Ovarian hormones, sleep and cognition across the adult female lifespan: An integrated perspective

Abstract

Loss of ovarian function in women is associated with sleep disturbances and cognitive decline, which suggest a key role for estrogens and/or progestins in modulating these symptoms. The effects of ovarian hormones on sleep and cognitive processes have been studied in separate research fields that seldom intersect. However, sleep has a considerable impact on cognitive function. Given the tight connections between sleep and cognition, ovarian hormones may influence selective aspects of cognition indirectly, via the modulation of sleep. In support of this hypothesis, a growing body of evidence indicates that the development of sleep disorders following menopause contributes to accelerated cognitive decline and dementia in older women. This paper draws from both the animal and human literature to present an integrated view of the effects of ovarian hormones on sleep and cognition across the adult female lifespan.

Keywords: Estrogens; Executive function; Hormone replacement therapy; Human; Memory; Menopause; Primate; Progesterone; Rodent; Sleep loss.

Figure 1.

Schematic model illustrating proposed effects of hormone deprivation resulting from menopause on sleep disruptions and selective cognitive deficits. Sleep disruptions may include reduced sleep quality/efficiency, or fragmented sleep, and in more severe cases, development of sleep disorders (i.e. insomnia or sleep disordered breathing). Since sleep is also known to modulate these cognitive abilities, it is proposed that loss of ovarian hormones can further exacerbate cognitive impairments via development of sleep disorders/fragmented sleep. There is some evidence that symptomatic women are more vulnerable. Extended periods of sleep disruptions could increase inflammation and synaptic damage leading to further cognitive deficits. Note: Aβ = β-amyloid; SDB = sleep-disordered breathing; WM = working memory.