Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women

Background: Sleep quality typically decreases after menopause, but the underlying mechanisms are poorly understood. Concentrations of melatonin are lower and its secretion profiles different before and after menopause. However, whether and how melatonin and sleep architecture are associated in women of different reproductive states have not been examined to date.Methods: Overnight serum melatonin samples were taken from 17 perimenopausal and 18 postmenopausal healthy women. Sleep quality was measured with all-night polysomnography recordings.Results: Melatonin concentrations tended to be the lowest during NREM sleep, and were associated with higher odds of transitions from wake to NREM sleep. The curves of predicted overnight melatonin values from linear mixed models varied according to sleep phases (NREM, REM, Wake) in perimenopausal, but not in postmenopausal women. In perimenopause higher melatonin area under curve (AUC) correlated with higher slow-wave activity (p = 0.043), and higher minimum concentrations with shorter slow-wave sleep (SWS) latency (p = 0.029). In postmenopause higher mean and maximum melatonin concentrations and AUC correlated with lower SWS percentage (p = 0.044, p = 0.029, p = 0.032), and higher mean (p = 0.032), maximum (p = 0.032) and minimum (p = 0.037) concentrations with more awakenings from REM sleep. In the age- and BMI- adjusted regression models, the association between higher maximum (p = 0.046) melatonin concentration and lower SWS percentage remained.Conclusions: The relationship between melatonin and sleep architecture differed in perimenopausal and postmenopausal women. After menopause, high melatonin concentrations were associated with worse sleep. Whether these different patterns are related to aging of the reproductive system, and to decrease in menopausal sleep quality, remains to be elucidated.</p

Faktorer som påverkar sexuellt välbefinnande: en fem års uppföljningsstudie av en randomiserad klinisk prövning om preventivmedel efter abort

Introduction Sexual well-being is associated with general well-being. Several factors, such as overweight, infertility, anxiety, and sex hormones, also play a role, but the effects of hormonal contraception remains a point of debate. We characterized the factors associated with sexual well-being in fertile-aged women following induced abortion. Methods A 5-year follow-up of a nested longitudinal cohort study examining the effects of routine provision of intrauterine contraception as part of abortion care. Sexual well-being, anxiety, and quality of life were assessed annually using validated questionnaires (McCoy Female Sexuality Questionnaire, State-Trait Anxiety Inventory and EuroQoL), along with data on general and reproductive health, and relationship status. Of the 742 women participating in the trial, 290 (39%) provided sufficient follow-up data and were included in this study. Results Based on trajectories of McCoy-scores across the 5-year follow up, two groups were identified: those with stable and higher (n=223, 76.9%) and those with declining sexual well-being (n=67, 23.1%). Women in the group of declining sexual well-being had significantly higher levels of anxiety and lower quality of life at all time points. They also had more often chronic diseases and were less happy in their relationships. No differences were found in method of contraception when classified as hormonal vs non- hormonal, or long-acting vs short-acting reversible contraception. Conclusions Lower anxiety and higher quality of life are associated with stable and higher sexual well- being. Method of contraception or relationship status are not associated with sexual well-being during long-term follow-up in fertile aged women.Introduktion Sexuellt välbefinnande är nära associerat med generellt välbefinnande. Flera olika faktorer som övervikt, infertilitet och könshormoner påverkar sexuella välbefinnandet, medan effekten av hormonella preventivmedel fortfarande är debatterad. Vi har undersökt faktorer som är associerade med sexuellt välbefinnande hos fertila kvinnor som genomgått framkallad abort. Metoder Det här är en modifierad longitudinell kohortstudie baserat på en randomiserad klinisk prövning med en uppföljning på fem år. Ursprungligen är studien utformad för att undersöka effekten av rutinmässig provision av intrauterint preventivmedel som en del av vården efter abort. Sexuellt välbefinnande, ångest och livskvalitet bedömdes med validerade frågeformulär (McCoy Female Sexuality Questionnaire, State-Trait Anxiety Inventory och EuroQoL), utöver de här hade vi data på generell och reproduktiv hälsa och relationsstatus. Av de sammanlagt 742 kvinnor som deltog i den ursprungliga studien inkluderades 290 kvinnor som försåg tillräcklig uppföljningsdata i denna modifierade studie. Resultat Baserat på trajektoria av McCoy-talet under fem års uppföljningstiden kunde två grupper identifieras: en med mer stabilt och högre sexuellt välbefinnande (n=223, 76.9%), och en med sjunkande sexuellt välbefinnande (n=67, 23.1%). Kvinnor i gruppen med sjunkande sexuellt välbefinnande hade högre nivå av ångest och lägre nivå av livskvalitet genom hela uppföljningstiden. De hade även mer kroniska sjukdomar och var mindre lyckliga i sitt förhållande. Vi kunde inte se någon skillnad gällande metod av preventivmedel mellan de två grupperna när vi klassificerade metoden som hormonell versus icke-hormonell och långverkande versus kortverkande reversibelt preventivmedel. Slutsatser Lägre nivå av ångest och högre livskvalitet är associerat med mer stabilt och högre sexuellt välbefinnande. Metod av preventivmedel eller relationsstatus är inte associerat med sexuellt välbefinnande på långt skikt bland kvinnor i fertil ålder