Restless Legs Syndrome - RLS and Menopause (en Inglés) - Khosro Hekmat

Is it the fall in oestrogen, not the level?

Many women between forty-five and fifty-five first notice restless legs. Sleep gets worse, they get up at night and walk around the flat, and when they mention it they are told: "That is the menopause." That answer is incomplete. Restless legs syndrome is a condition in its own right, with its own diagnostic criteria and its own treatment, and women report it about twice as often as men.

Whether natural menopause triggers it is a question on which the two most authoritative sources contradict one another. The European study group’s report says that menopause does not reduce the frequency of RLS and that hormone replacement therapy does not increase it. A 2020 review makes a stronger claim: that menopause increases symptom frequency and severity. This volume sets out that contradiction rather than smoothing it over, and examines one possible explanation: the hypothesis that a fall in oestrogen matters more than its level. No study has tested it directly.

Two situations of abrupt oestrogen loss are consistent with that hypothesis. After removal of both ovaries before the age of fifty, the hazard ratio for RLS was 1.44 in a cohort of 3,306 women. In a single-centre study of women with early breast cancer starting aromatase inhibitors, 36 of 137 women reported new RLS within 24 months, with no comparison group. A much-quoted pooled figure of 63.8% (confidence interval 10.6 to 96.3) is too imprecise to use.

Then comes iron. The end of menstrual bleeding ends the loss, but not necessarily the deficiency. In iron-deficient blood donors, replenishing iron improved RLS, fatigue and sleep quality, whether given by infusion or as tablets. The book explains why an old ferritin result does not show the current situation, why this series uses a ferritin below 100 µg/l as a threshold for discussing iron treatment, and why the upper limit for transferrin saturation matters more once periods stop.

WHAT IS IN THE BOOK

- Why women report RLS about twice as often as men, and the role of pregnancy

- The contradiction: why natural menopause barely moves the figures

- Removal of the ovaries and aromatase inhibitors: evidence from two other settings

- Why a widely quoted frequency figure is too imprecise, and which studies are more informative

- Iron after the last period, and why an old ferritin result does not show the current situation

- Hot flushes, insomnia, sleep apnoea and RLS: telling four night-time disorders apart

- Fatigue, mood and antidepressants that can make the legs worse

- Thyroid, weight, blood pressure and other conditions that may be mistaken for RLS

- Hormone therapy: what the available evidence says, and why none of it comes from a treatment study

- Guideline treatment, warning signs of augmentation and the non-drug methods

- Your own action plan and the medical consultation, step by step

- An evidence overview of how certain each finding is

WHO THIS BOOK IS FOR

For women whose legs first became restless during the menopausal transition, for women who have had their ovaries removed or are taking aromatase inhibitors, and for gynaecologists and GPs who want the evidence on RLS in midlife set out openly.