Sleep, Hormones, and Circadian Rhythms throughout the Menstrual Cycle in Healthy Women and Women with Premenstrual Dysphoric Disorder

Abstract

A relationship exists between the sleep-wake cycle and hormone secretion, which, in women, is further modulated by the menstrual cycle. This interaction can influence sleep across the menstrual cycle in healthy women and in women with premenstrual dysphoric disorder (PMDD), who experience specific alterations of circadian rhythms during their symptomatic luteal phase along with sleep disturbances during this time. This review will address the variation of sleep at different menstrual phases in healthy and PMDD women, as well as changes in circadian rhythms, with an emphasis on their relationship with female sex hormones. It will conclude with a brief discussion on nonpharmacological treatments of PMDD which use chronotherapeutic methods to realign circadian rhythms as a means of improving sleep and mood in these women.

Figure 1

The interaction between circadian (C) and homeostatic (S) processes in an “opponent-process” results in an uninterrupted 8-hour nocturnal sleep episode and a wake period maintained throughout the 16-hour day. The homeostatic drive for sleep (illustrated as the “sleep load”) increases throughout the waking period and reaches a peak just before habitual bedtime. The circadian drive for alertness (illustrated as the “alerting signal”) reaches a peak at this time and is lowest near the end of the sleep episode. From [8].

Figure 2

Pathways involved in the hypothalamic control of the circadian rhythms of sleep, wakefulness and body temperature. In the regulation of circadian sleep-wake patterns, outputs from the SCN relay at the vSPZ, and project to the DMH. The DMH then sends outputs to the VLPO (a sleep-activating center), and the LHA (where orexin neurons target downstream wake-promoting sites). The SCN regulates circadian body temperature rhythms through a relay at the dSPZ, which projects to the MPO. SCN, suprachiasmatic nucleus; vSPZ: ventral subparaventricular zone; dSPZ: dorsal subparaventricular zone; DMH: dorsomedial nucleus; VLPO: ventrolateral preoptic nucleus; LHA: lateral hypothalamic area; MPO: medial preoptic nucleus; MCH: melanin-concentrating hormone; TRH: thyrotropin-releasing hormone. Modified with permission from [9].

Figure 3

The relationship between melatonin secretion, body temperature and sleepiness. The onset of melatonin secretion during the early night causes an increase in heat loss at the extremities (i.e., rising distal skin temperature, and distal-proximal temperature gradient) and a drop in core body temperature, followed by an increase in sleepiness. From [21].

Figure 4

The variation of gonadotropic and sex steroid hormones, and the subsequent changes in daily body temperature across the full menstrual cycle. During the pre-ovulatory FP, estrogen levels are high. During the post-ovulatory LP, increasing levels of circulating progesterone are observed, along with increased daily body temperature. FSH, follicle stimulating hormone; LH, luteinizing hormone; FP, follicular phase; LP, luteal phase. From [22], as adapted from [23].