Menstrual regularity and bleeding is associated with sleep duration, sleep quality and fatigue in a community sample

Multidimensional outcomes associated with chronic fatigue over 12 months in youth with emerging mood disorders

BACKGROUND

Complaints of chronic fatigue lasting weeks or longer are common during adolescence. Little is known about factors associated with chronic fatigue in youth with mood disorders or potential sex-specific associations.

METHODS

496 young people (mean age = 18.36-years, SD = 3.22; 69 % female) seeking help for mental healthcare were assessed on psychological symptoms, lifestyle, and sleep at baseline and 12-months later. Fatigue was defined as a score of ≥3 on the somatic subscale of the Somatic and Psychological Health Report. Logistic regression models were used to examine associations between clinical, lifestyle, and related factors and chronic fatigue caseness, including main effects and sex interactions.

RESULTS

Half (52 % [N = 260]) of the sample reported fatigue at both baseline and 12-month follow-up ("chronic fatigue"). Univariately, chronic fatigue cases were more commonly at later clinical stages of mental disorder and had worse mental health, sleep disturbance, and disability at baseline and follow-up. In covariate-adjusted analyses, being a chronic fatigue case was associated with persistently elevated anxiety and, at 12-month follow-up, more disability, weight gain, and shorter sleep duration. In sex-interaction analyses, chronic fatigue in females was associated with longer sleep latency at follow-up (OR = 1.97), but not in males.

CONCLUSION

Chronic fatigue was common and associated with poorer mental health and functioning longitudinally. While there were no sex differences in the rates of chronic fatigue, there were some sex differences in the factors associated with it. Systematic screening and early intervention for chronic fatigue, considering sex-specific factors, may improve multidimensional outcomes in youth with emerging mood disorders.

Mental illness and sleep disorders among women with gynecological problems

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.

Menstrual Cycle Variations in Wearable-Detected Finger Temperature and Heart Rate, But Not in Sleep Metrics, in Young and Midlife Individuals

Most studies about the menstrual cycle are laboratory-based, in small samples, with infrequent sampling, and limited to young individuals. Here, we use wearable and diary-based data to investigate menstrual phase and age effects on finger temperature, sleep, heart rate (HR), physical activity, physical symptoms, and mood. A total of 116 healthy females, without menstrual disorders, were enrolled: 67 young (18-35 years, reproductive stage) and 53 midlife (42-55 years, late reproductive to menopause transition). Over one menstrual cycle, participants wore Oura ring Gen2 to detect finger temperature, HR, heart rate variability (root mean square of successive differences between normal heartbeats [RMSSD]), steps, and sleep. They used luteinizing hormone (LH) kits and daily rated sleep, mood, and physical symptoms. A cosinor rhythm analysis was applied to detect menstrual oscillations in temperature. The effect of menstrual cycle phase and group on all other variables was assessed using hierarchical linear models. Finger temperature followed an oscillatory trend indicative of ovulatory cycles in 96 participants. In the midlife group, the temperature rhythm's mesor was higher, but period, amplitude, and number of days between menses and acrophase were similar in both groups. In those with oscillatory temperatures, HR was lowest during menses in both groups. In the young group only, RMSSD was lower in the late-luteal phase than during menses. Overall, RMSSD was lower, and number of daily steps was higher, in the midlife group. No significant menstrual cycle changes were detected in wearable-derived or self-reported measures of sleep efficiency, duration, wake-after-sleep onset, sleep onset latency, or sleep quality. Mood positivity was higher around ovulation, and physical symptoms manifested during menses. Temperature and HR changed across the menstrual cycle; however, sleep measures remained stable in these healthy young and midlife individuals. Further work should investigate over longer periods whether individual- or cluster-specific sleep changes exist, and if a buffering mechanism protects sleep from physiological changes across the menstrual cycle.

Insomnia Symptoms and Menstrual Health: Is There a Link in Women During Reproductive Phase of Life?

OBJECTIVES

To investigate the association between insomnia severity symptoms and menstrual health, fatigue and anxiety symptoms in women at reproductive age.

METHOD

We used data from EPISONO (2007), an epidemiological study from the city of São Paulo, Brazil. Women completed the Insomnia Severity Index (ISI), the Chalder Fatigue Scale (CFS), and the Beck Anxiety Inventory (BAI) to obtain information about insomnia, fatigue, and anxiety symptoms. For menstrual health, we collected information using our Institutional Women's Questionnaire about menstrual flow and duration, the presence of pain during menstruation and menstrual cycle regularity. The statistical analysis was performed using ordinal logistic regression, considering p < .05.

RESULTS

Of the 1,042 participants, only 282 women met the inclusion criteria to participate in this study. The mean age was 34.4 years (SD ± 8.36), and the body mass index (BMI) was 25.7 (SD ± 5.39). According to the model, a 1-unit higher CFS score increased the odds of having more insomnia symptoms in the ISI (OR = 1.170; 95% CI=[1.073; 1.279]; p < .001). In the same way, a 1-unit higher BAI score increased the chance of presenting insomnia symptoms, according to the ISI (OR = 1.072; 95% CI=[1.042; 1.104]; p < .001). The menstrual variables did not represent statistical significance in the model.

CONCLUSIONS

Fatigue and anxiety symptoms were associated with insomnia symptoms; however, no association was observed between menstrual health and insomnia. The need to examine sleep when there are sleep complaints is essential to provide an accurate diagnosis that facilitates appropriate treatment and to provide better sleep quality for women.

Burden of irregular menstrual cycle and its predictors among reproductive-age women in Ethiopia: Systematic review and meta-analysis

Introduction

Irregular menstrual cycle has negative health and psychosocial repercussions for women of reproductive age worldwide. However, there is no national data for policymakers and health planners in Ethiopia. Therefore, this review aimed to determine the overall burden of irregular menstrual cycle and predictors among reproductive-age women in Ethiopia.

Methods

International databases (SCOPUS, CINAHL, CAB Abstract, EMBASE, PubMed, Web of Science, Google, and Google Scholar) and lists of references were employed to search literature in Ethiopia. The random-effects model was used to calculate the odds ratios of the outcome variable using STATA version 18. The heterogeneity of the studies was measured by computing I 2 and p-values. In addition, sensitivity analysis and funnel plots were performed to test the stability of pooled data in the presence of outliers and publication bias.

Results

The review includes 21 studies and 9109 populations. The overall burden of irregular menstrual cycles among reproductive-age women was 35% (95% CI: 30-41) with I 2 = 96.96%. Sleeping for <5 h a day (AOR: 2.49; 95% CI: 1.49-3.49) and a stressful life (AOR: 3.15; 95% CI: 1.44-4.85) were predictors of irregular menstrual cycles.

Conclusion

More than one in every three reproductive-age women in Ethiopia experience irregular menstrual cycles. Sleeping for <5 h a day and stress increase the likelihood of an irregular menstrual cycle, which can be modified by improving sleeping hours and decreasing stress stimulators through psychotherapy.

Factors influencing menstrual regularity among female workers: a cross-sectional analysis study

BACKGROUND

Regularity of menstrual cycles is an important indicator of women's health and fertility, and female workers are exposed to several factors, such as sleep disorders, stress, and shift work, that affect their menstrual regularity. This makes it necessary to comprehensively identify the determinants of menstrual regularity. Therefore, this study identified the factors affecting menstrual regularity among female workers from physiological, psychological, and situational dimensions based on the theory of unpleasant symptoms.

METHODS

This was a secondary analysis of the 2010-2012 Korea National Health and Nutrition Examination Survey and utilized the data of 2418 female workers. Based on the theory of unpleasant symptoms, physiological factors included age, age at menarche, childbirth experience, body mass index, and sleep duration. Psychological factors included stress level, depressive mood, and suicidal ideation. Situational factors included education level, household income, consumption of alcohol, engagement in smoking, and work schedule. The χ²-test and hierarchical logistic regression analysis were performed, reflecting the complex sample design.

RESULTS

Age at menarche, childbirth experience, and body mass index among physiological factors and education level and work schedule among situational factors were found to be related to menstrual regularity. A higher risk of menstrual irregularities was found among those who had given birth (versus those who had not), had a high age at menarche (versus those with a low age at menarche), were obese (versus those who had a normal body mass index), had elementary school-level or lesser educational achievements (versus those with college graduate-level or higher educational achievements), and who had a shift work schedule (versus those with a fixed schedule).

CONCLUSIONS

Intervention is needed for female workers who have these risk factors, and special attention must be paid to female workers who have a shift work schedule. Additionally, since body mass index can be controlled, intervention concerning body mass index is necessary to reduce menstrual irregularity.

Influence of chronotype on sleep quality and menstrual regularity in nurses on monthly shift rotations

OBJECTIVES

This study aimed to investigate factors that influence the sleep quality and menstrual cycles of female rotating-shift nurses.

METHODS

A cross-sectional study was conducted in which 213 female rotating-shift nurses between the ages of 20 and 45 were recruited from a medical center in Taiwan from November 1, 2023, to December 31, 2023. Binary logistic regression analysis was performed with regard to sleep quality or menstrual cycle.

RESULTS

Female rotating-shift nurses who perceived a higher level of stress (P < .001), were late chronotypes (P = .020), or were working the night shift (P = .006) were more likely to have poor sleep quality. Late-type nurses working the day shift were more likely to have poor sleep quality than were early- and intermediate-type nurses (P < .001). With regard to menstrual cycles, female rotating-shift nurses who perceived a higher level of stress (P = .008), were working the night shift (P < .001), or had poor sleep quality (P = .001) were more likely to have irregular menstrual cycles. Late-type nurses working the day shift were more likely to have irregular menstrual cycles than were early- and intermediate-type nurses (P = .013).

CONCLUSIONS

A higher likelihood of poor sleep quality was found in female rotating-shift nurses when they perceived high levels of stress, and the interactions between chronotype and shift type could influence sleep quality. Shift type and the interactions between chronotype and shift type could also influence menstrual regularity.

The Menstrual Cycle and Sleep

Aspects of sleep change across the menstrual cycle in some women. Poorer sleep quality in the premenstrual phase and menstruation is common in women with premenstrual symptoms or painful menstrual cramps. Although objective sleep continuity remains unchanged across the regular, asymptomatic menstrual cycle, activity in the sleep electroencephalogram varies, with a prominent increase in sleep spindle activity in the postovulatory luteal phase, when progesterone is present, relative to the follicular phase. Menstrual cycle phase, reproductive stage, and menstrual-related disorders should be considered when assessing women's sleep complaints.

The Relationship Between Mood and Sleep in Different Female Reproductive States

Mood and sleep are tightly interrelated. Mood and sleep symptoms and disorders are more common in women than in men and often associated with reproductive events. This article reviews the current literature on the reciprocal relationships between mood and sleep across reproductive phases in women, such as menstrual cycle and related disorders, pregnancy, climacteric, and use of hormonal contraception and hormone replacement therapy. Mood and sleep symptoms seem to covary in relation to physiologic and pathologic reproductive conditions, although the relationship seems more clear for subjective than objective sleep.

Menstrual disturbances and its association with sleep disturbances: a systematic review

BACKGROUND

Menstrual disturbances harm women's health, and general well-being. As growing evidence highlights the relationship between sleep and menstrual disturbances, it is imperative to comprehensively examine the association between sleep and menstrual disturbance considering the multiple dimensions of sleep. This systematic review aims to identify the association between sleep and menstrual disturbances by evaluating using Buysse's sleep health framework.

METHODS

A comprehensive search of the literature was conducted in PubMed, EMBASE, psychINFO, and CINAHL to identify publications describing any types of menstrual disturbances, and their associations with sleep published between January 1, 1988 to June 2, 2022. Quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The findings were iteratively evaluated menstrual disturbances and their association with sleep using Buysse's sleep health framework. This framework understands sleep as multidimensional concept and provides a holistic framing of sleep including Satisfaction, Alertness during waking hours, Timing of sleep, Efficiency, and Sleep duration. Menstrual disturbances were grouped into three categories: premenstrual syndrome, dysmenorrhea, and abnormal menstrual cycle/heavy bleeding during periods.

RESULTS

Thirty-five studies were reviewed to examine the association between sleep and menstrual disturbances. Premenstrual syndrome and dysmenorrhea were associated with sleep disturbances in sleep health domains of Satisfaction (e.g., poor sleep quality), Alertness during waking hours (e.g., daytime sleepiness), Efficiency (e.g., difficulty initiating/maintaining sleep), and Duration (e.g., short sleep duration). Abnormal menstrual cycle and heavy bleeding during the period were related to Satisfaction, Efficiency, and Duration. There were no studies which investigated the timing of sleep.

CONCLUSIONS/IMPLICATIONS

Sleep disturbances within most dimensions of the sleep health framework negatively impact on menstrual disturbances. Future research should longitudinally examine the effects of sleep disturbances in all dimensions of sleep health with the additional objective sleep measure on menstrual disturbances. This review gives insight in that it can be recommended to provide interventions for improving sleep disturbances in women with menstrual disturbance.

Influence of lifestyle factors with the outcome of menstrual disorders among adolescents and young women in West Bengal, India

Menstruation is a natural phenomenon for every female, starting from adolescents to menopausal age. Any disturbances in menstrual patterns can eventually affect one's physical as well as psychological health which in turn hamper the quality of life of women. Several factors including genetic predisposition as well as lifestyle modifications adversely affect normal menstrual patterns. Hence, this study aims to evaluate the prevalence of menstrual disorders among adolescents and young women as well as the associated risk factors. A cross-sectional random survey was conducted from January 2020 to January 2022 in various schools and colleges. A structured questionnaire was prepared which include anthropometric details, demographic information, and lifestyle patterns. The data were extracted for further statistical analysis. In the overall study population, the prevalence of PCOS, Dysmenorrhea, Menorrhagia, Polymenorrhea, Hypomenorrhea and the irregular menstrual cycle was found at 14.14%, 15.14%, 6.29%, 3.70%, 5.16% and 44.83% respectively. The mean BMI of the study population was 19.949 ± 4.801 kg/m² and the mean WHr was 0.872 ± 0.101, indicating a moderate to high risk of metabolic disorder among the study population. Increased BMI, short sleep, and sedentary and vigorous physical activity can contribute to the risk of developing menstrual disorders. Unhealthy food habits are a major risk factor for menstrual disorders. Lifestyle modifications like healthy food habits, sleeping patterns, physical activity, etc. can effectively reduce the risk of menstrual disorders and also cut down the severity of more complex health problems. In-depth biochemical and molecular analysis is required to identify specific biomarkers.

Sleep Characteristics According to Gender and Age Measured by Wrist Actigraphy

The sleep/wake rhythm is one of the most important biological rhythms. Quality and duration of sleep change during lifetime. The aim of our study was to determine differences in sleep efficiency, movement, and fragmentation during sleep period between genders and according to age. Sleep period was monitored by wrist actigraphy under home-based conditions. Seventy-four healthy participants-47 women and 27 men participated in the study. The participants were divided by age into groups younger than 40 years and 40 years and older. Women showed lower sleep fragmentation and mobility during sleep compared to men. Younger women showed a higher actual sleep and sleep efficiency compared to older women and younger men. Younger men compared to older men had a significantly lower actual sleep, lower sleep efficiency and significantly more sleep and wake bouts. Our results confirmed differences in sleep parameters between genders and according to age. The best sleep quality was detected in young women, but gender differences were not apparent in elderly participants, suggesting the impact of sex hormones on sleep.