Study data published in Menopause suggest that sleep trajectories remain stable before and after surgical menopause, or hysterectomy with bilateral oophorectomy, although 20% of women will experience sleep maintenance problems.

The Study of Women’s Health Across the Nation (SWAN) is a community-based, multisite cohort study of women in menopausal transition. Beginning in 1996, SWAN enrolled more than 3000 women aged 42 to 52 years from 7 sites in the United States. Eligible participants were premenopausal or early perimenopausal, had an intact uterus and at least 1 ovary, and had menstruated within the 3 months before enrollment.

Psychological, social, and health data were captured at baseline and at annual follow-up visits through 2013. At each visit, women self-reported frequency of the following sleep variables in the past 2 weeks: trouble falling asleep, waking several times, and early morning awakening. The present analysis used data from SWAN participants who had undergone a hysterectomy with bilateral oophorectomy to induce menopause (n=184). Group trajectory modeling was used to assess the relationship between presurgery and postsurgery sleep trajectories.

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At baseline, 33.5% of the entire cohort (n=176; median follow-up, 15.3 years; mean age at surgery, 51.2±4.0 years) endorsed 1 or more sleep problem. There were 4 distinct sleep problem trajectory groups: low prevalence of sleep problems (33.5%), moderate prevalence (33.0%), increasing prevalence during the presurgery period (19.9%), and high prevalence (13.6%). In general, sleep patterns remained stable across the pre- and postsurgical periods, and patients who reported an increase in sleep problems presurgery were more likely to endorse postsurgery sleep problems. Similarly, patients in the high trajectory group continued to report sleep troubles postsurgery, whereas patients in the low and moderate trajectories reported sleep problems with low and moderate prevalences, respectively. Adjusting for postsurgical early morning awakening, frequent vasomotor symptoms, and bodily pain attenuated, but did not remove, the associations between pre- and postsurgery sleep symptoms (all P <.01).

Approximately 20% of women experienced an increase in sleep maintenance issues during the presurgery period. Among the majority of women, however, sleep trajectories were generally stable pre- and postsurgery. As a study limitation, the investigators cited the use of self-report sleep data, which may have introduced information bias. “Clinicians and their patients might find it reassuring that for the majority of women who are surgically menopausal, sleep complaints do not worsen postsurgically,” the study authors wrote.

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures


Kravitz HM, Matthews KA, Joffe H, et al. Trajectory analysis of sleep maintenance problems in midlife women before and after surgical menopause: the Study of Women’s Health Across the Nation (SWAN) [published online January 13, 2020]. Menopause. doi:10.1097/GME.0000000000001475

This article originally appeared on Psychiatry Advisor