Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause

Na Young Cho, Soriul Kim, Sara Nowakowski, Chol Shin, Sooyeon Suh

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


Objective:Women who undergo surgical menopause (SM) experience a relatively more acute and precipitous drop of estrogen compared with women who experience natural menopause (NM). Few studies, however, have compared sleep quality in women who experience natural versus SM.Methods:Participants were 526 postmenopausal women (mean age 60.2 ± 7.64). All participants completed self-report questionnaires about insomnia symptoms, sleep-interfering behaviors, depression, sleep quality, and gynecological history. Analysis of covariance was conducted to compare women who experienced NM versus SM on sleep variables. Logistic regression analysis was used to determine whether NM or SM groups predicted insomnia status. Regression-based moderation analysis was conducted to explore the moderating effect of type of menopause on the relationship between sleep-interfering behaviors and insomnia symptoms.Results:Among the sample, 81.6% (n = 429) reported going through NM and 18.4% (n = 97) reported going through SM. The SM group was significantly younger by 7.2 years (P < 0.001). Women in the SM group reported significantly worse sleep quality (P = 0.007), especially for sleep duration (P = 0.001) and habitual sleep efficiency (P = 0.010) compared with women in the NM group. Regression analysis indicated that individuals in the SM group were 2.131 (95% CI 1.055-4.303) times more likely to have insomnia compared with the NM group (P = 0.027). In addition, women in the SM group who displayed more sleep-interfering behaviors also had a higher severity of insomnia symptoms compared with women who experience NM (ß = 0.26, P = 0.03).Conclusions:Menopause can be both physically and psychologically challenging, but women who undergo SM experience worse sleep quality compared with women who experience NM, and may benefit from behavioral interventions.

Original languageEnglish
Pages (from-to)357-364
Number of pages8
Issue number4
Publication statusPublished - 2019 Apr 1

Bibliographical note

Funding Information:
Received June 19, 2018; revised and accepted September 18, 2018. From the 1Department of Psychology, Sungshin University, Seoul, Republic of Korea; 2Korea University Ansan Hospital, Institute of Human Genomic Study, Ansan, Korea; 3Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX; 4Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, TX; and 5Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea. CS and SS equally contributed to this study. The abstract for this paper was presented internationally at World Sleep 2017 (Prague Czech Republic) and at Korean Society of Sleep Medicine (Seoul, Korea) as a poster presentation. Funding/support: This study was supported by the Korea Centers for Disease Control and Prevention (KCDC) grant (No. 2012-E71005-00) and by the Sungshin University Research Grant of 2018 (2018-2-82-001). Financial disclosure/conflicts of interest: None reported. Address correspondence to: Chol Shin, MD, PhD, Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Institute of Human Genomic Study, Korea University Ansan Hospital, Gojan 1-dong, Danwon-gu, Ansan-si, Gyeonggi-do 425-707, Korea. E-mail:; Sooyeon Suh, PhD, Department of Psychology, Sungshin University, 2 Bomun-ro 34da-gil, Seongbuk-gu, Seoul 02844, Republic of Korea. E-mail:

Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.


  • Insomnia
  • Menopause
  • Sleep
  • Sleep-interfering behaviors
  • Surgical menopause

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


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