Clinical Efficacy Of Menopausal Hormone Therapy In Menopausal Sleep Disorders And Its Effect On Vitamin D

Objective: To investigate the clinical curative effect of Femoston and Tibolone in the treatment of menopausal sleep disorders and their effect on serum 25 hydroxyvitamin D[25(OH)D] levels.Methods:From June 2021 to June 2022,a total of 120 menopausal women aged 45-60 years with sleep disorder who visited the Second Affiliated Hospital of Zhejiang Chinese Medical University were selected,they were randomly divided into two groups: Femoston group(60 cases)and Tibolone group(60 cases).They were given Femoston(1/10mg)and Tibolone(2.5mg)oral therapy,respectively.The course of treatment was 6 months.All subjects were evaluated using the Modified Kupperman Index(KI),Pittsburgh Sleep Quality Index(PSQI),and the Ford Insomnia Response to Stress Test Chinese Version(FIRST-C)for menopausal symptoms,sleep quality,and sleep responsiveness before treatment and 1,3,6 months after treatment.During the treatment,the researchers measured the serum 25(OH)D levels of the subjects and count the occurrence of side effects.Results:1.Finally,102 subjects completed the clinical follow-up,including 50 cases in the Femoston group and 52 cases in the Tibolone group.There were no obvious differences in age,menopause time,disease course,level of education,liver function,endometrial thickness,and other basic data between two groups(p>0.05).2.Only 6.9 percent of menopausal women with sleep disorders had sufficient vitamin D levels.The serum 25(OH)D level of patients with different degrees of sleep disorder was: mild > moderate > severe,and the difference between mild and severe was obvious(p<0.05).Patients with severe sleep disorder had the highest proportion of vitamin D deficiency(p<0.05).The total PSQI score of menopausal women with sleep disorders was negatively correlated with the serum 25(OH)D level(r=-0.57,p<0.05).3.Before intervention and 1,3,6 months after intervention,there were no obvious differences in Modified KI,PSQI and FIRST-C scores between the two groups(p>0.05).The scores of the three scales decreased markedly at the first and third months of therapy(p<0.05).There was a small decrease in the sixth month compared with the third month,but the difference was not visibly(p>0.05).4.Before treatment,there was no obvious differences in the scores of each symptom of the Modified KI between the groups(p>0.05).After treatment,the scores of each symptom of the Modified KI in both groups decreased compared to before(p<0.05).After treatment,the scores of hot flusher,sweating and dyspareunia in the Femoston group were less than the scores in Tibolone group,while the scores of irritability,depression,bone and joint pain and urinary symptoms were higher than the scores in Tibolone group(p<0.05).5.Before treatment,the scores of each PSQI index has no significant difference(p>0.05).After intervention,the scores of each index of the PSQI in both groups decreased compared to before(p<0.05).After treatment,the scores of sleep disorders and sleep efficiency in the Femoston group were less than the scores in Tibolone group,while the scores of sleep quality and daytime function were higher than the scores in Tibolone group(p<0.05).6.Before treatment,there were no significant differences in serum 25(OH)D level and vitamin D nutritional status between the groups(p>0.05).After treatment,the serum 25(OH)D level elevated in both groups,and the proportion of vitamin D sufficiency increased(p<0.05).There was no difference in serum 25(OH)D level between the two groups after therapy(p>0.05),but the proportion of vitamin D sufficiency in the Tibolone group was higher than another group(p<0.05).7.Unexpected vaginal bleeding,breast tenderness,gastrointestinal reaction and abnormal uterine ultrasound occurred in both groups.Liver function monitoring was within the normal range during treatment,there was no abnormal breast ultrasound in the two groups after treatment.There was no obvious difference in the incidence of side effects between the groups(p>0.05).Conclusion:1.The situation of vitamin D deficiency is severe in menopausal women with sleep disorders,and the total PSQI score of menopausal women with sleep disorders was negatively correlated with the serum 25(OH)D level.2.Both Femoston and Tibolone can relieve menopausal symptoms,reduce sleep reactivity and alleviate sleep disorders in menopausal women,with rapid and lasting efficacy and good safety.Femoston has advantages in hot flushes,sweating,dyspareunia,sleep disturbances and sleep efficiency.While Tibolone has better effects on irritability,depression,urinary symptoms,bone and joint pain,sleep quality and daytime function.3.Both Femoston and Tibolone can increase serum 25(OH)D level and improve vitamin D nutritional status while alleviating sleep disorders in menopausal women,with Tibolone having better advantages in improving vitamin D nutritional status.