Healthy Sleep and Rest

Healthy Sleep and Rest

Written by Gina Besteman, RPh, & Michelle Violi, PharmD – Women’s International Pharmacy

One of the more common symptoms of peri-menopause and menopause that patients complain of is difficulty sleeping. There is a significant amount of research showing how hormones affect healthy sleep. healthy sleep

Progesterone affects GABA receptors which are responsible for non-REM sleep, the deepest of the sleep stages. Progesterone also affects breathing. It’s been shown to be a respiratory stimulant and has been used to treat mild obstructive sleep apnea.

The role of estrogen in sleep appears to be more complicated than that of progesterone. Estrogen is involved in breaking down norepinephrine, serotonin, and acetylcholine in the body. It has also been shown to decrease the amount of time it takes to fall asleep, decrease the number of awakenings after sleep occurs, and increase total sleep time. Low estrogen levels may lead to hot flashes, which can also affect sleep.

Cortisol is a hormone produced by the adrenal glands in response to stress. It normally peaks in the early morning followed by a slow decline throughout the day and night. However, chronic stress can alter healthy cortisol production and lead to sleep problems if cortisol is low in the morning and increased in the evening and at night.

Melatonin is a hormone produced by the pineal gland in the brain that regulates sleep and wakefulness. Normally, melatonin levels begin to increase in the mid to late evening, remain elevated throughout the night and drop in the morning. In general, melatonin levels decrease with age and melatonin production can be shut off by bright light. If melatonin levels are disrupted, sleep may be disrupted as well.

In addition to hormones, sleep can be affected by a number of external factors. It is important to maintain proper sleep hygiene as follows:

  • Avoid napping during the day
  • Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime
  • Exercise can promote good sleep, but avoid vigorous exercise too close to bedtime
  • Food can be disruptive right before sleep
  • Ensure adequate exposure to natural light during the day
  • Establish a regular relaxing bedtime routine
  • Associate your bed with sleep
  • Make sure that the sleep environment is pleasant and relaxing and free from light pollution, e.g., lighted alarm clock faces, street lights through open windows, and cell phones/tablet devices
  • Eichling PS. Evaluating and Treating Menopausal Sleep Problems. Menopause Management. Sept/Oct 2002.
Healthy Sleep and Rest2017-12-14T15:01:55-05:00

What Does Tinnitus Have To Do With Hormones?

What Does Tinnitus Have To Do With Hormones?

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Tinnitus, commonly known as “ringing in the ears,” is prevalent among the elderly and in women. The severity can vary from a mild annoyance to significantly disturbing.

Tinnitus may also be associated with deafness and dizziness. Most will experience a temporary tinnitus when exposed to loud sounds. Loud sounds can also induce a chronic tinnitus.

The “ringing in the ears” can actually be heard as a variety of sounds such as ringing (the word tinnitus comes from the Latin word for “ringing”), buzzing, whooshing, swishing or clicking. These sounds create a background of noise when there is no sound actually present. In his book Musicophilia, Oliver Sachs even reports cases of tinnitus of a musical nature. The American Tinnitus Association website has recordings of the various sounds of tinnitus.

The onset of tinnitus in women seems to be particularly related to periods of hormone variability. It can be triggered by PMS, perimenopause, menopause and pregnancy. Menopausal symptoms such as sweating, hot flashes and mood changes may correlate with tinnitus.

Tinnitus can also be caused by some prescription medications, including antidepressants, aspirin and quinine, some antibiotics, benzodiazepines, anticonvulsants, some chemotherapy and certain diuretics. Sometimes conventional hormone treatments have brought on tinnitus. A review posted at compiled the details on side effects from 69,299 Premarin users, of whom 0.5% have reported tinnitus as a side effect. The incidence increases dramatically with the number of years on Premarin, and no one reported a recovery. While the search for a pharmacologic solution for tinnitus has been on for decades, there have not been any successful candidates thus far.

However, while presenting at the Royal Society of Medicine on May 8, 1985, Dr. Albert Gray successfully treated 7 of 14 patients with an injection of thyroxine (T4) solution through the tympanic membrane of the ear. Tinnitus has been identified as a symptom of both hypo- and hyperthyroidism. This observation should trigger more investigation into the thyroid status of a sufferer.

Tinnitus treatments involving the injection of other drugs (particularly the synthetic analogs to hydrocortisone) through the tympanic membrane have been attempted, also without success. Otologists had reasoned that this procedure would allow a larger concentration of the drug to reach the inner ear, and that the localized treatment would be more likely to have an effect.

Research in the last decade has increased our awareness of hormones acting on the central and peripheral nerves. Low estradiol, for instance, may be responsible for confusion in the transmitting of sound signals from the ear to the brain, possibly resulting in tinnitus.

In 2012, researchers from Nigeria reported on the correlation of vitamins C and B12 and melatonin by examining those levels in a group of elderly people, some with and some without tinnitus. They found no significant correlation with vitamin C levels, but found significantly lower levels of B12 and melatonin in those people with tinnitus.

Treatment options now offered include counseling, cognitive behavioral therapy, auditory stimulation, and neuro feedback. Efforts to mask the noise, such as using white sound or hearing aids, are also sometimes used. Drug therapies are not effective at treating tinnitus but may be offered to treat anxiety, depression or sleep deprivation, which may accompany it.

An evaluation of nutrition (particularly with regard to the B complex vitamins), stress levels, exposure to loud noise and hormone balance may be avenues to explore for tinnitus relief.

What Does Tinnitus Have To Do With Hormones?2018-04-05T11:22:18-05:00

Can Melatonin Reduce the Symptoms of Stress-related Tinnitus?

Can Melatonin Reduce the Symptoms of Stress-related Tinnitus?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


A study of 344 patients with tinnitus demonstrated that elevated stress hormones, as well as a break-down product of serotonin, appear to be related to tinnitus. Melatonin is thought to reduce these fight-or-flight stress hormones, while increasing blood flow and regulating inner ear immunity.

One study found that melatonin decreased the severity of tinnitus while improving sleep quality. A second study demonstrated that melatonin reduced subjective symptoms by 40%. In both studies, a 3mg dose was given daily over a 30-day period.

While there is no FDA-approved medication indicated for the treatment of tinnitus, there are several drugs in development. In the meantime, bioidentical melatonin may be worth trying to reduce tinnitus symptoms.

Methylcobalamin (MeB12) may actually assist in detoxifying inorganic mercury in the body. Related research is ongoing and we will be keeping a close eye on the results.

Can Melatonin Reduce the Symptoms of Stress-related Tinnitus?2018-04-03T17:14:16-05:00

Can Melatonin Help With Hair Loss?

Can Melatonin Help with Hair Loss?

Written by Kathy Lynch, PharmD – Women’s International Pharmacy


Women and men alike often express frustration with their attempts to slow down the effects of aging on their hair, particularly with regards to hair loss. A recent review article on hair loss examined the results of five studies conducted between January 2003 and October 2006. The studies used a topical hair solution formulated in Switzerland that contained 0.0033% melatonin. This product also included ginkgo biloba and biotin, which provide hair roots with beneficial nutritional support.

These studies yielded positive results for both men and women with early androgenetic alopecia or general hair loss. The melatonin solution was found to be safe and effective, decreasing hair loss while fostering new hair growth, in a significant number of study participants.

An earlier pilot study also found a 0.1% melatonin-alcohol solution to be effective. The theory is that, because hair follicles have melatonin receptors, melatonin may counteract androgenic hormone-induced hair loss.

Can Melatonin Help With Hair Loss?2018-04-05T12:02:15-05:00

Melatonin and the Heart

Melatonin and the Heart

Written by Kathy Lynch, PharmD – Women’s International Pharmacy

Melatonin is becoming more widely accepted by the scientific community as a beneficial hormone for heart health. It appears that melatonin decreases inflammation and positively affects blood pressure and cholesterol. Melatonin has also been identified as a powerful antioxidant.

Not only have low melatonin levels been observed at various stages of coronary heart disease, but the role melatonin plays in normal heart function is well established. Human coronary arteries have melatonin receptors on them, though their exact function has yet to be fully determined.

Melatonin is currently being studied to see if oral doses can protect against damage done when blood returns to a heart previously deprived of blood flow, for example, after a heart attack. Because melatonin has low toxicity and has been proven safe in varying strengths, both oral and intravenous, scientists are interested in studying melatonin for the treatment of heart disease.

For additional information on hormones and their relationship to heart health, please see our publication: Matters of the Heart.

Melatonin and the Heart2017-12-12T17:14:43-05:00