The email arrived over the weekend. The lady works north of Perth in the mines. “I’m really concerned about my sleep” she mentioned. “I work shifts in the mines and shift work is wrecking havoc on my sleep patterns. My hot flushes seem worse, so I’m already dreading summer when it arrives.”
Hormones play a major role in regulating our behaviour and our physiology, so many of us don’t think about the fact that their effectiveness is dependent on time-based circadian patterns of production and secretion.
With New Zealand and parts of Australia moving into daylight savings and with those of you in the Northern Hemisphere moving out of daylight savings, then it’s time to think about the remarkable relationship between our circadian rhythm and our menopause symptoms.
Many of us have also sought medical support for our symptoms in menopause, which is an appropriate action, but I wonder if the role of your circadian rhythm on your hormones even got a mention? Judging by the thousands of women who have joined me over the years on the MyMT™ programmes, and my own experience, I assume not. That’s why, in this article, I wanted to draw your attention to the powerful relationship between your circadian rhythm and menopause symptoms.
For women transitioning menopause who already suffer from insomnia, adjusting to the clock shifts with either shift work or daylight savings can be a tough gig. Simply because many women already have disrupted sleep patterns causing the chronic stress hormone, cortisol to be out of its normal daily pattern as well.
Adjustments to the clock with daylight savings or if daylight savings has ended, or with shift work can disrupt sleep hormones and cortisol further.
If this is you and you are experiencing hot flushes or waves of heat on awakening, which have got worse with seasonal changes to time-clocks, then this is because your cortisol (a chronic stress hormone) may be higher throughout the night, causing higher blood pressure throughout the night (non-dipping) and first thing in the morning. This phenomenon is known as your cortisol-awakening response.
What is Overnight non-dipping Blood Pressure?
First described in 1988, the night time dip has become an accepted measure of cardiovascular risk. The ‘dip’ is defined as the difference between the mean systolic pressure in the day and mean systolic pressure during the night.
Over the years, research has shown that poor sleep quality, sleep curtailment, and sleep disorders (e.g., sleep apnea) are linked with BP ‘non-dipping’ overnight and a surge in blood pressure in the morning – if you are getting extreme hot flushes in the morning when you wake up, then you might want to talk to your Doctor about getting your blood pressure checked.
It’s also why I encourage women to consider their blood pressure management if they want to sleep all night. Even if women are on menopause HRT, this is an important consideration in their approach to lifestyle changes during and after menopause.
In humans, almost all behavioral and physiological functions occur on a rhythmic basis. This is known as our circadian rhythm and for those of you who have been following my newsletters for a while, you will have heard me talk about this daily rhythm before. This is because this daily circadian rhythm is driven by hormones and with our reproductive hormones changing in peri-menopause and menopause, this circadian rhythm gets out of balance, thereby influencing our symptom chaos.
The term ‘Circadian’ means “about a day” so our circadian rhythms are daily fluctuations in our biology that can become messed up as we transition through menopause.
This internal clock, which gradually becomes established during the first months of life, controls the daily ups and downs of biological patterns, including body temperature, blood pressure, and the release of hormones that help our body to stay in balance.
Given that nearly all hormones (including reproductive hormones) play a key role in the cross-talk between different systems in the body, when the circadian rhythm gets out of balance (as in both menopause and daylight savings adjustments) the rhythmic release of these hormones changes too.
Scientists now know that this altered pattern of hormonal release may contribute to the pathophysiology of a wide range of human disorders, especially during ageing. [Urbanski, 2011]. These disorders include high blood pressure and altered cardiovascular effects, altered immune function, altered behaviour associated with seasonal affective disorders such as eating disorders and mental health disorders.
For shift workers, such as my mine-worker in Australia who emailed me this week, not only are menopause hormonal changes challenging enough for sleep disruption, but so too is the added effect of shift work and a change to daylight savings. As you can see from the image below, not only is blood pressure affected (which causes worsening hot flushes), but so too is the function of numerous organs.
It’s so important to turn around our sleep habits specific to our menopause transition. That’s why, the very first module that women listen to when they come onto either of the MyMT™ programmes is how to sleep all night again. If we aren’t sleeping, our hot flushes and night sweats become worse. So too does our weight, joint health and muscle pain.
Getting deep, restorative sleep (between 2-4am), is important to reduce our night sweats as well. When we sleep more deeply, blood flow is directed less toward your brain, which cools measurably. Your temperature regulation mechanisms are situated in your brain too.
But the main thing about our deep sleep is that during this time of the night, the pituitary gland releases a pulse of growth hormone that stimulates tissue growth and muscle repair. That’s why, when we are lying awake between 2 and 4am, this release of growth hormone does not reach the threshold it needs to for healing and repairing our body, including healing our gut overnight.
This is also why I hear from so many women who are avid exercisers and they don’t understand that their sore muscles and joints are due to not just declining oestrogen, but also to not sleeping!
When reproductive hormones change during a woman’s menopause transition, this causes disruption to the normal circadian rhythms. Which is why, as we transition into or through menopause, it’s really important to restore this biological rhythm and make lifestyle adjustments to restore sleep, especially when daylight savings arrives!
Doing this helps to reduce overnight blood pressure as well as cortisol and insulin levels. As such, sleeping all night is the start. If we don’t, then over time, our brain and body start to read this 2-3am ‘awake’ period as ‘normal’. When women restore their sleep, they restore their energy levels, their joints heal and their hot flushes and night sweats reduce too.
If women are overweight, then turning around sleep is equally important. This is because fat cells and the role of lipase, an enzyme which breaks down fat and releases it from fat cells, functions on a 24 hr circadian cycle.
Scientists who research lipid (fat) disorders, know that circadian clock disruption, causes disruption of the metabolism and transport of fats and proteins, and this disruption may be responsible for the development of a large spectrum of health problems, ranging from cardiovascular diseases, to metabolic syndrome, even to cancer development. [Gnocchi, Pedrelli et al., 2015]
As I often mention in my seminars, (UK and IRELAND live seminar dates are here), when we’ve been waking up night after night, then our brain and body reads this as our ‘new normal’. But this is what leads us down the path towards the build-up of inflammation in our cells and tissues.
Not sleeping is now recognised as one of the main contributing factors to changing health as we move into our post-menopause years and for women going into post-menopause, the concern is the trajectory towards heart disease that may ensue.
The United Kingdom, Australia and New Zealand have some of the highest incidence of post-menopause heart disease globally. America is up there too. But here’s the thing – if we aren’t sleeping, our heart and immune system stay under stress all day long, particularly, when we are regular exercisers or we have busy, stressful jobs or home environments. This causes more inflammation in cells and tissues and in ageing research, is known as oxidative stress or ‘inflammaging‘.
It’s why one of the main dietary changes that we can make, no matter where we live in the world, is to move towards a more Mediterranean Style dietary approach.
Ageing is typically associated with impairments of the circadian rhythm and a natural decrease in melatonin (sleep hormone) secretion. Menopause is the natural transition into our ageing, and whilst many of us still feel young as we enter this phase of our life, inside our body there are powerful inflammatory changes occurring, especially if women aren’t sleeping well.
Understanding how to slow these changes down using evidenced lifestyle strategies is important. When we do, we can resolve our symptoms, lose weight, improve mood and feel fabulous in our fifties all without diving into worsening health in post-menopause!
Many women go on menopause HRT and/or anti-depressants, which helps them enormously (and I don’t interfere in any medications women are on, because this is between you and your Doctor), but I am passionate about women also understanding the lifestyle-science solutions that can be easily put into place too.
I help you achieve this, through my two different programmes:
Both of these world-class 12 week programmes are done in your own time and you access them through your private learning hub. The very first module waiting for you is simply called ‘Sleep All Night’. I hope one day, you can join me.
Davis, S., Castelo-Branco, C. et.al. (2012). Understanding weight gain at menopause. Climacteric, 15: 419–429.
Harvard Health Report (2017). Improving Sleep. Harvard Health Publication
Geddes, L. (2019). Chasing the Sun: The new science of sunlight and how it shapes our bodies and minds. London: Profile Books.
Gnocchi D, Pedrelli M, Hurt-Camejo E, Parini P. Lipids around the Clock: Focus on Circadian Rhythms and Lipid Metabolism. Biology (Basel). 2015 Feb 5;4(1):104-32.
Jehan, S., Giardin, J-L, Auguste, E., et al (2017). Sleep, Melatonin and the Menopausal Transition: What are the links? Sleep Science, 10(1): 11-18.
Reinke H. & Asher G. (2017). Circadian clock control of liver metabolic functions. Gastroenterology, 150: 574–580.
Rizzi, M. et al. (2016). Sleep Disorders in Fibromyalgia Syndrome. Journal of Pain Relief, 5:2, 1-5
Sharma, S. & Kavuru, M. (2010). Sleep and Metabolism: An Overview. Int. Journal of Endocrinology, Article ID 270832, 1-12.
Urbanski HF. Role of circadian neuroendocrine rhythms in the control of behavior and physiology. Neuroendocrinology. 2011;93(4):211-22. doi: 10.1159/000327399.
Woods, N. et al. (2009). Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study. Menopause, 16(4): 708–718.