In my last post, I shared some keys to better sleep through hormone balance: for women who are still having periods, progesterone is likely what’s needed for balance, while postmenopausal women with classic symptoms like hot flashes and night sweats are likely to need some form of estrogen too. Whether a woman is perimenopausal or menopausal, progesterone is likely to be part of a HT (hormone therapy) prescription for restoring better sleep.
Any prescription for estrogen replacement, whether it’s a patch, pellet (inserted beneath the skin, where it slowly dissolves over the course of a few months), or cream, must be accompanied by progesterone! Given alone, estrogens can increase risk of uterine cancer. Even when women don’t have a uterus (because it has been removed in a hysterectomy), the balancing effects of progesterone are crucial for creating hormone balance and better sleep.
This is a much safer approach than addictive, side-effect-producing sleep medications. All you’re doing is restoring levels of hormone that produce the kind of sleep you got in your 20s and early 30s.
Avoid Progesterone “Wanna-Bes”
Stay away from hormone-like drugs called progestins, which are found in most birth control pills and oral hormone replacement medications like Prempro. Progestins won’t help sleep quality at all, and may impair it.
When I was researching my upcoming book, I spoke with a researcher who had been studying hormone therapy for drug companies for decades. He agreed that the progestins that have been prescribed as a standard part of birth control pills and hormone replacement since the 1970s are not good for women’s bodies. I asked him whether bioidentical progesterone might be the next hormone they’d study to accompany estrogens in hormone therapy.
He reported that actually, they were studying something else called basedoxefine, which is a selective estrogen receptor modulator (SERM) – nothing close to the hormone nature designed to do the important job of balancing estrogen effects in the body.
When I asked this doctor why he hadn’t studied bioidentical progesterone, he said that it’s because progesterone given by mouth is too sedating. If we give it in the mornings, he said, women get sleepy, and traffic accidents increase.
In my practice, I give oral progesterone at night to purposely cause the “side effect” of deep, restful sleep. In other words, the solution is simple – don’t take it in the mornings!
The real reason these companies resist offering bioidentical progesterone is that there’s not much money in it. The progesterone molecule can’t be patented. Oral micronized progesterone is a patented formula, but it can’t command the high prices basedoxefine would as a new, proprietary substance. Drug companies’ refusal to fund research on the benefits of bioidentical progesterone deprives women of the huge benefit of having a natural sleep aid that benefits their bodies in many other ways.
An added benefit of HT for insomnia: women whose sex drives have suffered due to hormonal imbalances will probably see improvements in libido and responsiveness. A pleasant evening of passionate lovemaking + a good night’s sleep will really get you ready for a good run the next day!
Quality of Life Matters
Let’s revisit the Wyoming researchers’ study I discussed in the last blog post. The real gold from this study, in my opinion, is the authors’ conclusions about the impact of hormone replacement in terms of lowered medical costs/sick leave days and heightened productivity.
Analyses of the risks and benefits of hormone therapy have looked mostly for positive impacts on bone and heart health and brain function. When studies have found that risks from HT outweigh those particular benefits, the conclusion is generally that HT isn’t worth it. But what these studies tend NOT to look at with any level of intensity is quality of life (QOL).
A big decline in quality of life is one of the most important parts of the picture of perimenopause (the years leading up to menopause) and the years during and after a woman’s final period. Really, when a woman needs menopause help, it isn’t because she’s concerned about her bones or her heart. It’s because she’s having ridiculous hot flashes, or can’t sleep, or loses her libido or her energy.
The research and medical communities owe it to women to seriously study the hormone therapies most likely to be both safe and effective when it comes to improving their quality of life, including their sleep quality – not just to study the ones likely to be most profitable.