Is PMS Disrupting Your Sleep? | FAMM Research Series | Ep. 584

Episode 584

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Friday Podcast, episode number 584.
In today’s episode, we are looking at the potential connection between sleep
disturbances and the menstrual cycle. More specifically, the likelihood of increased
sleep disturbances when you are approaching your period or around menstruation.
So we are delving into a study that looked at just that. They measured sleep
patterns across the menstrual cycle and they came to some interesting conclusions. As
usual, we are going to talk about some of the strengths and the implications of the
study as well as some of the potential drawbacks. And of course, I’ll be looking at
how they determined the different phases of the menstrual cycle and how they drew
their conclusions about it. So without further ado, let’s go ahead and jump into
today’s newest FAM research series episode.
So the paper that we are diving into today is called The Interaction of Sleep and
Emotion Across the Menstrual Cycle. And, of course, it’s always fantastic when we’re
seeing this type of research being done. This is actually a newer study that was
recently released in the Journal of Sleep Research. And of course, the researchers
are trying to see if there is a pattern of disrupted sleep across the menstrual
cycle. And one of the reasons why this is a topic of interest, I mean, the
researchers talked through a few different reasons why they were interested to study
this. One is that women do tend to experience disrupted sleep more commonly than
men. They certainly have a higher instance of insomnia and that is thought to be
related to the sex differences between men and women and so they’re looking at that
for that perspective and they’re also trying to determine if there is a relationship
between how these sleep disruptions are happening and the menstrual cycle itself. So
that’s a little bit of background, and essentially what they did, the way that they
designed this study, is that they had women, of course, they didn’t have them track
and chart their menstrual cycles, but they determined what phase of the menstrual
cycle they were in based on their self -reporting of when their periods happened, so
when the onset of menstrual bleeding took place, and they also had the women test
their LH levels. And this is very standard. This is typically how ovulation is
identified in research. Of course, I’ve spoken about this many times. And I think
that part of the reason they do this as well is just due to budgetary limitations
when you’re dealing with the logistics of setting up a study. I think that they’re
looking for the ways that they can test these things that are the least invasive
and least time -consuming especially to get people to participate. So I do think
there are some reasons why they do it this way. So I mean, the good thing is that
they actually have these markers. So they are able to identify the period of time
that they were looking at. So they were specifically looking at the kind of three
-day period leading up to your period plus the first three days of menstruation. So
they were looking at that specific phase to see if there were cycle disruptions
related to the menstrual cycle there. And in terms of confirming ovulation,
looking at luteal phase length, although they discussed the potential role of hormonal
fluctuations, the potential role of estrogen and progesterone in sleep disruptions,
they didn’t specifically measure those hormone levels. So we’ll get into a little bit
more of the potential implications there. That’s how they were identifying where these
women were in their cycle. And then to identify if there were any sleep disruptions,
they tracked that into specific ways, which I think was really interesting. So they
had the women wear a wrist device that was measuring their sleep. And so this is a
validated way to kind of measure the different stages of sleep. And so I But that
was interesting that they did that in a very specific way. And then they also had
the women note down in their diary, like so they had them keep a journal of their
self -reported sleep disturbances. So that was interesting as well to compare their
subjective experience of their sleep experience to the actual data that was kind of
given by this risk device that was attached to an app. So I think that that’s
really interesting. and they didn’t measure a ton of other details. They measured
mood, so they were looking at different emotional fluctuations as well, but that was
kind of their main measure. So what did they find? What were the findings of their
study? So as I mentioned, they did measure the sleep in two different ways,
and so during that perimenstrual phase, so the three days leading up to the
menstrual period plus the first three days of the period. The self -reported data, so
the women wrote in their diaries, significantly increased disrupted sleep.
And they measured this by a measure they called total wake time. So they’re looking
at their wake during the middle of the night or what’s going on. And so the women
self -reported about eight to 16 minutes a wake time during that specific phase of
the cycle overall. And interestingly, when they looked at the risk data only,
so the more objective measure of it, they found that the total wake time was also
significantly higher, but it was four to seven minutes. So that is really interesting
finding, and the researchers commented on that when they’re experiencing it to be
basically double twice or even more, the women are experiencing and self -reporting
double the actual time that they were awake based on the objective measure of the
wrist tracking device. So I thought that that was really interesting. And when they
looked at mood, there were significant mood changes around that time as well. And
positive mood dropped when the total wake time increased. So when the women’s sleep
was more disrupted, that affected their mood. And one of the things that they said
was kind of the most significant mood change that they found was that women were
kind of reporting higher levels of anger and frustration and irritability around that
time. So that is really interesting. And I think that the researchers looked at
that, they found this correlation, and then their question is, well, how significant
is it? What does it mean that there is this difference between how they experienced
it and what the kind of more objective data showed? And they also talked a little
bit about, in general, there is an increased correlation of even other emotional or
psychological issues when women are experiencing insomnia or disrupted sleep.
Those other conditions worsen as well, so they do know that this can be a really
significant challenge. I feel that these results aren’t necessarily surprising. I think
that we know that there’s a variety of different things that can change around that
phase of the cycle. One comment that I want to make,
well, several, but one of the interesting observations that I’ve made when looking at
PMS research is I do feel that assumptions are made about why these things are
happening or assumptions in general. Of course, I do feel that they’re not
necessarily looking deep enough into this issue to draw meaningful conclusions. Let me
explain what I mean by that. When looking at the research, and this is about, I
would say this carries over into hormone research in general, Estrogen tends to be
the focus. When this is something that Dr. Gerilyn Pryor has pointed out,
I’ve interviewed her a few times on the show, and Dr. Pryor has been studying and
increasing the research literature and curiosity around progesterone for decades because
the research often tends to be estrogen -focused. They’ll look at the correlation
between estrogen and bone density or estrogen and a variety of different things, but
they’re not necessarily focused on progesterone so much. So in this, there was a
couple of things that the researchers said in here that I thought were really
interesting. And this is based on research, but again, I just don’t know if this is
a true conclusion that can be made. So I’m just gonna look for these couple of
quotes that I found here. So One thing that I thought was a really interesting
statement, and again, like where is this coming from? So they said increased
progesterone is thought to initiate a rise in core body temperature disrupting sleep,
which I think even just that is interesting because they’re saying it’s thought to.
It does. You can measure it. You can just take the BBT, right? So anyways, so
that’s what they say. And they say progesterone is associated with nearly one degree
Fahrenheit increase in core body temperature, which may contribute to sleep
fragmentation. So this is what I was in university and went into my statistics
classes, the university level statistics classes. One of the things that they would
say over and over again is correlation doesn’t equal causation. And so what that
means is when you see two parameters that are associated with each other, you can’t
just automatically assume that one causes the other. And this to me is just bizarre
that they’re saying that, “Okay, so because progesterone increases in the luteal
phase, that’s the reason why the sleep is disrupted.” What? And especially when
you’re looking at issues around the kind of premenstrual syndrome conversation, again,
if that was true, then if we looked at the luteal phase, so for anyone who is a
little bit new to this, the first day of your cycle would be the first day of
your menstrual period, and then once you move into that premenstrual phase, that is
characterized by follicular development. That’s why we’re often calling that
preovulatory phase the follicular phase. And as the ovarian follicles are developing,
they’re producing significant estrogen. So the estrogen would be highest several days
prior to ovulation because ultimately that peak in estrogen levels is what triggers
the LH surge, the surge of luteinizing hormone that ultimately triggers ovulation.
So we have estrogen reaching its peak shortly before ovulation, and then estrogen
dips a bit, but estrogen is still fairly strong in the post -ovulatory phase. After
ovulation is the only time we’re making significant progesterone, and in a healthy
cycle, your luteal phase, so the second half, the post -ovulatory phase of the cycle
would be anywhere from 12 to 14 days long, typically in a healthy cycle. And when
we’re looking at the rise and fall of progesterone in a healthy cycle, you would
actually have a significant rise in progesterone that would peak mid -ludial. So
around seven days after ovulation, the progesterone would be highest. So to kind of
call this interesting conclusion that we’re just throwing two pieces of data that are
correlated together and saying one causes the other, if the progesterone was directly
responsible for the sleep disruptions, we would expect then the majority of the sleep
disruptions to be in the mid -ludial part, right? We would expect that to happen in
the middle of the luteal phase when progesterone is highest if it has such a
destabilizing effect. But interestingly with PMS, what we see is that it’s during
that week leading up to the menstrual period when we’re seeing, whether it’s classic
symptoms of PMS, increased depression, anxiety, or we’re seeing carbohydrate cravings
or bloating or a variety of different, some of those different factors, we tend to
see those increased during the days leading up to the period. And that would be
when progesterone is dropping, right? Not when it’s the highest. So I would kind of
add to that conversation and say that without a solid understanding of the menstrual
cycle, we’re coming to these conclusions that don’t even necessarily make sense when
we look at what’s happening from a biological and physiological perspective. So if,
as what they’re saying is, progesterone is associated with this increase in
temperature, and so therefore, because the temperature is higher, it’s also causing
sleep disruptions. What? If that was the case, then like I said, we would expect
those sleep disruptions to be more consistently mid -ludial when the progesterone’s
highest, that’s not what we see. So based on the research, and if you’re tracking
women’s menstrual cycles, one of the key things I feel like is missing from these
discussions around PMS is that every single woman doesn’t experience PMS in the same
way. There are some women that experience moderate to severe PMS. There’s some women
who sometimes are so severe that they border on PMDD or enter straight into PMDD
territory, premenstrual disorder. And in that situation, that is a really exacerbated
version of PMS that results in a significant disruption to your day -to -day life.
So these are women who are finding it difficult to actually participate in life, to
go to work for several days every cycle, related to their intense PMS symptoms.
Whereas other women have very mild symptoms, if any at all, that don’t affect their
daily life whatsoever. So one of the things I find interesting about PMS research is
that it’s almost assumed that this is just a woman thing, and we’re not looking at
what are the differences between women who had these symptoms and women who do not.
And then even if they test those types of scenarios, they’re often not testing
hormone levels levels either at all, as in this study. They didn’t look at
progesterone and estrogen levels. They didn’t track to see if there were differences
between women. They were just looking for general trends of sleep disruptions and
making those correlations, which is fine. It still gives us some information, but I
would obviously want to take this deeper and I would want to know, okay, so based
on all the women in the study, how severely were these issues? Were there women
that had little sleep disruption where there were women that had a lot of sleep
disruption and what were the differences in hormone levels, what were the differences
in luteal phase menstrual cycle like other PMS symptoms across the menstrual cycle
and between these women, depending on the severity of the sleep disruption, because
then we can actually have a meaningful conversation of what is potentially driving
it. And of course, my hypothesis would be that it’s not progesterone causing it
because that makes no sense, as I explained already. What potentially could be
causing it would be the significant drop in progesterone before it’s supposed to. So
essentially a luteal phase issue, luteal phase defect, or a sharp drop in
progesterone or significantly lower progesterone relative to estrogen is their
difference between the overall progesterone levels between women who are experiencing
these symptoms versus who are not, and you wouldn’t be able to gather that
information by simply testing progesterone once or something like that. You would
actually have to have these women come in every other day or every three days and
actually spot test those levels, those hormone levels throughout the cycle, and you’d
have to more specifically clarify and confirm ovulation, identify ovulation, whether
it’s with the basal body temperature testing, whether it’s with on testing, but to
be a lot more specific as to identify that ovulation day and then kind of tease
out the hormonal fluctuations throughout the cycle. Of course, this is not what was
done here.
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So I’m just pointing this out, I’m critical of research, especially menstrual cycle
research, because I feel like this kind of worldwide overall lack of information
about the menstrual cycle and how it works and the hormones and the lack of
appreciation for just fertility awareness techniques for tracking and understanding the
different phases of the cycle and the different parameters and factors. I feel like
that lack of information results in research that, again,
it’s good to have any research. It’s good that we have this data that we can build
upon, but I feel that it just shows in the poor design of these studies.
And like I said, that particular comment I found really interesting. It’s like, oh,
So just because progesterone raises temperature, we’re going to say that that causes
sleep disruptions when not all women have that. We’re not going to look at that
maybe as women, our bodies aren’t just naturally flawed, and progesterone just causes
us to not be able to sleep. And maybe our bodies are fine, but it’s when the
cycle isn’t functioning normally, when the hormones are imbalanced. Maybe that’s when
we see the issues. But of course, that’s not what their hypothesis was. And one
other thing I thought was really interesting, so this is another quote from the
paper. So they were talking about the changes in hormones and the sex differences
between men and women and trying to hypothesize why we might be seeing these changes
in sleep patterns around that time. They say, “Although these complex relationships
are poorly understood,” so they’re acknowledging that they’re poorly understood,
Evidence suggests estrogen has positive effects on mood and cognition. Conversely,
progesterone is associated with more negative mood, for example, irritability and
depression. So again, I think that that’s such a surface level analysis of what’s
going on. So we have two phases of the menstrual cycle, the first half and the
second half. We’ve got the pre -ovulatory phase in the post and pre -ovulatory phase
is characterized by higher levels of estrogen. And the post -ovulatory phase, it’s not
devoid of estrogen. It’s just the levels are a bit lower, and then progesterone
obviously is quite significant, and we only produce significant amounts post -ovulation.
When they’re looking at mood changes throughout the menstrual cycle, since women have
elevated moods, they typically have more neutral moods in terms of their reporting
around ovulation. One estrogen is higher, and since their mood tends to change and
be more poorly even in this study, there was a higher rate of kind of reported
anger, frustration, irritability. During that post -ovulatory late luteal phase shift,
they’re just saying, “Well, progesterone just causes poor mood.” And I feel like
that’s really interesting because progesterone has a calming effect. And again, the
issue isn’t that progesterone is causing women to have a poor mood. The issue is
that when we have an imbalance of hormones in that late luteal phase when we have
too little progesterone, that is what is actually associated with the mood changes
and the increased PMS symptoms. But we’re not looking at the nuances. We’re not
looking deeply into it. We’re just making these broad sweeping conclusions like, well,
these two things are correlated, so one must have caused the other. So those are a
couple of my critiques of this paper. But I think, again, the good thing is that
this research is being done. The good thing is that now we have more researchers
paying attention to some of these shifts. And of course, that’s a good thing, but
when you are missing that nuanced perspective, when you’re missing that deeper
understanding of not just the fact that women make estrogen and progesterone at
different times of the cycle and just kind of throwing this in as, and so therefore
that causes all the problems across all women, looking at the, between women
differences, right? Looking at that. And what I’m finding when I’m looking at PMS
-related research is even when they do look at potential hormone differences between
women, they’re not, again, looking at the nuance. They’re potentially taking one spot
check of progesterone or estrogen once per cycle. So imagine doing a study and
trying to determine whether or not the fluctuations of progesterone or the levels of
progesterone versus estrogen are contributing to these symptoms, but literally in the
course of an entire 29 -day menstrual cycle on average, we’re going to spot test for
estrogen once, and we’re going to spot test for progesterone once in the whole
cycle, and then draw a conclusion that if those levels or not necessarily what we
thought they would be or if they’re similar, that there’s no differences, right? So
I think for future research, I mean, like I would love to be in charge because I
think I could design some interesting studies or at least come up with some new
standards for testing hormones before researchers are making all these comments about
the hormones, but to actually to get more meaningful information, we would really
have to not only test in this general way about the menstrual cycle. But I think
if we really wanted to know, like if there was enough curiosity and enough concern
that we really wanted to understand what was happening with women and we really
wanted to understand the menstrual cycle, then we would actually have to take the
time to understand the menstrual cycle. And we would also have to take the time and
care to accurately identify ovulation using the LA strips fine,
but also correlating with other data, considering doing the morning temperature data.
And interestingly, we do have a lot of different devices now. So women can wear
wearable devices to measure their temperature, and they can correlate that with the
LH testing, and that’s not as energy -intensive as it once was. While it may not be
the most perfect measure, it would still be a step up to be able to correlate the
LH testing with the wearable temperature device in a research setting. that would
make a lot of sense to me. And also to do hormone testing. And again, now there
are a lot of different companies that are coming up with at -home hormone testing
options. So I do think that while at one stage in the research world,
this would have been very cumbersome for the participants to be going in and being
clinically tested on a daily basis. So there’s certainly an argument to be had for
making the research design something that people are actually likely to do and to
complete. But with that said, I think we have to balance that with what are we
trying to do here? Are we just trying to give lip service to these things and get
touch on the most basic surface level understanding of these changes? Or are we
wanting to really know what the role is of the hormones, the menstrual cycle, and
to really understand what’s at the root of this? And that’s a whole question I
don’t think we have the answer to, because if we do determine that it’s not just
an inherent problem with females as a whole sex category, and we do determine that
some women are fine because their hormone levels are optimal and other women are not
fine because they have this imbalance to hormones. And we go beyond, especially when
it comes to issues of whether it’s sleep dysregulation or whether it’s emotional or
mood dysregulation, whether it’s issues such as depression or other psychological or
psychiatric conditions, if we actually look at this potential hormone component in
there, that could have a ripple effect where we are less reliant on psychiatric
medication if women actually improve their symptoms by simply balancing their hormones,
right? So there are potential implications for an entire industry of pharmaceutical
drugs that may not actually want to, for us to come to those conclusions.
So I guess it’s just to be seen. Is this research, like this lack of research
rigor, this core design, and it’s a theme. For anybody who reads research a lot,
you can see this theme. Anytime we’re looking at menstrual research. I’ve talked
about it for years now. In my family research series where we’re looking deeply into
the research, the way that they look at menstrual psychoparameters, it’s just not
specific enough. I would say it’s a poor design. It’s a good start. It’s certainly
a good start, but I’m recording this in 2025. I feel like we could do better, and
especially with the advent of all of these new technologies that make it easier, all
of these different tracking devices, the whole world of FemTech. They’re wanting to
make it easier for us to test our hormones at home. I get DMs on a daily basis
from new companies that pop up all the time. I want you to share this device and
that device and this device. I’m pretty narrow as to what I share on the podcast.
I want to make sure that I’m not presenting information to you that I haven’t had
a chance to vet and all of that kind of stuff. But what I’m telling you is that
there’s a huge industry now of all of these different tech tools and different ways
of measuring hormones. All things female hormones, there are devices and tools for
now. So there’s not as much of an excuse as even 10 years ago in terms of how
difficult this might have been to implement with research study participants. I think
that we’ve crossed that bridge and it’s a little bit easier now. So in conclusion,
this was a really interesting study. I think the takeaways for us are that we can
see with the data that the menstrual cycle does play a role in a variety of
different aspects of our lives. I wouldn’t conclude that inherently with the menstrual
cycle, it’s going to disrupt sleep and it’s going to cause you to have severe PMS
symptoms and this is just normal and this is just hormonal and this is just a part
of being a woman. Based on what I’ve talked about so far, it should be clear that
what I’m talking about is if we look at our menstrual cycle as a vital sign and
we understand that there are normal parameters, then we would want to look deeper.
And we would want to find out the differences between women who have these moderate
to severe symptoms, women who are experiencing a greater disrupted sleep around the
time of menstruation, leading up to menstruation and shortly after. And we would want
to find out definitively if there is a hormone component and not just by spot
testing once in the cycle or not testing the hormones at all and drawing random
conclusions about how progesterone just causes sleep disturbance. This is because it’s
associated with an increased temperature, which makes no sense. We would actually look
at that scientifically. We would look at the take that progesterone testing and spot
test her every other day or every three days throughout her cycle and compare that
data to the women. We could plot her progesterone on a graph to determine if her
progesterone curve is normal, or if she’s experiencing a sharp drop in progesterone
that correlates with her symptoms. And if we have that level of data, then we can
draw meaningful conclusions about why some women are experiencing these sleep
disruptions and why they are not, instead of just making all these assumptions that
the menstrual cycle just is like this, and this is just something that happens to
all women when we know that it doesn’t. So while I am happy that they are doing
this research, I certainly think that there’s room for improvement. And I know that
there are a lot of women’s health professionals and researchers that tune in to
these episodes. So I am always hoping that this information will kind of have a
ripple effect and the quality of research will be better. And for those of you who
tune into this episode but never thought about it this way. For those of you who
have read certain research like this or are interested to learn more about it, or
for those of you who may even be in the field of research and are currently doing
your graduate studies or PhD level studies, these are legitimate questions.
And sure, it can be challenging to get funding, I’m sure. And to design a study
that is this in depth, I’m sure it would be difficult, potentially more difficult to
have participants follow through, because I mean, that’s a significant issue in all
research studies. In this study, they had such a significant number of participants
who initially said yes, but in terms of the actual data that they could use
afterwards, it’s a much smaller number. But this is an inherent challenge in all
research. So hopefully I’ve given you lots to think about in this. And I think that
when you don’t assume that the menstrual cycle is inherently problematic and all of
these issues that women experience are just a part of being a woman. When you start
to understand that these are symptoms of potentially an imbalance or things that
could be rectified, and when we have a structure and way to actually look at the
cycle to track what’s happening, to start improving some of what we call in FAM,
our foundational factors and start to see those improvements, Then it really gives us
hope and it gives us a plan and a structure for how to improve our day -to -day
experiences instead of feeling like we are just subject to these things instead of
just being told it’s in our head or it’s not a big deal or feeling like, well,
it’s just like this because this is what happens when I have my period and there’s
nothing I can do. I feel like it really gives us not only hope, but a specific
strategy. So let’s see what So, let’s see what happens in the next few years. Let’s
see what happens in this field of research around menstruation. I’m really curious to
see if it will improve, and if I ever have the opportunity to participate in this
research studies or study design, I would certainly be putting in my two cents,
although I’m not sure if my paper would be flagged or if it would actually be
published if that ever happened. So, with that said, I hope you have a wonderful
weekend whenever you’re tuning into the show. If you enjoyed today’s episode and you
can think of someone who would benefit from hearing it, you have a friend who you
know has been struggling with sleep issues. Now one thing I’ll say as well is that
we did not talk about issues specifically related to the pre -menopause phase today.
This was more of a general study. They actually excluded women who were over the
age of 35. So the participants in the study were specifically from ages 18 to 35.
So that would be another interesting conversation. And what I’ll leave you with my
thought on that is that when we are in that pre -menopause phase, the 10 years
leading up to our last period, typically in our early to mid -40s, then this is a
time when we are gradually starting to wind down and gear towards our final
ovulation. And it becomes harder to produce significant progesterone. Our bodies are a
lot more sensitive during that time to the insults that can impair our optimal
progesterone production. And so I’m not of the opinion that as women, we’re just
designed incorrectly and that all of the symptoms that women experience during that
phase are just inherent, normal. This is just what we can expect to have this
terrible experience, not be able to sleep and all that. I do think that to some
degree, though when a woman has greater symptoms, more significant symptoms, we could
in the same way look at what is the difference. And these are the questions I
would love to see asked more often instead of looking at perimenopause as every
woman’s having this horrible experience. That’s not true. If you dig deep enough,
there are some women who have mild symptoms during that phase. And so the research
I would like to see is, well, compare the women who are having these really
challenging experiences, significant sleep disruptions during that period of time,
versus women who are having very mild symptoms and are not having these challenges,
and see if we can find differences hormonally so that we can get a better
understanding. Instead of assuming that it’s just this issue with all women, we can
actually look at who’s suffering and compare them to who’s not and see what the
differences are. So I have a lot more curiosity about that and I’m sure as I get
closer into those phases, I’ll have a whole lot more to say. So enjoy the rest of
your day. And if you’re wanting to share this episode, FertilityFriday .com /584 is
the share link. Again, that’s FertilityFriday .com /584. And with that said, have a
wonderful weekend whenever you’re tuning into the show. And of course, as always,
until next time, be well and happy charting. If you’re loving the podcast and you’re
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