A population‐based survey on the influence of the menstrual cycle and the use of hormonal contraceptives on sleep patterns in São Paulo, Brazil
Abstract
Objective: To investigate the effects of the phases of the menstrual cycle and the use of hormonal contraception on sleep patterns in a population‐based study. Methods: In a prospective study carried out among premenopausal women between July and December 2007, a 3‐stage cluster sampling was used to ensure accurate representation of the general population of São Paulo, Brazil. Questionnaires were administered, hormonal assays were performed, and full‐night polysomnography was recorded. Results: The study sample included 297 premenopausal women. Women in the follicular phase complained of fatigue more than those in the luteal phase and those using hormonal contraceptive treatment. Premenopausal women using hormonal contraceptives had a significantly lower apnea–hypopnea index (1.1 ± 2.0) compared with women in both the follicular (2.2 ± 4.5) and the luteal (2.9 ± 5.4) phases (P = 0.01). Women taking hormonal contraceptives tended to have increased sleep efficiency compared with women in either the follicular or luteal phases. Conclusion: The use of hormonal contraceptives was associated with a lower apnea–hypopnea index and a trend toward improved sleep efficiency. The current findings suggest that the use of hormonal contraceptives has a stronger association with sleep duration compared with menstrual cycle phase.
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During the luteal phase of the menstrual cycle, an increased occurrence of sleep disturbances and decreased sleep quality result.
“Multiple studies have reported that during the luteal phase of the menstrual cycle, an increased occurrence of sleep disturbances and decreased sleep quality result [252–254].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [254]
Cites
An inventory for measuring depression
BECK, A. T. (1961) · Archives of General Psychiatry · doi:10.1001/archpsyc.1961.01710120031004 · Cited by 38,032 · see citing works
The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989) · Psychiatry Research · doi:10.1016/0165-1781(89)90047-4 · Cited by 35,234 · see citing works
A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale
Johns, M. W. (1991) · Sleep · doi:10.1093/sleep/14.6.540 · Cited by 17,364 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772 · see citing works
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Bastien, C. (2001) · Sleep Medicine · doi:10.1016/s1389-9457(00)00065-4 · Cited by 8,067 · see citing works
(2007) · Cited by 6,530 · see citing works
Skevington, S. M., Lotfy, M., & O'Connell, K. A. (2004) · Quality of Life Research · doi:10.1023/b:qure.0000018486.91360.00 · Cited by 4,686 · see citing works
Development of a fatigue scale
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(93)90081-p · Cited by 3,032 · cited 1× · see citing works
“[9], Chalder fatigue scale [10], Epworth sleepiness scale [11], insomnia severity index [12], Beck anxiety inventory [13], and Beck depression inventory [14].”
MethodThe Effects of Coffee and Napping on Nighttime Highway Driving
Philip, P., Taillard, J., Moore, N. D., Delord, S., Valtat, C., Sagaspe, P., & Bioulac, B. H. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-144-11-200606060-00004 · Cited by 650 · see citing works
Circadian rhythms, sleep, and the menstrual cycle
Baker, F. C., & Driver, H. S. (2007) · Sleep Medicine · doi:10.1016/j.sleep.2006.09.011 · Cited by 529 · see citing works
Baker, F. C., Waner, J. I., Vieira, E. F., Taylor, S. R., Driver, H. S., & Mitchell, D. (2001) · The Journal of Physiology · doi:10.1111/j.1469-7793.2001.0565k.x · Cited by 207 · see citing works
High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea
Baker, F. C., Driver, H. S., Rogers, G. G., Paiker, J. E., & Mitchell, D. (1999) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1999.277.6.e1013 · Cited by 152 · see citing works
The Influence of the Menstrual Cycle on Upper Airway Resistance and Breathing During Sleep
Driver, H. S., Mclean, H., Kumar, D. V., Farr, N., Day, A. G., & Fitzpatrick, M. F. (2005) · Sleep · doi:10.1093/sleep/28.4.449 · Cited by 124 · see citing works
Circadian Variation of Sleep During the Follicular and Luteal Phases of the Menstrual Cycle
Shechter, A., Varin, F., & Boivin, D. B. (2010) · Sleep · doi:10.1093/sleep/33.5.647 · Cited by 119 · see citing works
Hachul, H., Bittencourt, L. R. A., Andersen, M. L., Haidar, M. A., Baracat, E. C., & Tufik, S. (2008) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2008.07.009 · Cited by 101 · see citing works
Self-citationDoes the reproductive cycle influence sleep patterns in women with sleep complaints?
Hachul, H., Andersen, M. L., Bittencourt, L., Santos‐Silva, R., Conway, S. G., & Tufik, S. (2009) · Climacteric · doi:10.3109/13697130903450147 · Cited by 93 · see citing works
Self-citationThe effects of paradoxical sleep deprivation on estrous cycles of the female rats
Ishikura, I. A., Andersen, M. L., Baracat, E. C., & Tufik, S. (2005) · Hormones and Behavior · doi:10.1016/j.yhbeh.2005.09.005 · Cited by 76 · see citing works
Self-citationSleep Complaints in the Adult Brazilian Population: A National Survey Based on Screening Questions
Bittencourt, L., Santos‐Silva, R., Taddei, J. A., Andersen, M. L., de Mello, M. T., & Tufik, S. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27603 · Cited by 73 · see citing works
Self-citationSleep apnea and hormone replacement therapy: a pilot study and a literature review
Wesström, J., Ulfberg, J., & Nilsson, S. (2004) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/j.0001-6349.2005.00575.x · Cited by 66 · see citing works
Brown, S. G., Morrison, L. A., Calibuso, M. J., & Christiansen, T. M. (2008) · Women & Health · doi:10.1080/03630240802575179 · Cited by 55 · see citing works
Baker, F. C., & Colrain, I. M. (2009) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2009.00782.x · Cited by 46 · see citing works
Female social and sexual interest across the menstrual cycle: the roles of pain, sleep and hormones
Guillermo, C. J., Manlove, H. A., Gray, P. B., Zava, D. T., & Marrs, C. (2010) · BMC Women s Health · doi:10.1186/1472-6874-10-19 · Cited by 43 · see citing works
Effects of sleep loss on sleep architecture in Wistar rats: Gender-specific rebound sleep
Andersen, M. L., Ishikura, I. A., Silva, A., Alvarenga, T. A., Baracat, E. C., & Tufik, S. (2008) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2008.01.007 · Cited by 43 · see citing works
Self-citationNon-contraceptive benefits of hormonal contraceptives.
Schindler, A. E. (2010) · PubMed · Cited by 21 · see citing works
Sleep quality based on the use of different sanitary pads during menstruation
Hachul, H., Andersen, M. L., & Tufik, S. (2011) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2011.05.015 · Cited by 5 · see citing works
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International society of sports nutrition position stand: nutritional concerns of the female athlete
Sims, S. T., Kerksick, C. M., Smith-Ryan, A. E., Janse de Jonge, X. A. K., Hirsch, K. R., Arent, S. M., Hewlings, S. J., Kleiner, S. M., Bustillo, E., Tartar, J. L., et al. (2023) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2023.2204066 · Cited by 91 · see citing works
“However, not all studies agree and some report no changes in sleep quality between the phases of the menstrual cycle [255,256].”
BackgroundSleep Disturbances Across a Woman's Lifespan: What Is the Role of Reproductive Hormones?
Haufe, A., & Leeners, B. (2023) · Journal of the Endocrine Society · doi:10.1210/jendso/bvad036 · Cited by 84 · see citing works
Sleep quality and the menstrual cycle
Romans, S. E., Kreindler, D., Einstein, G., Laredo, S., Petrovic, M. J., & Stanley, J. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2014.12.001 · Cited by 63 · see citing works
Waist circumference and postmenopause stages as the main associated factors for sleep apnea in women
Polesel, D. N., Hirotsu, C., Nozoe, K. T., Boin, A. C., Bittencourt, L., Tufik, S. B., Andersen, M. L., & Hachul, H. (2015) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000406 · Cited by 55 · see citing works
Self-citationSleep quality of mother-caregivers of Duchenne muscular dystrophy patients
Nozoe, K. T., Polesel, D. N., Moreira, G. A., Pires, G. N., Akamine, R. T., Tufik, S., & Andersen, M. L. (2015) · Sleep And Breathing · doi:10.1007/s11325-015-1196-9 · Cited by 40 · see citing works
Self-citationThe relationship between mood and sleep in different female reproductive states
Toffol, E., Kalleinen, N., Urrila, A., Himanen, S., Porkka-Heiskanen, T., Partonen, T., & Polo-Kantola, P. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-177 · Cited by 37 · see citing works
Sleep disorders in polycystic ovary syndrome: influence of obesity and hyperandrogenism
Hachul, H., Polesel, D. N., Tock, L., Carneiro, G., Pereira, A. Z., Zanella, M. T., Tufik, S., & Togeiro, S. M. (2019) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.65.3.375 · Cited by 36 · see citing works
Self-citationAlzueta, E., & Baker, F. C. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2023.06.003 · Cited by 49 · see citing works
Hormonal contraceptive use and subjective sleep reports in women: An online survey
Bezerra, A. G., Andersen, M. L., Pires, G. N., Banzoli, C. V., Polesel, D. N., Tufik, S. B., & Hachul, H. (2020) · Journal of Sleep Research · doi:10.1111/jsr.12983 · Cited by 31 · see citing works
Self-citationHachul, H., Castro, L. D. S., Bezerra, A. G., Pires, G. N., Poyares, D. R., Andersen, M. L., Bittencourt, L., & Tufik, S. (2021) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9432 · Cited by 26 · see citing works
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Fárková, E., Šmotek, M., Bendová, Z., Manková, D., & Kopřivová, J. (2019) · Biological Rhythm Research · doi:10.1080/09291016.2019.1630096 · Cited by 24 · see citing works
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Frange, C., Banzoli, C. V., Colombo, A. E., Siegler, M., Coelho, G. A., Bezerra, A. G., Garcia, M. C., Naufel, M. F., Cesar-Netto, C. A., Andersen, M. L., et al. (2017) · Sleep Science · doi:10.5935/1984-0063.20170030 · Cited by 24 · see citing works
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Guida, M., Rega, A., Vivone, I., Saccone, G., Sarno, L., Carlo, C. D., Aquino, C. I., & Troisi, J. (2019) · Gynecological Endocrinology · doi:10.1080/09513590.2019.1640204 · Cited by 23 · see citing works
Nozoe, K. T., Hachul, H., Hirotsu, C., Polesel, D. N., Moreira, G. A., Tufik, S., & Andersen, M. L. (2014) · Sexual Medicine · doi:10.1002/sm2.29 · Cited by 20 · see citing works
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Laird, S., Ney, L., Felmingham, K., & Gogos, A. (2019) · Current Psychiatry Research and Reviews · doi:10.2174/1573400515666190521113841 · Cited by 18 · see citing works
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Hachul, H., Polesel, D. N., Nozoe, K. T., Zm, S., Prado, M. C. O., Andersen, M. L., Bittencourt, L., & Tufik, S. (2016) · Journal of Women s Health Care · doi:10.4172/2167-0420.1000335 · Cited by 16 · see citing works
Self-citationNozoe, K. T., Kim, L. J., Polesel, D. N., Hirotsu, C., de Souza, A. A. L., Hachul, H., Tufik, S. B., Tufik, S. B., Andersen, M. L., & Moreira, G. A. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2016.11.020 · Cited by 15 · see citing works
Self-citationSleep quality in women who use different contraceptive methods.
Hachul, H., Bisse, A. R., Sanchez, Z. M., Araujo, F., Guazzelli, C. A. F., Tufik, S., & Barbieri, M. (2020) · PubMed Central · doi:10.5935/1984-0063.20190142 · Cited by 15 · see citing works
Self-citationBezerra, A. G., Andersen, M. L., Pires, G. N., Tufik, S., & Hachul, H. (2018) · Sleep Science · doi:10.5935/1984-0063.20180025 · Cited by 12 · see citing works
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Polo‐Kantola, P., & Toffol, E. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2023.06.002 · Cited by 10 · see citing works
Oxygen saturation during sleep as a predictor of inflammation in anovulatory women
Araujo, P., Polesel, D. N., Hachul, H., Bittencourt, L., Tufik, S., & Andersen, M. L. (2020) · Sleep And Breathing · doi:10.1007/s11325-020-02233-8 · Cited by 8 · see citing works
Self-citationBoivin, D. B., Caetano, G., Kervezee, L., Gonzales-Aste, F., & Boudreau, P. (2023) · SLEEP Advances · doi:10.1093/sleepadvances/zpac049 · Cited by 8 · see citing works
Senaratna, C. V., Priyadarshanie, M. N., Fernando, S., Goonewardena, S., Piyumanthi, P., Perret, J. L., Lodge, C., Hamilton, G. S., & Dharmage, S. C. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032070 · Cited by 8 · see citing works
Hormonal contraceptive use and women’s well-being: links with body image, eating behavior, and sleep
Gillen, M. M., Rosenbaum, D. L., Winter, V. R., & Bloomer, S. A. (2023) · Psychology Health & Medicine · doi:10.1080/13548506.2023.2216468 · Cited by 6 · see citing works
The Effects of Hormonal Contraceptive Use on Sleep Patterns in Women of Reproductive Age
Whitney, M. A., Schultz, D. N., Huber, L. R. B., Finke, A., Fitzgerald, A., & Hyde, A. (2022) · Annals of Epidemiology · doi:10.1016/j.annepidem.2022.07.006 · Cited by 4 · see citing works
Elkinbard, I. S., Ritterbusch, D., Shandra, O. O., & Rowe, R. K. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1672744 · Cited by 3 · see citing works
Cortisol dynamics and sleep quality: The role of sex and oral contraceptive use
Morssinkhof, M. W. L., Larsen, S. V., Ozenne, B., Nasser, A., Hvitved, S., van der Werf, Y. D., Penninx, B. W. J. H., Broekman, B. F. P., & Frøkjær, V. G. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107497 · Cited by 2 · see citing works
Baber, F., Chassard, T., Badier, N., Lafitte, A., Dupuit, M., Saulière, G., Debaud, E., Toussaint, J., & Antero, J. (2025) · Chronobiology International · doi:10.1080/07420528.2025.2594720 · Cited by 2 · see citing works
The Effects of Hormonal Contraceptives on the Sleep of Women of Reproductive Age
Bezerra, A. G., Pires, G. N., Andersen, M. L., Tufik, S., & Hachul, H. (2023) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2023.06.005 · Cited by 2 · see citing works
Self-citationContraception for adolescent and young women. A consensus conference results
Fruzzetti, F., Cagnacci, A., Farris, M., Dei, M., Caruso, S., Fidecicchi, T., Paolo, G. D., Londero, A. P., & for the Italian Society of Contraception (S.I.C.) (2025) · The European Journal of Contraception & Reproductive Health Care · doi:10.1080/13625187.2025.2586091 · Cited by 1 · see citing works
Ma, J., Cheng, M., Thabane, L., Ma, C., Zhang, N., Wang, Q., Kim, H.-W., Reza, H., Wang, C., & Yao, X. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045819 · Cited by 1 · see citing works
Assessing sleep among the next generation of healthcare delivery professionals.
Rossener, R., Morais, I. R., Caldeira, M. F., Tufik, S., & Hachul, H. (2020) · PubMed Central · doi:10.5935/1984-0063.20190129
Self-citationWaves of Change: Sex Hormones, Depression and Sleep
Morssinkhof, M. W. L. (2024) · doi:10.5463/thesis.676
Sleep Disorders in Pelvic and Women’s Health
Özkutlu, Ö., & İnal, Ö. (2026) · Springer eBooks · doi:10.1007/978-3-032-28741-0_25
- Authors
- Hachul, H., Andersen, M. L., Bittencourt, L., Santos‐Silva, R., & Tufik, S.
- Affiliations
- Universidade Federal de São Paulo (BR)
- Corresponding author
- Hachul, Helena
- Venue
- International Journal of Gynecology & Obstetrics
- Publisher
- Wiley
- Published
- 2012-11-27
- Volume
- 120
- Issue
- 2
- Pages
- 137-140
- ISSN
- 0020-6695 (ISSN-L)
- 0020-7292
- 1879-3479
- OpenAlex
- W1984769304
- Cited by
- 35
- References
- 27
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 8 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 4 · 2018: 1 · 2017: 2 · 2016: 1 · 2015: 3 · 2014: 2
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Gynecology & Obstetrics (publishedVersion)
- PubMed (publishedVersion)
- UNIFESP Institutional Repository (Universidade Federal de São Paulo) (submittedVersion)
- Funders
- AFIP
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- menstrual cycle, hormonal contraception, sleep patterns, premenopausal women, apnea-hypopnea index, sleep efficiency, sleep duration, fatigue, follicular phase, luteal phase, polysomnography
- MeSH terms
- Adult, Brazil, Contraceptive Agents, Female, Cross-Sectional Studies, Female, Follicular Phase, Humans, Luteal Phase, Sleep, Polysomnography, Young Adult
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