TITLE:
Possible Role of Exogenous Melatonin and Melatonin-Receptor-Agonists in the Treatment of Menopause―Associated Sleep Disturbances
AUTHORS:
Amnon Brzezinski
KEYWORDS:
Melatonin; Melatonin Agonists; Menopause; Sleep; Insomnia; Ramelteon; Agomelatine
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.4 No.6,
April
24,
2014
ABSTRACT: One of the core symptoms
of the menopausal transition is sleep disturbance. Peri-menopausal women often
complain of difficulties initiating and/or maintaining sleep with frequent
nocturnal and early morning awakenings. Factors that may play a role in this
type of insomnia include vasomotor symptoms and changing reproductive hormone
levels, circadian rhythm abnormalities, primary insomnia, mood disorders,
coexistent medical conditions, and lifestyle. Exogenous melatonin reportedly
induces drowsiness and sleep, and may ameliorate sleep disturbances, including
the nocturnal awakenings associated with old age and the menopausal transition.
Recently, more potent melatonin analogs with prolonged effects and slow-release
melatonin preparations have been developed. The melatonergic receptor ramelteon
is a selective melatonin-1 (MT1) and melatonin-2 (MT2) receptor agonist with
negligible affinity for other neuronal receptors, including gamma-aminobutyric
acid and benzodiazepine receptors. It was found effective in increasing total
sleep time and sleep efficiency, as well as in reducing sleep latency, in
insomnia patients. The melatonergic antidepressant agomelatine, displaying
potent MT1 and MT2 melatonergic agonism and relatively weak serotonin 5HT2C
receptor antagonism, reportedly is effective in the treatment of depression
associated insomnia. This article presents the currently available evidence
regarding the effects of these compounds on sleep quality and their possible
use in menopause associated sleep disturbances.