What is melatonin?

Melatonin is a hormone that is secreted by the pineal gland in the brain and plays a key role in the maintenance of the sleep-wake cycle. In addition to its function regarding sleep, melatonin has been proposed to have many varied properties as it also functions as an antioxidant and anti-inflammatory. Because of melatonin’s diverse characteristics, it has been studied for a wide variety of common ailments including the following:

 

Insomnia:

Sleep is one of the most fundamental elements supporting human health; it is necessary for healthy cognitive functioning and supports our mental and physical wellbeing. Unfortunately, insomnia is incredibly common and is responsible for over 5 million medical office visits annually in the United States. This complex condition has many potential causes and can lead to widespread disruptions to a person’s general health. Whatever the cause, sleep hygiene can be a baseline factor in treatment plan.

Here are a few key points on how to improve your sleep hygiene, laying the groundwork to achieving a night of quality sleep.

  • Daily exercise can help promote quality sleep. However, many people find that intense physical activity close to bedtime can also disturb sleep.
  • Timed light exposure. To ensure a healthy sleep-wake cycle we want more robust exposure to sunlight during the morning and daytime and then a reduction in light exposure in the evening and night.
  • Keep your sleep environment cool, dark, and quiet. Creating a cool sleeping space can be as simple as making sure to remove the extra blanket as we transition into spring and warmer weather. Or could entail the addition of a small fan or cracked window to help keep a bedroom cool. You may consider blackout curtains or an eye mask to ensure that you are sleeping in a dark room. Ideally, your sleep space will be dark enough that if you stretch your arm out in front of your face, you will not be able to see your hand. To craft a quiet room – use of earplugs, a fan, or white noise machine can help even out background noises.
  • Establish a pre-sleep routine. Even if our personalities do not love a routine, our bodies do. Choosing a couple of activities that you perform as a pre-bedtime ritual can help signal to the brain that it is time to start winding down and preparing for sleep. Examples of such activities could include light reading, a warm shower, a small cup of relaxing tea, or meditation.
  • Go to sleep at the same time each night and wake at the same time each morning on a schedule that will allow you to get 7-9 hours of sleep nightly.
  • Limit or avoid afternoon and evening stimulants. Use of alcohol, caffeine, and nicotine can result in significant sleep disturbance, especially if consumed close to bedtime.
  • Avoid eating immediately prior to bed.
  • Keep your bedroom for sleep and sexual activity only. For example, do not use your bed as a location for watching TV or preparing your taxes.
  • Limit screen use, be it TV, phone, computer, or tablet, for 30-60 minutes prior to bed. The blue light from these devices can profoundly disturb our sleep and the hormones that help regulate it.
  • Limit daytime napping. While daytime napping does not make up for lost nighttime hours, it can help improve alertness and mood. Keep naps to less than 20-30 minutes.

 

Sleep hygiene alone may be adequate for many to achieve sound and restful sleep but others may need additional support. Low doses of melatonin have been shown to demonstrate sleep related benefits including reducing time to falling asleep and improving the quality of sleep. Interestingly, melatonin’s action is not dose dependent, meaning a higher dose will not lull you off to sleep faster.

 

Migraine headaches:

Migraine headaches are characterized by severe throbbing head pain, which is often associated with nausea, vomiting, and light and sound sensitivity and require the sufferer to retreat into a dark and quite space for hours on end. Women are disproportionately impacted by migraines with incidents impacting roughly 17% of women but only about 6% of men each year. Due to the disabling nature of migraine headaches there is an associated notable financial cost largely attributable to loss of productivity.

Treatments generally fall into one of two categories, prophylactic (used to prevent development of a headache) or abortive (taken in the moment to resolve a migraine). Prophylactic measures generally include avoidance of triggers, stress management, and lifestyle elements like sleep hygiene, quality diet, and regular exercise. Additionally, certain antidepressants, anticonvulsants, and blood pressure medications can be used as for migraine prevention. Common abortive treatments include: nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, triptans, and anti-nausea agents. However, there are also natural agents, which can be used for migraine prophylaxis, including melatonin. Several studies have examining this use of melatonin resulted in reduced frequency intensity, and duration of migraine headaches.

 

 

Endometriosis:

Endometriosis is a complex, inflammatory condition where endometrial tissue (cells that line the inside of the uterus) grows outside of the uterus, which can result in abdominal pain, pain with sex, painful periods, and fertility challenges. Symptom severity can range widely as some affected women are asymptomatic and others are profoundly impacted. Depending on the severity of the condition, a variety of treatments are available and range from pain management medication and birth control pills to surgical interventions. However, there is also a place for natural agents in the treatment of endometriosis. A 2013 publication explored the use of melatonin as a natural treatment option for endometriosis. The results of this study revealed a statistically significant reduction in daily pain, decreased pain with menses, lower use of pain medication during menses, and improved sleep quality.

 

 

Infertility:

Infertility is a mixed bag with possible causes falling into bucket diagnoses labeled as female infertility, male infertility, or unexplained infertility. Depending upon the cause, infertility can be treated with a variety of measures ranging from short-term oral medications to complex procedures like in vitro fertilization (IVF). For many couples, IVF is the method utilized to grow their families. IVF is a process overseen by reproductive endocrinologists who specialize in infertility. During IVF, the female’s ovaries are stimulated to grow a whole cohort of egg (oocytes) that are then retrieved one by one via a surgical procedure and later joined with the male’s sperm to create embryos. The embryos are then grown in a lab for a few days prior to being transferred into the uterus or being frozen for use at a later date.

Because of the complicated nature of IVF, there are numerous elements that impact the ultimate success of the process. The quality and quantity of oocytes are two such factors. While it is possible to estimate the number of oocytes that will be retrieved, there is currently is no reliable way to evaluate the quality of oocyte quality prior to retrieval. And there are, of course, a variety of natural agents that have been studied in relation to IVF outcomes. Melatonin is one such supplement that has been assessed to this end. In fact, several studies have shown regular use of melatonin prior to an IVF cycle may increase oocyte quality and quantity.

 

 

Are there side effects to using melatonin?

– Melatonin is not believed to be addictive or habit forming.

– The use of supplemental melatonin has not been established to cause a reduction in the body’s natural production of melatonin.

– It should be noted that some people find the use of melatonin results in very vivid dreams. If this is bothersome to you, melatonin may not be a good choice for you.

– At present, there is insufficient data to indicate that melatonin is safe during pregnancy and therefore is not recommended.

 

 

There are a multitude of supplements available online and in stores. It is important to understand the literature and how certain supplements may be helpful or harmful to each individual. Be sure to check with a qualified healthcare provider who is knowledgeable about supplements prior to initiating a new regimen for yourself. If you need assistance with any of the above delineated health conditions or a different women’s health concern, please feel free to schedule with me at A Woman’s Time.

 

 

 

References:

 

Batioglu, A. S., Sahin, U., Gurlek, B., Ozturk, N., & Unsal, E. (2012). The efficacy of melatonin administration on oocyte quality. Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology, 28(2), 91–93. http://doi.org/10.3109/09513590.2011.589925

 

Bougea A, Spantideas N, Lyras V, Avramidis T, Thomaidis T. Melatonin 4 mg as prophylactic therapy for primary headaches: a pilot study. Funct Neurol. 2016;31(1):33-37.

 

Eryilmaz, O. G., Devran, A., Sarikaya, E., Aksakal, F. N., Mollamahmutoglu, L., & Cicek, N. (2011). Melatonin improves the oocyte and the embryo in IVF patients with sleep disturbances, but does not improve the sleeping problems. Journal of Assisted Reproduction and Genetics, 28(9), 815–820. http://doi.org/10.1007/s10815-011-9604-y

 

Ford ES, Wheaton AG, Cunningham TJ, Giles WH, Chapman DP, Croft JB. Trends in outpatient visits for insomnia, sleep apnea, and prescriptions for sleep medications among US adults: findings from the National Ambulatory Medical Care survey 1999-2010. Sleep. 2014;37(8):1283-1293.

 

Gonçalves AL, Martini Ferreira A, Ribeiro RT, Zukerman E, Cipolla-Neto J, Peres MF. Randomised clinical trial comparing melatonin 3 mg, amitriptyline 25 mg and placebo for migraine prevention. J Neurol Neurosurg Psychiatry. 2016;87(10):1127‐1132. doi:10.1136/jnnp-2016-313458

 

Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007;16(4):372–380.

 

Peres MFP, Zukerman E, da Cunha Tanuri F, Moreira FR, Cipolla-Neto J. Melatonin, 3 mg, is effective for migraine prevention. Neurology. 2004;63(4):757.

 

Schwertner A, Conceição Dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: a phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-881.

 

Stewart WF, Shechter A, Rasmussen BK. Migraine prevalence. A review of population-based studies. Neurology. 1994;44(6 Suppl 4):S17-S23.

 

van Geijlswijk IM, Mol RH, Egberts TC, Smits MG. Evaluation of sleep, puberty and mental health in children with long-term melatonin treatment for chronic idiopathic childhood sleep onset insomnia. Psychopharmacology (Berl). 2011;216(1):111–120. doi:10.1007/s00213-011-2202-y