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Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis

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Abstract

Sleep complaints are reported by 40–60 % of menopausal women. Poor sleep is a risk factor for cardiovascular disease, diabetes, and obesity. The effect of menopausal hormone therapy on sleep quality is unclear. A systematic review and meta-analysis were conducted to summarize the efficacy of menopausal hormone therapy on self-reported sleep quality. Electronic databases (PubMed, Scopus, Ovid MEDLINE, EMBASE, EBM Reviews CENTRAL, and PsycInfo) were searched from 2002 to October 2015. Randomized trials assessing the effect of menopausal hormone therapy with a minimum follow up of 8 weeks were included. Titles, abstracts, and full texts were screened independently and in duplicate. Primary outcome included sleep items within a questionnaire, scale or diary. Standardized mean differences across trials were pooled using random-effects models. The search identified 424 articles, from which 42 trials were included. Seven trials at a moderate to high risk of bias enrolling 15,468 women were pooled in meta-analysis. Menopausal hormone therapy improved sleep quality in women who had vasomotor symptoms at baseline [standardized mean difference –0.54 (−0.91 to −0.18), moderate quality evidence]. No difference was noted when women without such symptoms were analyzed separately or combined. Across 31 sleep quality questionnaires, daytime dysfunction was the most evaluated sleep domain. Menopausal hormone therapy improves sleep in women with concomitant vasomotor symptoms. Heterogeneity of trials regarding study population, formulations, and sleep scales; limit overall certainty in the evidence. Future menopausal hormone therapy trials should include assessment of self-reported sleep quality using standardized scales and adhere to reporting guidelines.

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Acknowledgments

D.C., M.R.G., and G.S.B. were supported by TL1 TR000137 from the National Center for Advancing Translational Science, a component of the National Institutes of Health. V.M.M. is supported by National Institutes of Aging P50-AG44170 and the Mayo Foundation.

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Authors and Affiliations

  1. Mayo Graduate School, Mayo Clinic, Rochester, MN, USA

    Dahima Cintron, Gabriela Spencer-Bonilla & Michael R. Gionfriddo

  2. Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA

    Melissa Lipford & Robin Lloyd

  3. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA

    Laura Larrea-Mantilla, Gabriela Spencer-Bonilla, Michael R. Gionfriddo & Mohammad Hassan Murad

  4. Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA

    Shalak Gunjal & Mohammad Hassan Murad

  5. Mayo Medical Library, Mayo Clinic, Rochester, MN, USA

    Ann M. Farrell

  6. Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA

    Virginia M. Miller

  7. Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA

    Mohammad Hassan Murad

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  1. Dahima Cintron
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Correspondence to Mohammad Hassan Murad.

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Cintron, D., Lipford, M., Larrea-Mantilla, L. et al. Efficacy of menopausal hormone therapy on sleep quality: systematic review and meta-analysis. Endocrine 55, 702–711 (2017). https://doi.org/10.1007/s12020-016-1072-9

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