Over 50% of women affected by menopausal sleep disorders: urgent need to integrate sleep management into menopause guidelines

Despite the authoritative framework for hormone therapy provided by the 2025 European Society of Endocrinology Clinical Practice Guidelines for the Assessment and Management of Menopause and Perimenopause, there remains a notable absence of diagnostic and therapeutic protocols for sleep disorders. Given that sleep disorders affect 50%-55% of the perimenopausal population, they constitute an independent risk factor for severe adverse health outcomes. Leveraging landmark data from the 2024 Study of Women's Health Across the Nation (SWAN), persistent insomnia symptoms are associated with a 71% increased incidence of cardiovascular events, independent of vasomotor symptoms. Furthermore, the unique female phenotype of obstructive sleep apnea frequently leads to misdiagnosis in endocrine clinical practice. The "tipping point" of late perimenopause presents a critical window for intervention. A more comprehensive approach-combining mandatory screening with tiered sleep interventions-can enhance daytime functioning, prevent misdiagnosis, and reduce long-term cardiovascular disease incidence. Future guidelines should explicitly address this intersection to support more personalized care for middle-aged women.