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Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause

Cho, Na Young BA1; Kim, Soriul PhD2; Nowakowski, Sara PhD3,4; Shin, Chol MD, PhD2,5; Suh, Sooyeon PhD1

doi: 10.1097/GME.0000000000001257
Original Articles

Objective: Women who undergo surgical menopause (SM) experience a relatively more acute and precipitous drop of estrogen compared with women who experience natural menopause (NM). Few studies, however, have compared sleep quality in women who experience natural versus SM.

Methods: Participants were 526 postmenopausal women (mean age 60.2 ± 7.64). All participants completed self-report questionnaires about insomnia symptoms, sleep-interfering behaviors, depression, sleep quality, and gynecological history. Analysis of covariance was conducted to compare women who experienced NM versus SM on sleep variables. Logistic regression analysis was used to determine whether NM or SM groups predicted insomnia status. Regression-based moderation analysis was conducted to explore the moderating effect of type of menopause on the relationship between sleep-interfering behaviors and insomnia symptoms.

Results: Among the sample, 81.6% (n = 429) reported going through NM and 18.4% (n = 97) reported going through SM. The SM group was significantly younger by 7.2 years (P < 0.001). Women in the SM group reported significantly worse sleep quality (P = 0.007), especially for sleep duration (P = 0.001) and habitual sleep efficiency (P = 0.010) compared with women in the NM group. Regression analysis indicated that individuals in the SM group were 2.131 (95% CI 1.055-4.303) times more likely to have insomnia compared with the NM group (P = 0.027). In addition, women in the SM group who displayed more sleep-interfering behaviors also had a higher severity of insomnia symptoms compared with women who experience NM (ß = 0.26, P = 0.03).

Conclusions: Menopause can be both physically and psychologically challenging, but women who undergo SM experience worse sleep quality compared with women who experience NM, and may benefit from behavioral interventions.

1Department of Psychology, Sungshin University, Seoul, Republic of Korea

2Korea University Ansan Hospital, Institute of Human Genomic Study, Ansan, Korea

3Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX

4Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX

5Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea.

Address correspondence to: Chol Shin, MD, PhD, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Institute of Human Genomic Study, Korea University Ansan Hospital, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Korea. E-mail:; Sooyeon Suh, PhD, Department of Psychology, Sungshin University, 2 Bomun-ro 34da-gil, Seongbuk-gu, Seoul 02844, Republic of Korea. E-mail:

Received 19 June, 2018

Revised 18 September, 2018

Accepted 18 September, 2018

CS and SS equally contributed to this study.

The abstract for this paper was presented internationally at World Sleep 2017 (Prague Czech Republic) and at Korean Society of Sleep Medicine (Seoul, Korea) as a poster presentation.

Funding/support: This study was supported by the Korea Centers for Disease Control and Prevention (KCDC) grant (No. 2012-E71005-00) and by the Sungshin University Research Grant of 2018 (2018-2-82-001).

Financial disclosure/conflicts of interest: None reported.

© 2019 by The North American Menopause Society.