European Journal of Cardiovascular Medicine

Menstruation and sleep, both are essential cycles for every woman belonging to the reproductive age group. Menstruation is the cyclic shedding of blood from the endometrial layer of the Uterus (1). Menstrual cycle, of 21 to 30 days span is controlled by several hormones like Gonadotrophin Releasing Hormone, Follicle Stimulating Hormone, Luteal Hormone, Progesterone and Oestrogen (1).The sleep cycle on the other hand, is regulated by different parts of human brain like hypothalamus , hippocampus, amygdala, thalamus and reticular formation (1). During menstruation, women often suffer from troubled sleep cycle. The altered oestrogen and progesterone level may cause the interrupted sleep (1). Mental anxiety, stress and different life style changes also contribute to sleep disturbances (1). On the other hand, the irregularity of menstrual cycle directly affects one's quality of life.Durations of periods and amount of bleeding differ from person to person. Obese ladies are more prone to menstrual irregularities (2). Women doing  heavy physical work are more likely to have prolonged menstrual cycles (3). Short sleep duration, overstrain and stress may cause heavy bleeding and other menstrual irregularities (4). A cross-sectional study on 12-25 age group pointed out that premenstrual symptoms and dysmenorrhea are associated with insomnia, although sleep hour has hardly any affect on most menstrual symptoms (5). Poor sleep pattern  during pre-menstrual and menstrual phases are more frequent in PMS and the EEG shows increased sleep spindle activity in the luteal phase (6). Circadian rhythm may be hampered and daytime dizziness increases in the luteal phase (7). Woosley et al (8) revorded moderate to severe dysmenorrhea in patients with persistent problems of falling asleep and staying awake. Sleep is more disturbed in the pre-menstrual phase compared to other phases (9). Kocabey et al (10) proposed that high premenstrual syndrome assessment scale (PMSAS) has low sleep quality scale; dysmenorrhea and other menstrual symptoms have lower sleep efficiency, but the difference is insignificant in participants with HMB. Khotimah et al (11) reported that 7.3% females with good-quality sleep have abnormal menstrual cycle, whereas 18.7% with disturbed sleep show irregular menstrual pattern.

The present study aims to assess the correlation, if any, between the menstruation cycle during the last one month and the sleep hygiene. The work distinguishes itself from most of the previous works in its samples,  population and the questionnaire.

Hypotheses: To find out how the menstrual pattern of an individual influences her sleep.

Sample Collection Technique: Google Forms

Inclusion Criterion: Menstruating women

Exclusion Criterion: Pre-menarche girls, post-menopausal women.

Sample Size: 115

Study Population: Women from the age-group 14-50, Post-Menarcheal and Pre-Menopausal.

Ethical Approval: Since no intervention, pharmacological or invasive, were performed, institutional ethical clearance was not required for survey based study.

Tools used:

1. A Questionnaire of 10 items to understand every minute details of the subject's menstrual pattern, from the age of menarche to duration, intensity of bleeding, occurrence of pain, and various irregularities in the cycle (12).

2. The Sleep Quality Scale is a 28 item Questionnaire that measures sleep quality in the general population. It assesses the various aspects of sleep including daytime symptoms, restoration after sleep, problems in initiating sleep, problems in maintaining sleep, difficulty in waking up or feeling refreshed in the mornings (13).

Methods: 115 females of the age-group 14-50, who attained menarche but did not attain menopause yet, were interviewed on the basis of the two above mentioned questionnaires, through Google Form based on what they had observed in the last 1 month. Informed consent was taken from all participants. Their responses were recorded and analyzed using MS Excel.

PCOD Diagnosis

Clots in Menses

Prolonged Cycle Length

Heavy Menstrual Bleeding

Shorter Cycles with Heavy Bleeding

Reduction in Bleeding Intensity

Absence of Menstruation

Continuous Bleeding

Painful Periods/Dysmenorrhea

Vaginal Discharge

The present study found that clots in menses can impact the quality of sleep negatively. Increased bleeding duration/Intensity (HMB). This synchronises with the findings of Kathryn et al (4), who observed that short sleep duration can cause Heavy Menstrual Bleeding. Absence of Menstruation (without lactation or pregnancy) was also found to negatively influence sleep quality. Similar to the findings of Woosley et al (8) painful periods or dysmenorrhea increased acute sleep disturbances. Vaginal Discharge also significantly increased the score of sleep disturbances. These alterations could possibly be due to the changes of oestrogen and progesterone levels in the body (1).

Factors found to increase the score of acute sleep disturbances were Clots in menses, Increased bleeding duration/Intensity (HMB), Absence of Menstruation (Dysmenorrhea), Painful periods and Vaginal Discharge.

There could have been lack of generalisability in this study for it was conducted on a limited population only  inclusive of women in the menstrual age group. Further studies on similar grounds can be conducted on larger populations inclusive of post-menopausal women as well, to get a comprehensive understanding on how the hormones influence the sleep cycle.

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