According to study results published in Menopause, women who undergo surgical menopause have significantly worse sleep quality than those who experience natural menopause, possibly because of a sharper decrease in estrogen levels.

To compare differences in quality of sleep between women who underwent surgical menopause vs women with natural menopause, researchers asked 526 postmenopausal women (average age, 60.2) to complete questionnaires about insomnia symptoms, sleep-interfering behaviors, hormonal medication use, depression, sleep quality, and gynecologic history.

Overall, 81.6% of the study population reported a natural transition to menopause. Women who underwent surgical menopause (n = 97) were on average 7.2 years younger at the start of menopause (P <.001) than women who experienced natural menopause. Women with surgical menopause were also more likely to have used hormonal medication (4.4% vs 8.3% for natural vs surgical; P =.02) and had a longer average menopause duration (10.13 vs 16.22 years for natural vs surgical; P <.001). All other demographic characteristics were similar between groups.

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Using adjusted and unadjusted statistical models, the researchers found that women who underwent surgical menopause experienced significantly worse sleep quality (P =.007), with shorter duration (P =.001) and worse habitual sleep efficiency (P =.01) vs women who had natural transition to menopause.

Compared with the natural menopause group, women who underwent surgery were also 2.13 times more likely to have insomnia (P =.027). Furthermore, women in the surgical group who reported more sleep-interfering behaviors (alcohol/caffeine consumption, heavy meals before bed, etc.) tended to have more severe insomnia symptoms (sleep onset/sleep maintenance difficulties, early morning awakenings) than women with the same habits who underwent natural menopause (P =.03).

The researchers reported several limitations to their study, including its reliance on subjective reports of menopause and sleep.

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“Sleep is often overlooked in the course of potential consequences of gynecological surgery and induced menopause,” the researchers said, adding that “assessing sleep quality may be particularly important in women who undergo gynecological surgery that results in menopause because they may be more vulnerable to poor sleep quality.”


Cho NY, Kim S, Nowakowski S, Shin C, Suh S. Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause [published online November 12, 2018]. Menopause. doi:10.1097/GME.0000000000001257

This article originally appeared on Endocrinology Advisor