Case report| Volume 58, ISSUE 3, P319-322, November 20, 2007

Estrogen therapy reduces nocturnal periodic limb movements

Published:September 18, 2007DOI:


      It is believed that periodic limb movement (PLM) and more specifically, restless leg syndrome (RLS), are a common cause of insomnia. And one study in the literature examined PLM when associated to the use of estrogens. Polo-Kantola et al. [Polo-Kantola P, Rauhala E, Erkkola R, Irjala K, Polo O. Estrogen replacement therapy and nocturnal periodic limb movements: a randomized controlled trial. Obstet Gynecol 2001;97(4):548–54] observed that estrogen therapy improved subjective sleep quality regardless of periodic limb movements or related arousals. Herein is a case of a symptomatic postmenopausal patient with high PLM index who complained of insomnia and leg pain. Given that the patient had hot flashes and a high Kupperman Menopausal Index (which evaluates climacteric symptoms), we decided to administer transdermal ESTRADOT 25 μg (Novartis, Brazil) twice-a-week. Our patient experienced a significant decrease in PLM as well as a great increase in REM and a slight increase in slow wave sleep (stages 3 and 4), as shown in the polysomnography. The patient reported an overall improvement in her condition.


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        • Von Muhlen D.G.
        • Kritz-Silverstein D.
        • Barrett-Connor E.
        A community-based study of menopause symptoms and estrogen replacement in older women.
        Maturitas. 1995; 22: 71-78
        • Kuh D.L.
        • Wadworth M.
        • Hardy R.
        Women's health in midlife: the influence of the menopause social factors and health in earlier life.
        Br J Obstet Gynaecol. 1997; : 923-933
        • Guilleminault C.
        • Raynal D.
        • Weitzman E.D.
        • Dement W.C.
        Sleep-related periodic myoclonus in patients complaining of insomnia.
        Trans Am Neurol Assoc. 1975; 100: 19-21
        • Polo-Kantola P.
        • Rauhala E.
        • Erkkola R.
        • Irjala K.
        • Polo O.
        Estrogen replacement therapy and nocturnal periodic limb movements: a randomized controlled trial.
        Obstet Gynecol. 2001; 97: 548-554
        • Hruska R.E.
        • Silbergeld E.K.
        Increased dopamine receptor sensitivity after estrogen treatment using the rat rotation model.
        Science. 1980; 208: 1466-1468
        • Morissette M.
        • Di Paolo T.
        Effect of chronic estradiol and progesterone treatments of ovariectomized rats on brain dopamine uptake sites.
        J Neurochem. 1993; 60: 1876-1883
        • Ball P.
        • Knuppen R.
        • Haupt M.
        • Breuer H.
        Interactions between estrogens and catechol aminesInteractions between estrogens and catechol amines. 3. Studies on the methylation of catechol estrogens, catechol amines and other catechols by the ctechol-O-methyltransferases of human liver.
        J Clin Endocrinol Metab. 1972; 34: 736-746
        • Foreman M.M.
        • Porter J.C.
        Effects of catchol estrogens and catecholamines on hypothalamic and corpus striatal tyrosine hydroxylase activity.
        J Neurochem. 1980; 34: 1175-1178
        • Koller W.C.
        • Weiner W.J.
        • Klawans H.J.
        • Nausieda P.A.
        Influence of female sex hormones on neuroleptic-induced behavioral supersensitivity.
        Neuropharmacology. 1980; 19: 387-391
        • Hornyak M.
        • Trenkwalder C.
        Restless legs syndrome and periodic limb movement disorder in the elderly.
        J Psychosom Res. 2004; 56: 543-548
        • Manconi M.
        • Govoni V.
        • De Vito A.
        • et al.
        Restless legs syndrome and pregnancy.
        Neurology. 2004; 28: 1065-1069
        • American Academy of Sleep Medicine
        International classification of sleep disorders.
        Diagnostic and coding manual. 2nd ed. American Academy of Sleep Medicine, Werchester, IL2005
        • Ancoli-Israel S.
        • Kripke D.F.
        • Mason W.
        • Kaplan O.J.
        Sleep apnea and periodic movements in an aging sample.
        J Gerontol. 1985; 40: 419-425
        • Hornyak M.
        • Feige B.
        • Reirmann D.
        • Voderholzer U.
        Periodic leg movements in sleep and periodic limb movement disorder; prevalence, clinical significance and treatment.
        Sleep Med Rev. 2006; 10: 169-177
        • Kupperman H.S.
        • Wetchler B.B.
        • Blatt M.H.G.
        Contemporary therapy of the menopausal syndrome.
        J Am Med Assoc. 1959; 171: 1627-1637
        • Johns M.W.
        A new method of measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540-545
        • Rechschaffen A.
        • Kales A.
        A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects.
        UCLA Brain Information Service/Brain Research Institute, Los Angeles1968 (p. 57)
        • American Academy of Sleep
        Sleep-related breathing disorders in adults: recommendations for syndrome definitions and measurements techniques in clinical research. The report of an American Academy of Sleep Medicine Task Force.
        Sleep. 1999; 22: 667-689
        • American Sleep Disorders Association
        Practice Parameters for the treatment of restless legs Syndrome and Periodic Limb Movement Disorders.
        Sleep. 1999; 22: 968
        • Brodeur P.
        • Mockus M.
        • McCullough R.
        • Moore L.G.
        Progesterone receptors and ventilatory stimulation by progestin.
        J Appl Physiol. 1986; 60: 590-595
        • Mello M.T.
        • Esteves A.M.
        • Tufik S.
        Comparison between dopaminergic agents and physical exercise as treatment for limb movements in patients with spinal cord injury.
        Spinal Cord, Reino Unido. 2004; 42: 218-221
        • Mello M.T.
        • Esteves A.M.
        • Silva A.C.
        • Tufik S.
        Reduction of periodic leg movement in individuals with paraplegia following physical exercise.
        Spinal Cord, Reino Unido. 2002; 40: 646-649
        • Weston G.C.
        • Haviv I.
        • Rogers PA
        Microarray analysis of VEGF-responsive genes in myometrial endothelial cells.
        Mol Hum Reprod. 2002; 8: 855-863
        • Kim J.K.
        • Levin E.R.
        Estrogen signaling in the cardiovascular system.
        Nucl Recept signal. 2006; ([4 e013 Epub2006 July 7])
        • Suzuki S.
        • Brown C.M.
        • Dela Cruz C.D.
        • Yang E.
        • Bridwell D.A.
        • Wise P.M.
        Estrogen signaling in the cardiovascular system. Timing of estrogen therapy after ovariectomy dictates the efficacy of its neuroprotective and antiinflammatory actions.
        Proc Natl Acad Sci U S A. 2007; 3 ([Epub 2007 March 26]): 6013-6018