopausal women receiving EPT had more awakenings from stage 1 sleep (p = 0.047) and postmenopausal women with EPT had a greater total number of awakenings (p = 0.031) than the corresponding placebo group. Further, sleepiness decreased less in the premenopausal EPT group than in the placebo group (p=0.031). In postmenopausal women, EPT decreased and placebo slightly increased slow wave activity during the second non-rapid eye movement sleep episode (p = 0.046). Conclusions In premenopausal and late postmenopausal women, EPT had only random and marginal effects on sleep. Although the limited findings were mostly unfavorable for EPT, one cannot conclude that EPT deteriorates sleep. Further, neither middle-aged cycling premenopausal women nor older postmenopausal women benefit from estrogen-progestin treatment in terms of their sleep quality.