Menopause is related to major hormonal, physical, and psychological changes for women, each of which could influence their sleep. However, sleep in women post-menopause may differ by race and ethnicity. We aimed to examine associations between age at menopause and insomnia symptoms among US women by race and ethnicity.
We utilized 2008-2012 data from the Health and Retirement Study, a nationally representative cohort of US adults age 50+, restricted to women with natural transition to menopause. Age at menopause was retrieved from baseline information (2008) and was used to categorized women into premature menopause (age≤40y), early menopause (age 41-45y), and normal menopause (age>45y). An insomnia composite score was constructed from 2010 and 2012 survey items that assessed insomnia symptoms (i.e., trouble falling asleep, nighttime awakenings, early morning awakenings, and feelings of nonrestorative sleep). Insomnia items that were reported as “most of the time” were considered positive and contributed to the composite score (range: 0-4). We estimated associations between age at menopause and insomnia symptoms using linear regression models and logistic regression models for continuous and binary outcomes, respectively. Models were stratified by White/non-White race and were adjusted for age, education, physical activity, parity, marital status, and survey year.
Among 4,435 women, 338, 701, and 3,396 reported premature, early, and normal menopause, respectively. In White women, premature menopause was associated with a higher mean composite insomnia score than those who had normal menopause (b=0.20, p=0.03). However, this association was not seen in non-Whites. For individual insomnia survey items, premature menopause in White women was associated with greater odds of nonrestorative sleep (OR=1.98, 1.30-3.03) compared with normal menopause. In contrast, a premature menopause was not associated with nonrestorative sleep in non-Whites. Premature menopause was not associated with other individual insomnia symptoms for both groups.
Premature transition to menopause is associated with increased insomnia symptoms in White women. Among individual insomnia features, premature menopause had the greatest impact on nonrestorative sleep. Given the importance of sleep quality for various health outcomes, our findings highlight a need for more dedicated sleep assessments in women who experience premature menopause.