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Objective To examine the effect of hormone replacement therapy upon sleep quality and duration in postmenopausal women. Design Randomised, single‐blind, placebo‐controlled trial. Setting Sleep research laboratory. Subjects Thirty‐three healthy postmenopausal women. Interventions Continuous 0–625 mg conjugated equine oestrogens with 0.15 mg cyclic norgestrel taken for 12 days per 28 day cycle. Main outcome measures Occurrence of vasomotor symptoms, polysomnographic sleep stage measures, Stanford sleepiness questionnaire, Crown‐Crisp experiential index and the cognitive failures questionnaire. Results Hormone replacement therapy results in an improvement in menopausal symptoms but not in parameters of sleep quality. Despite this, certain measures of psychological wellbeing showed significant improvement in the hormone replacement therapy group. Conclusion Hormone replacement therapy results in a measurable improvement in physical and psychological welfare, the latter being independent of improvement in sleep quality.

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Sex steroid secretions are generally synchronous with the circadian rhythm and sleep, and there is evidence that prolactin secretion is sleep-dependent. Polysomnographically assessed changes in sleep during the menstrual cycle are characterized by increased EEG activity in the 14-15-Hz (sleep spindle) range in the luteal phase accompanying an increase in core temperature. There are no other consistent changes in sleep architecture associated with the menstrual cycle. The hot sweats which disturb sleep in menopausal women are attributable to oestrogen deficiency and are reduced by oestrogen replacement therapy. Although it is often assumed that the psychological changes during the menopause are attributable to chronic sleep disturbance caused by hot sweats, the evidence for this is uncertain. Sex steroids have also been shown to have a role in the aetiology of obstructive sleep apnoea and its treatment. It is clear that the sex steroids are all implicated in sleep and thermoregulatory processes, although we cannot as yet define their precise roles.