Advertisement

Clinical Management of Menopause-Related Sleep Disturbance

  • Sarah B. Mathews
  • C. Neill EppersonEmail author
Chapter

Abstract

Sleep disturbances are common during the menopause transition. Women with vasomotor symptoms may be more at risk for insomnia, particularly if night sweats cause awakenings. Other sleep difficulties, such as difficulty with initiating sleep, and early morning awakening can also occur often in this population. Psychiatric disorders, involving depressive and anxiety symptoms, and medical issues such as obstructive sleep apnea, restless legs syndrome, and incontinence are also common in this population and can contribute to sleep difficulties. Any sleep disturbance, regardless of cause, can lead to daytime fatigue and can negatively impact functioning and quality of life, and therefore, identifying and treating insomnia in menopausal women is essential for their well-being. With many options of pharmacological and non-pharmacological treatments for insomnia, tailoring treatment to a patient’s particular sleep issue and preference is ideal. This chapter focuses on the assessment and treatment of insomnia in menopausal women utilizing typical clinical case examples.

Keywords

Menopause Sleep Sleep disturbance Insomnia 

Notes

Acknowledgments

The writing of this chapter was funded in part by the National Institutes of Health Office of Research on Women’s Health (P50 MH099910), the National Institute for Mental Health (P50 MH099910), the National Institute on Aging (R01 AG030641), the National Institute on Drug Abuse (R01 DA03289 and K24 DA030301), and the National Institute for Diabetes Digestive and Kidney Disorders (U01 DK106892).

References

  1. 1.
    Keenan SA. Normal human sleep. Respir Care Clin N Am. 1999;5(3):319–31.PubMedGoogle Scholar
  2. 2.
    Crowley SJ. Sleep behavior across the lifespan: How a model can expand our current understanding. Sleep Med Rev. 2015;S1087–0792(15):00162–8.Google Scholar
  3. 3.
    Woods NF, Mitchell ES. Sleep symptoms during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Sleep. 2010;33(4):539–49.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Freeman EW, Sammel MD, Boorman DW, Zhang R. Longitudinal pattern of depressive symptoms around natural menopause. JAMA Psychiatry. 2014;71(1):36–43.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yoon IY, Kripke DF, Elliott JA, et al. Age-related changes of circadian rhythms and sleep-wake cycles. J Am Geriatr Soc. 2003;51(8):1085–91.CrossRefPubMedGoogle Scholar
  6. 6.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  7. 7.
    Soules MR, Sherman S, Parrott E, Rebar R, Santoro N, Utian W, et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Fertil Steril. 2001;76:874–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psych. 2004;61:62–70.CrossRefGoogle Scholar
  9. 9.
    Epperson CN, Sammel M, Freeman EW. Menopause effects on verbal memory: Findings from a longitudinal community cohort. J Clin Endocrin Metab. 2013;98(9):3829–38.CrossRefGoogle Scholar
  10. 10.
    Shanmugan S, Epperson CN. Estrogen and the prefrontal cortex: towards a new understanding of estrogen’s effects on executive functions in the menopause transition. Hum Brain Mapp. 2014;35(3):847–65.CrossRefPubMedGoogle Scholar
  11. 11.
    Dennerstein L, Dudley EC, Hopper JL, Guthrie JR, Burger HG. A prospective population-based study of menopausal symptoms. Obstet Gynecol. 2000;96(3):351.PubMedGoogle Scholar
  12. 12.
    Kravitz HM, Ganz PA, Bromberger J, Powell LH, Sutton-Tyrrell K, Meyer PM. Sleep difficulty in women at midlife: a community survey of sleep and the menopausal transition. Menopause. 2003;10(1):19–28.PubMedGoogle Scholar
  13. 13.
    Xu M, Belanger L, Ievers H, et al. Comparison of subjective and objective sleep quality in menopausal and non-menopausal women with insomnia. Sleep Med. 2011;12:65–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Young T, Finn L, Austin D, Peterson A. Menopausal status and sleep-disordered breathing in the Wisconsin Sleep Cohort Study. Am J Respir Crit Care Med. 2003;167:1181–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Owens JF, Matthews KA. Sleep disturbance in healthy middle-aged women. Maturitas. 1998;30(1):41–50.CrossRefPubMedGoogle Scholar
  16. 16.
    Hollander LE, Freeman EW, Sammel MD, Berlin JA, Grisso JA, Battistini M. Sleep quality, estradiol levels, and behavioral factors in late reproductive age women. Obstet Gynecol. 2001;98(3):391–7.PubMedGoogle Scholar
  17. 17.
    Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Bolge SC, Balkrishnan R, Kannan H, Seal B, Drake CL. Burden associated with chronic sleep maintenance insomnia characterized by nighttime awakenings among women with menopausal symptoms. Menopause. 2010;17(1):80–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Shaver JL, Paulsen VM. Sleep, psychological distress, and somatic symptoms in perimenopausal women. Fam Pract Res J. 1993;13:373–84.PubMedGoogle Scholar
  20. 20.
    Shaver J, Gblin E, Paulsen V. Sleep patterns and stability in perimenopausal women. Sleep. 1991;14:18–23.CrossRefPubMedGoogle Scholar
  21. 21.
    Brown JP, Gallicchio L, Flaws JA, Tracy JK. Relations among menopausal symptoms, sleep disturbance and depressive symptoms in midlife. Maturitas. 2009;62(2):184–9.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Joffe H, Soares CN, Thurston RC, White DP, Cohen LS, Hall JE. Depression is associated with worse objectively and subjectively measured sleep, but not more frequent awakenings, in women with vasomotor symptoms. Menopause. 2009;16(4):671–9.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kravitz H, Zhoa X, Bromberger J, et al. Sleep disturbance during the menopause transition in a multi-ethnic community sample of women. Sleep. 2008;31:979–90.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Paulsen V, Shaver JL. Stress, support, psychological states and sleep. Soc Sci Med. 1991;32:1237–43.CrossRefPubMedGoogle Scholar
  25. 25.
    Freedman RR, Roehrs TA. Sleep disturbance in menopause. Menopause. 2007;14:1826–9.CrossRefGoogle Scholar
  26. 26.
    Freeman EW, Sammel MD, Lin H. Temporal associations of hot flashes and depression in the transition to menopause. Menopause. 2009;16(4):728–34.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Sowers MF, Zheng H, Kravitz HM, et al. Sex steroid hormone profiles are related to sleep measures from polysomnography and the Pittsburgh Quality Sleep INdex. Sleep. 2008;31:1339–49.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Gibson-Helm M, Teede H, Vincent A. Symptoms, health behavior and understanding of menopause therapy in women with premature menopause. Climacteric. 2014;17(6):666–73.CrossRefPubMedGoogle Scholar
  29. 29.
    Lampio L, Polo-Kantola P, Polo O, et al. Sleep in midlife women: effects of menopause, vasomotor symptoms, and depressive symptoms. Menopause. 2014;21:1217–24.CrossRefPubMedGoogle Scholar
  30. 30.
    Andersen ML, Bittencourt LRA, Antunes IB, Tufik S. Effects of progesterone on sleep: a possible pharmacological treatment for sleep-breathing disorders? Curr Med Chem. 2006;13(29):3575–82.CrossRefPubMedGoogle Scholar
  31. 31.
    Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB. Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep. 2005;28(10):1289–96.CrossRefPubMedGoogle Scholar
  32. 32.
    Ikehara S, Iso H, Date C, et al. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep. 2009;32:259–301.CrossRefGoogle Scholar
  33. 33.
    Sabanayagam C, Shankar A. Sleep duration and cardiovascular disease: results from the National Health Interview Survey. Sleep. 2010;33:1037–42.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33:585–92.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Vgontzas AN, Liao D, Pejovic S, et al. Insomnia with Short Sleep Duration and Mortality: The Penn State Cohort. Sleep. 2010;33(9):1159–64.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab. 2010;24(5):775–84.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Hachul de Campos H, Brandao LC, D’Almeida V, et al. Sleep disturbances, oxidative stress and cardiovascular risk parameters in postmenopausal women complaining of insomnia. Climacteric. 2006;9(4):312–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Anttalainen U, Saaresranta T, Aittokallio J, et al. Impact of menopause on the manifestation and severity of sleep-disordered breathing. Acta Obstet Gynecol Scand. 2006;85(11):1381–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Berger K, Luedemann J, Trenkwalder C, John U, Kessler C. Sex and the risk of restless legs syndrome in the general population. Arch Intern Med. 2004;164(2):196–202.CrossRefPubMedGoogle Scholar
  40. 40.
    Allen R. Dopamine and iron in the pathophysiology of restless legs syndrome (RLS). Sleep Med. 2004;5(4):385–91.CrossRefPubMedGoogle Scholar
  41. 41.
    Wesstrom J, Nilsson S, Sundstrom-Poromaa I, Ulfberg J. Restless legs syndrome among women: prevalence, co-morbidity and possible relationship to menopause. Climacteric. 2008;11(5):422–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Dzaja A, Wehrle R, Lancel M, Pollmächer T. Elevated estradiol plasma levels in women with restless legs during pregnancy. Sleep. 2009;32(2):169–74.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Jones HJ, Huang AJ, Subak LL, Brown JS, Lee KA. Bladder symptoms in early menopause. J Womens Health. 2017;25:457–63.CrossRefGoogle Scholar
  44. 44.
    Lukacz ES, Sampselle C, Gray M, Macdiarmid S, Rosenberg M, Ellsworth P, et al. A healthy bladder: a consensus. Int J Clin Pract. 2011;65(10):1026–36.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Altemus M, Sarvaiya N, Epperson CN. Sex differences in anxiety and depression: Clinical perspectives. Front Neuroendocrinol. 2014;35(3):320–30.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, et al. Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Arch Gen Psych. 2009;66(7):785–95.CrossRefGoogle Scholar
  47. 47.
    Schmidt PJ, Haq N, Rubinow DR. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 2004;161:2238–44.CrossRefPubMedGoogle Scholar
  48. 48.
    Marsh WK, Templeton A, Ketter TA, Rasgon NL. Increased frequency of depressive episodes during the menopausal transition in women with bipolar disorder: preliminary report. J Psychiatr Res. 2008;42(3):247–51.CrossRefPubMedGoogle Scholar
  49. 49.
    Altshuler LL, Kupka RW, Hellemann G, Frye MA, Sugar CA, McElroy SL, et al. Gender and depressive symptoms in 711 patients with bipolar disorder evaluated prospectively in Stanley Foundation bipolar treatment outcome network. Am J Psychiatry. 2010;167:708–15.CrossRefPubMedGoogle Scholar
  50. 50.
    Benazzi F. The role of gender in depressive mixed state. Psychopathology. 2003;36:213–7.CrossRefPubMedGoogle Scholar
  51. 51.
    Blehar MC, DePaulo Jr JR, Gershon ES, Reich T, Simpson SG, Nurnberger Jr JI. Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull. 1998;34(3):239–43.PubMedGoogle Scholar
  52. 52.
    Seritan AL, Iosif AM, Park JH, et al. Self-reported anxiety, depressive, and vasomotor symptoms: a study of perimenopausal women presenting to a specialized midlife assessment center. Menopause. 2010;17(2):410–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Bromberger JT, Kravitz HM, Chang Y, Randolph Jr JF, Avis NE, Gold EB, et al. Self-reported anxiety, depressive, and vasomotor symptoms: a study of perimenopausal women presenting to a specialized midlife assessment center Study of women’s health across the nation. Menopause. 2010;20(5):488–95.Google Scholar
  54. 54.
    Siegel A, Mathews SB. Diagnosis and treatment of anxiety in the aging woman. Curr Psychiatry Rep. 2015;17:93.CrossRefPubMedGoogle Scholar
  55. 55.
    Juang KD, Wang SJ, Lu SR, Lee SJ, Fuh JL. Hot flashes are associated with psychological symptoms of anxiety and depression in peri- and post- but not premenopausal women. Maturitas. 2005;52(2):119–26.CrossRefPubMedGoogle Scholar
  56. 56.
    Freeman EW, Sammel MD, Lin H, Gracia CR, Kapoor S, Ferdousi T. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause. 2005;12:258–66.CrossRefPubMedGoogle Scholar
  57. 57.
    Tasdemir S, Oz O (2015). The factors causing bad sleep. Brain Behav Immun. pii: S0889-1591(15)30065-9. 53:278.Google Scholar
  58. 58.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  59. 59.
    Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR, Jacobs AG. Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto: Consulting Psychologists Press, Inc.; 1983.Google Scholar
  60. 60.
    Johns M. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.CrossRefPubMedGoogle Scholar
  61. 61.
    Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D, et al. Actigraphy validation with insomnia. Sleep. 2006;29(2):232.PubMedGoogle Scholar
  62. 62.
    Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE. Cognitive behavioral therapy for treatment of chronic primary insomnia. JAMA. 2001;285(14):1856–64.CrossRefPubMedGoogle Scholar
  63. 63.
    Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. J Behav Med. 2006;29:223–7.CrossRefPubMedGoogle Scholar
  64. 64.
    Green SM, Haber E, McCabe RE, Soares CN. Cognitive-behavioral group treatment for menopausal symptoms: a pilot study. Arch Womens Ment Health. 2013;16(4):325–32.Google Scholar
  65. 65.
    Keefer L, Blanchard EB. A behavioral group treatment program for menopausal hot flashes: results of a pilot study. Appl Psychophysiol Biofeedback. 2005;30(1):21–30.CrossRefPubMedGoogle Scholar
  66. 66.
    Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. 2011;18(6):611–20.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Afonso RF, Hachul H, Kozasa EH, de Souza OD, Goto V, Rodrigues D, et al. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial. Menopause. 2012;19(2):186.CrossRefPubMedGoogle Scholar
  68. 68.
    Oliveira D, Hachul H, Tufik S, Bittencourt L. Effect of massage in postmenopausal women with insomnia: a pilot study. Clinics (Sao Paulo). 2011;66(2):343–6.CrossRefGoogle Scholar
  69. 69.
    Kung YY, Yang CC, Chiu JH, Kuo TB. The relationship of subjective sleep quality and cardiac autonomic nervous system in postmenopausal women with insomnia under auricular acupressure. Menopause. 2011;18(6):638–45.CrossRefPubMedGoogle Scholar
  70. 70.
    Borud EK, Alraek T, White A, et al. The Acupuncture on Hot Flushes Among Menopausal Women (ACUFLASH) study, a randomized controlled trial. Menopause. 2009;16(3):484–93.CrossRefPubMedGoogle Scholar
  71. 71.
    Passos GS, Poyares DL, Santana MG, Tufik S, Mello MT. Is exercise an alternative treatment for chronic insomnia? Clinics (Sao Paulo). 2012;67(6):653–60.CrossRefGoogle Scholar
  72. 72.
    Sternfeld B, Guthrie KA, Ensrud KE, LaCroix AZ, Larson JC, Dunn AL, et al. Efficacy of exercise for menopausal symptoms: a randomized controlled trial. Menopause. 2014;21(4):330–8.PubMedPubMedCentralGoogle Scholar
  73. 73.
    NAMS. The 2012 hormone therapy position statement of: The North American Menopause Society. Menopause. 2012;19(3):257–71.CrossRefGoogle Scholar
  74. 74.
    Furness S, Roberts H, Marjoribanks J, Lethaby A. Hormone therapy in postmenopausal women and risk of endometrial hyperplasia. Cochrane Database Syst Rev. 2012;15:8.Google Scholar
  75. 75.
    Schiff I, Regestein Q, Tulchinsky D, Ryan KJ. Effects of estrogens on sleep and psychological state of hypogonadal women. JAMA: the journal of the American Medical Association. JAMA. 1979;242(22):2405–7.CrossRefPubMedGoogle Scholar
  76. 76.
    Antonijevic IA, Stalla GK, Steiger A. Modulation of the sleep electroencephalogram by estrogen replacement in postmenopausal women. Am J Obstet Gynecol. 2000;182(2):277–82.CrossRefPubMedGoogle Scholar
  77. 77.
    Saletu-Zyhlarz G, Anderer P, Gruber G, Mandl M, Gruber D, Metka M, Huber J, Oettel M, Gräser T, Abu-Bakr MH, Grätzhofer E, Saletu B. Insomnia related to postmenopausal syndrome and hormone replacement therapy: sleep laboratory studies on baseline differences between patients and controls and double-blind, placebo-controlled investigations on the effects of a novel estrogen-progestogen combination (Climodien, Lafamme) versus estrogen alone. J Sleep Res. 2003;12(3):239–54.Google Scholar
  78. 78.
    Welton AJ, Vickers MR, Kim J, et al. WISDOM team: Health related quality of life after combined hormone replacement therapy; randomized controlled trial. BMJ. 2008;337:1190.CrossRefGoogle Scholar
  79. 79.
    Kalleinen N, Polo O, Himanen SL, Joutsen A, Polo-Kantola P. The effect of estrogen plus progestin treatment on sleep: a randomized, placebo-controlled, double-blind trial in premenopausal and late postmenopausal women. Climacteric. 2008;11(3):233–43.CrossRefPubMedGoogle Scholar
  80. 80.
    Montplaisir J, Lorrain J, Denesle R, Petit D. Sleep in menopause: differential effects of two forms of hormone replacement therapy. Menopause. 2001;8(1):10.CrossRefPubMedGoogle Scholar
  81. 81.
    Purdie DW, Empson JA, Crichton C, Macdonald L. Hormone replacement therapy, sleep quality and psychological wellbeing. Br J Obstet Gynaecol. 1995;102(9):735–9.CrossRefPubMedGoogle Scholar
  82. 82.
    Schussler P, Kluge M, Yassouridis A, et al. Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocrinology. 2008;33(8):1124–31.CrossRefPubMedGoogle Scholar
  83. 83.
    Gurney EP, Nachtigall MJ, Nachtigall LE, Naftolin F. The Women’s Health Initiative trial and related studies: 10 years later: A clinician’s view. J Steroid Biochem Mol Biol. 2014;142:4–11.CrossRefPubMedGoogle Scholar
  84. 84.
    Lacey J. The WHI ten year’s later: An epidemiologist’s view. J Steroid Biochem Mol Biol. 2014;142:12–5.CrossRefPubMedGoogle Scholar
  85. 85.
    Soares CN, Joffe H, Rubens R, Caron J, Roth T, Cohen L. Eszopiclone in patients with insomnia during perimenopause and early postmenopause: a randomized controlled trial. Obstet Gynecol. 2006;108(6):1402–10.CrossRefPubMedGoogle Scholar
  86. 86.
    Joffe H, Petrillo L, Viguera A, et al. Eszopiclone improves insomnia and depressive and anxious symptoms in perimenopausal and postmenopausal women with hot flashes: a randomized, double-blinded, placebo-controlled crossover trial. Am J Obstet Gynecol. 2010;202(2):171.CrossRefPubMedGoogle Scholar
  87. 87.
    Dorsey CM, Lee KA, Scharf MB. Effect of zolpidem on sleep in women with perimenopausal and postmenopausal insomnia: a 4-week, randomized, multicenter, double-blind, placebo-controlled study. Clin Ther. 2004;26(10):1578–86.CrossRefPubMedGoogle Scholar
  88. 88.
    Dobkin RD, Menza M, Bienfait KL, Allen LA, Marin H, Gara MA. Ramelteon for the treatment of insomnia in menopausal women. Menopause Int. 2009;5(1):13–8.Google Scholar
  89. 89.
    Soares CN, Arsenio H, Joffe H, Bankier B, Cassano P, Petrillo LF, Cohen LS. Escitalopram versus ethinyl estradiol and norethindrone acetate for symptomatic peri- and postmenopausal women: impact on depression, vasomotor symptoms, sleep, and quality of life. Menopause. 2006;13(5):780–6.CrossRefPubMedGoogle Scholar
  90. 90.
    Kornstein SG, Clayton AH, Bao W, Guico-Pabia CJ. A pooled analysis of the efficacy of desvenlafaxine for the treatment of major depressive disorder in perimenopausal and postmenopausal women. J Womens Health. 2015;24(4):281–90.CrossRefGoogle Scholar
  91. 91.
    Ensrud KE, Guthrie KA, Hohensee C, Caan B, Carpenter JS, Freeman EW, LaCroix AZ, et al. Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep. 2015;38(1):97–108.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Ensrud KE, Joffe H, Guthrie KA, Larson JC, Reed SD, Newton KM, et al. Effect of escitalopram on insomnia symptoms and subjective sleep quality in healthy perimenopausal and postmenopausal women with hot flashes: a randomized controlled trial. Menopause. 2012;19(8):848–55.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Waldinger MD. Psychiatric disorders and sexual dysfunction. Handb Clin Neurol. 2015;130:469–89.CrossRefPubMedGoogle Scholar
  94. 94.
    Gilron I, Baron R, Jensen T. Neuropathic pain: principles of diagnosis and treatment. Mayo Clin Proc. 2015;90(4):532–45.CrossRefPubMedGoogle Scholar
  95. 95.
    Johanessen Landmark C. (2015). Antiepileptic drugs in non-epilepsy disorders: relations between mechanisms of action and clinical efficacy. CNS Drugs. 2008;22(1):27–47.CrossRefGoogle Scholar
  96. 96.
    Howland RH. Gabapentin for the treatment of substance use disorders. J Psychosoc Nurs Ment Health Serv. 2013;51(12):11–4.CrossRefGoogle Scholar
  97. 97.
    Butt DA, Lock M, Lewis JE, Ross S, Moineddin R. Gabapentin for the treatment of menopausal hot flashes: a randomized controlled trial. Menopause. 2008;15:310–8.CrossRefPubMedGoogle Scholar
  98. 98.
    Reddy SY, Warner H, Guttuso Jr T, et al. Gabapentin, estrogen and placebo for treating hot flashes: a randomized controlled trial. Obstet Gynecol. 2006;108:41–8.CrossRefPubMedGoogle Scholar
  99. 99.
    Yurcheshen ME, Guttuso Jr T, McDermott M, Holloway RG, Perlis M. Effects of gabapentin on sleep in menopausal women with hot flashes as measured by a Pittsburgh Sleep Quality Index factor scoring model. J Womens Health (Larchmt). 2009;18:1355–60.CrossRefGoogle Scholar
  100. 100.
    Dolev Z. Case series of perimenopausal women with insomnia treated with mirtazapine followed by prolonged-release melatonin add-on and monotherapy. Arch Womens Health. 2011;14(3):269–73.CrossRefGoogle Scholar
  101. 101.
    Hasnain M, Vieweg WV. Weight considerations in psychotropic drug prescribing and switching. Postgrad Med. 2013;125(5):117–29.CrossRefPubMedGoogle Scholar
  102. 102.
    Pansini F, Albertazzi P, Bonaccorsi G, Zanotti L, Porto S, Dossi L, et al. Trazodone: a non-hormonal alternative for neurovegetative climacteric symptoms. Clin Exp Obstet Gynecol. 1995;22(4):341–4.PubMedGoogle Scholar
  103. 103.
    NAMS. Nonhormonal management of menopause-associated vasomotor symptoms: 2015 position statement of The North American Menopause Society. Menopause. 2015;22(11):1155–74.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of PsychiatryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Penn Center for Women’s Behavioral Wellness, Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Departments of Psychiatry and Obstetrics and GynecologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  4. 4.Penn PROMOTES Research on Sex and Gender in HealthUniversity of PennsylvaniaPhiladelphiaUSA

Personalised recommendations