Variations in sleep associated with different types of hormonal contraceptives

Abstract

Progesterone and some of its metabolites are neuroactive steroids that affect sleep by increasing melatonin secretion and stimulating GABA-A receptors. The effect of progestogens in hormonal contraceptives on sleep has not been thoroughly investigated. This observational study assessed possible associations in sleep changes induced by estrogen–progestogens in contraceptives in 108 women between the ages of 20 and 50 years. We assessed mean nightly sleep time with a 31-day sleep diary, and subjective sleep quality with the five subjective subscores of the Pittsburgh Sleep Quality Index (PSQI). Included women were of childbearing age, healthy, sexually active and had been using a hormonal contraceptive method (pill, intrauterine system (IUS), subcutaneous implant, vaginal ring) for at least six months. Results were compared to a matched control group that did not use hormonal contraceptives. The longest mean nightly sleep time, compared to control (450 min), occurred in women who used progestogen-only oral contraception (510 min), followed by IUS delivery of levonorgestrel 13.5 mg (480 min) and oral ethinylestradiol 0.02/0.03 mg plus gestodene 0.075 mg (475 min). Global subjective sleep quality was influenced most by the administration of etonorgestrel 0.120 mg/ethinylestradiol 0.015 mg via the vaginal route. Our results show that low-doses of progestins affect various aspects of sleep, and that this is influenced by the route of administration.

摘要

孕酮及其某些代谢物是具有神经活性的类固醇激素, 可通过上调褪黑素分泌和激活GABA-A受体影响睡眠。关于睡眠问题, 激素避孕药中孕激素的作用尚未彻底研究清楚。这项观察性研究评估了108名20到50岁女性, 口服避孕药中雌激素-孕激素与睡眠变化可能的关系。我们通过31天的睡眠日记评估了平均每晚睡眠时间并通过匹兹堡睡眠质量指数（PSQI）的五个主观分评估了主观睡眠。本研究纳入了育龄期, 健康, 性活跃并使用激素避孕方法（口服药, 子宫内系统（IUS）, 皮下植入物, 阴道环）至少六个月的女性。对照组是匹配的未使用激素避孕药的女性。与对照组（450分钟）相比, 夜间睡眠时间均值最长的是仅用口服孕激素避孕的女性（510分钟）, 然后是IUS左炔诺孕酮13.5mg（480分钟）和口服乙炔雌二醇0.02 / 0.03mg加孕二烯酮0.075mg（475分钟）。总体主观睡眠质量多数受到经阴道途径给药的依托孕酮0.120mg /炔雌醇0.015mg影响。我们的结果表明, 低剂量的孕激素会影响睡眠各个方面, 这受到给药途径影响。

Keywords:

• Hormonal contraceptives
• sleep quality
• progestin
• sleep duration
• administration route

Disclosure statement

No potential conflict of interest was reported by the authors.