Neuroendocrine Crosstalk Between Sleep and Ovarian Function: Insights Into Hormonal Homeostasis

Tanima Saha; Pratheeksha Kamath; Deepthi Devadas; Harry Mary Samantha; Vadhtyavath Anusha; Sonal Grace; Kasaragod Palla Shreyas; Gargi Ray Chaudhuri

doi:10.33069/cim.2025.0063

Chronobiol Med > Volume 7(4); 2025 > Article

Saha, Kamath, Devadas, Samantha, Anusha, Grace, Shreyas, and Chaudhuri: Neuroendocrine Crosstalk Between Sleep and Ovarian Function: Insights Into Hormonal Homeostasis

Review Article

Chronobiology in Medicine 2025;7(4):196-207.

Published online: December 31, 2025

DOI: https://doi.org/10.33069/cim.2025.0063

Neuroendocrine Crosstalk Between Sleep and Ovarian Function: Insights Into Hormonal Homeostasis

Tanima Saha¹

, Pratheeksha Kamath²

, Deepthi Devadas²

, Harry Mary Samantha³

, Vadhtyavath Anusha⁴

, Sonal Grace⁵

, Kasaragod Palla Shreyas⁶

, Gargi Ray Chaudhuri⁷

¹Department of Medical Laboratory Technology, School of Allied and Healthcare Sciences, Centurion University of Technology and Management, Odisha, India

²Faculty of Life and Allied Health Sciences, MS Ramaiah University of Applied Sciences, Bengaluru, India

³Department of Physiotherapy, School of Allied Health Sciences, REVA University, Bengaluru, India

⁴Department of Medical Laboratory Technology, NIMS College of Paramedical Sciences, NIMS University, Rajasthan, India

⁵GEMS Legacy School, Al Garhoud, Dubai, Saudi Arabia

⁶School of Science and Applications, REVA University, Bengaluru, India

⁷Department of Physiotherapy, Nopany Institute of Health Care Studies, Kolkata, India

Corresponding author: Gargi Ray Chaudhuri, PhD, Department of Physiotherapy, Nopany Institute of Health Care Studies, Kolkata, West Bengal, India.
Tel: 91-9831900694, E-mail: raychaudhurigargi@gmail.com

Received October 7, 2025 Revised November 22, 2025 Accepted December 3, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

In humans, the sleep-reproductive endocrinology interface is likely overly conserved due to the neuroendocrine regulation of circadian rhythms, pulsatile hormonogenesis, and ovarian physiology. This review explores the bidirectional relationship between sleep architecture and the hypothalamic-pituitary-ovarian axis, emphasizing how circadian timing, sleep-wake patterns, and melatonin release influence the pulsatile secretion of gonadotropin-releasing hormone, luteinizing hormone, follicle-stimulating hormone, and ovarian steroidogenesis. Sleep disturbances, such as insomnia, obstructive sleep apnoea, and circadian misalignment, can disrupt follicular development, ovulation, and menstrual regularity, all associated with subfecundity and endocrine disorders like polycystic ovary syndrome and endometriosis. Melatonin, with its antioxidant and chronobiotic properties, appears central to reproductive timing and the synchronization of light-dark cycles. This neuroendocrine interaction evolves across key sexual milestones (puberty, pregnancy, menopause) and is influenced by age and chronotype. Emerging neural imaging tools, biomarker assays, and chronotherapy studies now offer potential for personalized treatments that normalize melatonin levels. When combined with cognitive behavioral therapy for insomnia, such approaches may help restore hormonal balance and optimize reproductive outcomes. Sleep health should be integrated into reproductive medicine, requiring a holistic approach that incorporates circadian biology, stress responses, and environmental influences to support hormone regulation and women’s health across the lifespan.

Keywords: Circadian rhythm; Ovarian functions; Female reproductive hormones; Age; Menstrual health

INTRODUCTION

The relationship between sleep and ovarian function is intricate and encompasses the neuroendocrine axis, which involves the regulation of the central nervous system (CNS), circadian rhythms, and reproductive endocrinology. This balance of hormones is crucial for women’s health [1]. The suprachiasmatic nuclei (SCN) of the hypothalamus control the sleep-wake cycle and function as the principal circadian pacemaker of the human body. The SCN regulates the 24-hour rhythm of wakefulness and sleep, stimulates the rhythmic production of melatonin by the pineal gland, or modulates the activity of the hypothalamic–pituitary–adrenal (HPA) axis [2]. Epidemiological studies have shown that women who work rotating night shifts or long hours outside of the day are more likely to have irregular periods, endometriosis, miscarriages, and problems getting pregnant. This indicates that the disruptions in the circadian system can affect reproduction [3].

During normal sleep, especially in the slow-wave sleep (SWS) or rapid eye movement (REM) phases, there is a pattern of neuroendocrine signals that control the release of slow-wave growth hormone, lower cortisol levels, and change the pulsatility of gonadotropin-releasing hormone (GnRH) characteristics [4]. The hypothalamic-pituitary-ovarian (HPO) axis is the neuroendocrine system that controls the female reproductive endocrine system. GnRH neurons tell the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which regulate ovarian folliculogenesis, steroidogenesis, and ovulation functions [5,6].

It is imperative to investigate the neuroendocrine regulation of sleep or ovarian function, as recent findings indicate that reproductive wellness and sleep physiology are not opposing mechanisms, but rather two interconnected systems in women that regulate each other’s hormone status, fertility, and ultimately the overall health of the woman throughout her lifespan [7,8].

The purpose of this review is to summarize the evidence for a reciprocal association between sleep physiology and ovarian endocrine function in reproductive-aged women in the immediate postpartum period, as circadian control and steroidogenic signaling co-modulate aspects of reproductive health. This relation indicates a neuroendocrine equilibrium, since ovarian steroids can alter the sleep-wake cycle while the architecture of sleep promotes the pulsatile release of reproductive hormones. Therefore, knowledge of the neuroendocrine basis for sleep-ovary interaction is vital to individualized reproductive medicine, fine-tuning fertility treatment and fertility preservation therapy, treating hormone-related sleep issues in women, and ensuring that women receive health benefits in the long term.

SLEEP ARCHITECTURE AND CIRCADIAN REGULATION

Stages of sleep and hormonal fluctuations

In this respect, sleep architecture and circadian rhythm are an important background to understanding the neuroendocrine dialogue of sleep on ovarian function, given the close cycling of stages of sleep and their association with circadian rhythmicity of hormones that can greatly impact female reproductive endocrinology [8]. Sleep, in its homeostatic state, is organized into non-rapid eye movement sleep (NREM) stages N1 and N2, SWS or N3, and REM sleep, each distinguished by unique electroencephalographic and CNS evolutionary patterns and specific neuroendocrine profiles.

On the other hand, more REM sleep during the night is linked to higher levels of neurotransmitters or cholinergic tone, as well as small rises in cortisol. This is compatible with the purpose of this state, which is to balance emotional and mental functions with hormonal control. The timing of these sleep stages in relation to several hormonal rhythms, including melatonin secretion by the pineal gland and pulsatility of GnRH, is regulated by the SCN in the hypothalamus [9].

Sleep architecture is also suppressed/determined by the menstrual cycle: in the follicular phase, rising estradiol shortens sleep onset and increases REM density, while during the luteal phase, progestagens as well as its metabolites act to sedate through GABA-A receptor activity, deepening NREM sleep, albeit with increased night awakenings and altered thermoregulation [10]. Circadian disruption, such as shift work, jet travel, or chronic insomnia, can disturb the normally coordinated concurrence of sleep stages and hormonal rhythms, thereby undermining the potential for pulsatile release of GnRH, LH, and FSH, leading to decreased ovulation capacity and luteal phase adequacy with menstrual cyclicity.

Role of the SCN in circadian rhythm

The master pacemaker of the brain, which drives circadian rhythmicity in terms of sleep and wakefulness in humans, is a structure known as SCN. Located above the optic chiasm in the anterior hypothalamus, the SCN coordinates to a great extent the timing between sleep architecture and endocrine regulation, thus influencing neuroendocrine crosstalk mediating synchrony between sleep pattern and ovarian function [11]. As the master clock, SCN receives direct photic inputs from intrinsically photosensitive retinal ganglion cells (iPRGCs), which allow it to reset intrinsic physiology to environmental light–dark cycles. These close to 24-h cycles govern cyclic secretion of neuroendocrine signals and hormones and are regulated by an endogenous molecular clock, composed of a series of transcriptional-translational units as well as interlocked autoregulatory feedback loops involving core clock genes such as CLOCK, BMAL1, PER, and CRY within the SCN.

More specifically, the SCN entrains rhythmic firing by GnRH neurons, a pattern which is requisite for generating an estrogen-dependent preovulatory LH surge as well as a pulsatile peptidergic release that drives subsequent normal menstrual cyclicity. SCN malfunction or circadian disruption—such as that caused by shift work, chronic jet lag, or exposure to irregular light patterns—will alter hormonal rhythms and sleep-wake cycles [12]. Like a reset switch, SCN synchronizes the timing of melatonin production, changing rhythmic secretory pattern in cyclic GnRH-LH/FSH motor system, driving evolutionarily ancient circuits installed along the HPO axis, waking up anovulatory menstrual cycle luteal phase anomalies even menstrual irregularities.

Melatonin synthesis and its reproductive implications

The synthesis of melatonin and its significance in reproduction is a critical aspect of the neuroendocrine interplay between sleep and ovarian function, as melatonin regulates our circadian rhythms and serves as a powerful modulator of female reproductive endocrinology. Melatonin is synthesized through a metabolic process wherein tryptophan is transformed into serotonin and subsequently into N-acetylserotonin, which is then methylated by hydroxyindole-O-methyltransferase (HIOMT) to produce melatonin [13]. This rhythmically released indoleamine acts on MT1 and MT2 receptors located in the CNS, reproductive tissues, and peripheral organs to relay circadian timing information to endocrine and cellular function. It has great antioxidant properties and thus may preserve ovarian follicles and oocytes from oxidative damage and ovarian reserve/fertility preservation. Melatonin shows multiple changes over reproductive life, including high values in childhood, decreasing at puberty to allow the start of gonadotropin release, stable concentrations during reproductive ages, and a decrease at advanced age affecting reproductive aging and entry into menopause.

The inhibition of melatonin production due to disruption of the circadian rhythms, exposure to light at night, or sleep deprivation disrupts synchronization of the HPO axis, which causes alterations in the rhythm of GnRH pulses/persistence of LH surges, anovulatory cycles, shifts in menstrual cycle, and reduced fertility relationship also stand between the pineal gland and female reproductive endocrine system [14]. Clinical and experimental evidence has shown that melatonin is required for pregnancy, as it not only sustains placental function and progesterone production but also fetal growth because of its antioxidant and circadian entrainment effects. Moreover, in assisted reproductive technology (ART), melatonin supplementation exerts protective effects on the oocyte quality, fertilization rates, and embryo viability, emphasizing that melatonin is a promising therapeutic drug in reproductive medicine (Figure 1).

NEUROENDOCRINE AXIS: LINKING SLEEP AND REPRODUCTIVE HORMONES

HPG axis overview

There also seems to be an inevitable bond between brain, sex hormones, and sleep architecture mediated through the circadian and homeostatic processes, and controlling the synthesis of gonadal steroid hormones. The HPG axis is the fundamental neuroendocrine system that connects the physiology of sleep [15]. Sleep architecture perturbations (e.g., insomnia, sleep apnea, circadian misalignment) may disrupt GnRH pulsatility, inhibit LH/FSH secretion, and impair ovulation, directly linking sleep disruptions to subfertility, abnormal menstrual cycle, and disorders such as polycystic ovary syndrome (PCOS) [16].

Reproductive milestones—such as puberty age, pregnancy, and menopause—influence sleep and HPG functioning change, suggesting bidirectional communication between sleep and the HPG axis. For instance, increased nocturnal GnRH secretion at puberty is coincident with changes in the sleep-wake cycle; pregnancy involves increased progesterone-related sleepiness and peripheral HPG function, and menopause involves the reduction in the levels of both estrogen and progesterone, which reduces circadian regulation and promotes risk of insomnia and increased gustatory thresholds [16].

GnRH pulsatility and LH/FSH secretion are influenced by sleep

It has been shown that sleep affects numerous biological processes of the HPGA. Pulsatility of GnRH and the subsequent secretory activity of LH and FSH during sleep indicate significant acute and long-term changes [17]. There are strategically placed neurons in the hypothalamus that may meet Voigtländer's criteria. These neurons release pulsatile patterns that signal the anterior pituitary gonadotroph cells correctly for both the frequency and amplitude of LH and FSH secretion. These dynamics do not remain fixed; they are clearly influenced by sleep distribution and circadian input.

Furthermore, such sleep-dependent sensitivity is conditioned by age and stage of reproduction. During adolescence, the re-entry of nocturnal GnRH secretion signals the onset of puberty, whereas in the perimenopausal transition, fragmented sleep and falling ovarian steroids disrupt the frequency with which GnRH pulsing and gonadotropin rhythm (and, by implication, ovarian cyclical function) can oblige [18]. Another potentially complicating factor in this relationship is that modified feedback via ovarian inhibitory GABAergic control of the GnRH pulse generator and sleep indicates an integrated neuroendocrine and endocrine regulation. High levels of LH hormones, like those experienced in high progestin states, make you unconscious by acting on the GABA system.

These relationships have considerable clinical ramifications: in women suffering from sleep disorders and circadian disruption, there is a higher incidence of infertility, irregular menstrual cycles, and diseases such as PCOS, for which modified GnRH/LH pulsatility is utilized as a diagnostic criterion [19].

Interaction with stress hormones (CRH, cortisol)

The interaction among sleep, reproductive hormones, and stress-related hormones—especially corticotropin-releasing hormone (CRH) or cortisol—is essential to the neuroendocrine connection between sleep and ovarian function, as the HPA axis engages with the HPG axis in the maintenance of female reproductive homeostasis [20]. The hypothalamus’ paraventricular nucleus (PVN) sends CRH to the anterior pituitary gland when it senses stress or circadian cues. The anterior pituitary gland then discharges adrenocorticotropic hormone (ACTH). This hormone instructs the adrenal cortex to make cortisol. Cortisol levels usually follow a daily pattern, remaining low during sleep and rising before awakening.

CRH induces pulse inhibition of GnRH release or gonadotroph responses, diminishing preovulatory/LH surges, at least partially through kisspeptin and opioid neuropeptides, resulting in further disruption of central control over the HPG-axis. The ramifications of this conflicting HPA–HPG crosstalk are most effectively illustrated in the context of stress-induced reproductive disorders, including hypothalamic amenorrhea, luteal phase deficiencies, anovulation, and menstrual irregularities, which are frequently associated with chronic sleep deprivation [21]. Clinical evidence indicates that dysregulation of the HPA axis, alterations in cortisol rhythm, and excessive reproductive endocrine control create a feedback loop between sleep disturbances and ovarian dysfunction [22]. Key studies examining the relationship between sleep patterns and ovarian hormones are presented in Table 1 [23-37].

OVARIAN FUNCTION AND HORMONAL HOMEOSTASIS

Follicular development and ovulatory cycles

Folliculogenesis and the ovulatory cycles represent the primary biological events related to ovarian function, which are exquisitely controlled by neuroendocrine feedback pathways and also include regulatory influences of sleep and circadian rhythmicity, which appear to be key factors affecting hormonal homeostasis in women [38]. Sleep–wake physiology regulates these endocrine rhythms, which is important because SWS and nighttime circadian time-keeping signals increase GnRH pulsatility and LH production, which are necessary for the follicles to mature and for ovulation to occur [39]. Melatonin is released by the pineal gland in a circadian manner regulated by the SCN, and it not only influences sleep but also exerts a local action on ovarian tissue, with capacity to inhibit steroidogenesis and shield developing follicles from oxidative stress besides exerting beneficial effects on oocyte quality (Figure 2).

The interactions between estrogen/progesterone on sleep quality

The inter-relationship of estrogen and progesterone with sleep is complex, and it makes the control of these hormones a likely player in the complicated interaction between ovarian function and sleep behavior. Changes in these reproductive steroids not only impact reproductive cycles but also facilitate nootropic regulation of inductive processes, including sleep architecture, circadian phase, or hormone array balance [40]. Granulosa cells in developing follicles synthesize most of the estrogen, subsequently influencing central neurotransmitter systems, including serotonergic, cholinergic, and gamma-aminobutyric acid pathways. These neurotransmitter systems are related to the time it takes to fall unconscious, the amount of REM sleep, and the effectiveness of the thermoregulatory control.

Estrogen has a small effect on circadian or REM cycles, but progesterone helps deepen sleep and has anti-anxiety effects, both of which are part of the 24-hour menstrual cycle. When these rhythms become altered (e.g., luteal phase defects, irregular anovulatory cycles, or endocrine syndromes), sleep gets fragmented, the transition between REM and NREM sleep is disrupted, and the disconnection between ovarian steroid functions or sleep physiology adversely impacts both reproductive and systemic health [41].

Sleep-dependent regulation of anti-Müllerian hormone and inhibin

The effects of estrogen, progesterone, or testosterone in gynecological endocrinology relate not only to the maintenance of the menstrual cycle and reproductive capacity but also to sleep stimulation, the nature of which remains uncertain. Finally, sleep-dependent regulation of anti-Müllerian hormone (AMH) and inhibin adds a first virtual at bottom stone to the complex network of brain-ovary crosstalk, because both these two ovarian hormones function as “markers” and “modulators” for follicle growth (FG), reproductive life-span, and hormonal homeostasis release, depending also on good quality/sleep profile, circadian fitness, and neuroendocrine health. AMH, which is produced from the granulosa cells of preantral and early antral follicles, serves as an ovarian reserve marker and plays a major role in directing the process of folliculogenesis by inhibiting primordial follicle recruitment and FSH sensitivity [42].

Inhibin, produced by the granulosa cells of developing follicles (inhibin B in the early to middle follicular phase) as well as luteal tissue (inhibin A luteal phase), provides negative feedback on anterior pituitary FSH release, thus precisely regulating follicle growth and preventing excessive recruitment. AMH and inhibin both vary throughout the menstrual cycle and reproductive lifespan, with each being dynamically regulated, but novel data suggest that this regulation is not entirely ovarian conditioning of systemic neuroendocrine influence [43]. There is emerging clinical and experimental evidence linking sleep disorders and circadian disruption with alterations in AMH levels, accelerated ovarian aging, impaired recruitment of the follicles, and diminished fertility potential, suggesting that sleep may be a significant environmental modulator of the ovarian reserve [44].

Furthermore, based on responses by disturbed sleep quality, for example, the antioxidant property of melatonin in granulosa cells and the increase in serum AMH, or cognitive behavioral therapy for insomnia (CBT-I) for the maintenance of circadian rhythm control, it is conceivable that basal AMH and inhibin may result from an increase to replace damaged ovarian function as a form of fertility reserve (Figure 3). It follows that sleep-dependent regulation of AMH and inhibin uncovers a complex, hitherto unestimated ovarian endocrine-exocrine facet whereby the sleep/circadian system influences not only the dynamics of GnRH and gonadotropins but also ovarian reserve markers, follicular recruitment, and reproductive span, which is further consistent with evidence in favor of restored sleep positively influencing women’s endocrine and reproductive health [45].

Figure 3 shows a diagrammatic layout of the female reproductive system in terms of hormones that are released during the HPO axis stimulation. GnRH is released in pulses by the hypothalamus, and it is controlled by neuropeptides such as, for example, kisspeptin (KISS, excitatory), neurokinin B (NKB), or dynorphins (DYN, inhibitory), which administer external signals to modulate reproductive function. GnRH is responsible for inducing LH and FSH release through the anterior pituitary, which acts on the ovary to mediate follicular growth and steroidogenesis. Whereas the ovary secretes estradiol and inhibins, which influence the release of gonadotropins through feedback. Estradiol exerts negative feedback in the follicular phase by inhibiting GnRH, LH, and FSH. It becomes positive feedback near ovulation and induces an LH surge. Inhibin B is inhibitory to FSH in the follicular phase, and inhibin A is inhibitory during the luteal phase. Estradiol stimulates the uterus to build up the endometrium, which provides an optimal environment for implantation to take place.

SLEEP DISTURBANCES AND REPRODUCTIVE DYSREGULATION

Insomnia, sleep apnea, and circadian misalignment

Nocturnal insomnia, sleep apnea, and circadian misalignment are the main types of sleep disturbance that, by interrupting the interdependent cycle of neuroendocrinal signals from sleep to ovarian function, affect the entire HPG axis, including reproductive cyclicity as well as ovarian reserve and systemic homeostasis of hormones in females [46]. The sleep disorder insomnia, which is characterized by difficulty falling asleep or staying asleep, often results in prolonged and severe sleep deprivation, hyperactivation of the HPA axis, and raised nocturnal cortisol levels 1 that can all disrupt the frequency of GnRH pulses as well as pituitary secretion of gonadotropins (LH/FSH). Clinically, it is expressed as luteal phase deficiency, anovulation, menstrual derangements, and subfertility. Insomnia also compounds disturbances of an already disrupted estrogen and progesterone profiles, especially in perimenopause, as evidenced by increased luteal phase hormone variability in perimenopausal women compared with postmenopausal women.

In women, obstructive sleep apnoea (OSA) has more recently been related to PCOS, having GnRH/LH pulsatility disturbances associated with obesity, insulin resistance, and disordered breathing. This suggests that sleep apnea not only worsens the disruption of reproductive endocrine but also further enhances metabolic and endocrinological dysfunction [47].

Crucially, such sleep disturbances lead to metabolic dysfunction and systemic inflammation to potentiate their effects on ovarian physiology. Therapies that restore sleep quality and circadian alignment—for example, cognitive-behavioral therapy for insomnia, continuous positive airway pressure (CPAP) therapy for OSA, melatonin supplements, and strategic light exposure for circadian realignment—offer promise for the amelioration of menstrual cyclicity, fertility outcomes, and endocrine health [48].

Impact on menstrual irregularities, anovulation, and fertility

Despite growing interest in this andrological issue, sleep disruption in women has dramatic consequences on menstrual cyclicity, ovulatory function, and fertility, and represents one of the most relevant expressions of perturbed neuroendocrine crosstalk between sleep and ovarian activity, in that changes in sleep architecture, circadian alignment, and hormone signaling converge to dysregulate the HPG axis and ovarian function [49]. In addition, the quality of ovulation is generally inferior in sleep-disrupted conditions because poor sleep disrupts progesterone production during the luteal phase and impairs endometrial receptive state and implantation, which leads to early pregnancy loss or infertility. There is also clinical and experimental evidence for an association between nights of poor sleep and altered levels of AMH and inhibin, both markers of ovarian reserve, thereby indicating a role for sleep in the modulation of long-term fertility potential [50,51].

Sleep problems in PCOS, endometriosis, and menopause

Characterization of sleep disturbances in PCOS, endometriosis, and menopause is a clear illustration of how the disruption of sleep/circadian rhythms can exert additional detrimental effects on reproductive dysfunction through the complex central neuroendocrine axis and stress but also emphasizes the inherent bidirectionality in relationship between sleep physiology, ovarian function, and systemic hormonal homeostasis [50]. This is in line with other data and highlights the idea that sleep disorders are not only comorbid condition but an active player influencing disease body progression, reproductive malfunction as well. Altogether, it points out lack of good sleep could have a role in this scenario, affecting a female hormone homeostasis lifelong, thus likely having an impact supporting how important being functionally sound in sleeping might be, at least for helping to control ovarian dysfunction/hormonal balance during human life [52,53].

AGE, CHRONOTYPE, AND HORMONAL SENSITIVITY

Adolescent sleep patterns and pubertal hormone shifts

The sexual dimorphism of adolescent sleep during pubertal endocrine sex transitions serves as a critical window to speculate on the possibility of dialogue between sleep and ovarian activity neuroendocrine systems, as there is extensive biologically transformatory circadian as well as endocrinal remodeling in this specific phase of human development that shapes subsequent developmental trajectories with respect to reproductive health and hormonal balances across life span [54,55]. Due to an increased sensitivity of the ovarian axis to exogenous hormonal signals during adolescence, this is a critical time in the life cycle when sleep disruptions that may only be temporary, such as psychosocial stressors, lifestyle changes, and circadian misalignment, may nonetheless have persistent negative effects. Such disruptions may also impact GnRH and gonadotropin secretion by increasing frequency and decreasing amplitude during early reproductive years much more so than in later years [56,57], leading to anovulation and luteal phase insufficiency.

Sleep and reproductive aging in perimenopausal women

Sleep and reproductive aging in perimenopausal women is one of the most complicated aspects of neuroendocrine crosstalk between sleep and ovarian physiology, since the reproductive transition from maturity to menopause is orchestrated by profound hormonal alterations, disruption in the central and peripheral circadian clock function, and sleep fragmentation, leading cumulatively to an attack against systemic-reproductive homeostasis and physiology [58]. This symptom not only keeps you up at night, but also starts a cycle of increased arousal, activation of the sympathetic nervous system, and stimulation of the HPA axis, making it more difficult to fall back asleep.

Chronotype variations and hormonal responsiveness

The rapid pain response range may create a complex telecommunication loop involving sleep regulation, endocrine balance, and reproduction, wherein circadian biology, hormonal environment, and reproductive signaling interact. Within this feedback mechanism, both chronotype propensity and hormonal issues act as determining variables that regulate reproductive health at various stages of the life course [30]. The amplitude of the signals is influenced by a person’s chronotype, which is based on whether they prefer “morningness,” “eveningness,” or any other acrophase time.

Another intriguing discovery is that circadian behavior can improve and change the hormonal responses. Evening types show less sensitivity to melatonin, an irregular response of the corticoadrenal system to stress, and more anti-insulin activity, which is in line with what has been discovered in studies on melatonin supplementation. These involve both disrupted leptin and ghrelin signaling and difficulties in energy homeostasis, which subsequently influence the hypothalamic control of GnRH, potentially establishing an adaptive loop for menstrual irregularities [59].

THERAPEUTIC AND LIFESTYLE INTERVENTIONS

Sleep hygiene and CBT-I

Sleep hygiene interventions encompass behavioral and environmental strategies, typically involving structured activities [60]. These include maintaining a consistent sleep-wake schedule, avoiding artificial blue light exposure in the evenings, optimizing the sleep environment to be dark, quiet, and cool with minimal noise levels; refraining from stimulant drugs such as caffeine and nicotine, alongside moderate alcohol consumption or daily aerobic exercise (20–30 minutes); and implementing pre-sleep routines that incorporate relaxation and mindfulness exercises to facilitate the transition from wakefulness to sleep [10].

As an evidence-based psychotherapeutic intervention, CBT-I addresses maladaptive cognitive and behavioral patterns that maintain insomnia, such as cognitive restructuring to challenge distorted beliefs about sleep deprivation, stimulus control to strengthen associations between the bed and sleep and weaken arousal in the sleep environment, sleep restriction to reconsolidate fragmented sleep and improve sleep efficiency, relaxation training to attenuate hyperarousal and sympathetic overactivity, and education about circadian alignment for matching sleep timing with circadian rhythms [61].

Chronotherapy and melatonin supplementation

The neuroendocrine interaction between sleep and ovarian functions is a highly dynamic, intricate sequence of events, wherein circadian oscillations, pulsatile hormonal secretion, and environmental exposure occur to regulate reproductive health and overall endocrine balance with potential therapeutic and lifestyle (e.g., melatonin supplementation) implications [62]. Thus, chronotherapy provides a targeted approach to re-entrain disrupted circadian systems with HPO function, such as to optimize hormone balance and most effective reproductive physiology through appropriate timing of exposure to natural or artificial light relative to sleep to phase shift circadian rhythms, meal timing and exercise to reinforce synchrony or alignment to circadian system, and aligning sleep-wake timing to the individual system chronotype to optimize hormone responsiveness and efficiency of sleep (Table 2).

Additionally, melatonin therapy exerts a potent chronobiotic and antioxidant activity, since melatonin is not just a master regulator of the circadian pacemaker of the pineal gland but also an extensive modulator of both body physiology and local modulation of peripheral processes, such as in the reproductive system, thus affecting ovarian steroidogenesis, follicular transduction, and the antiapoptotic pathways of the granulosa cells. They are also very flexible during the reproductive years because they cause perimenopause and postmenopause to occur again in postmenopausal women who have circadian desynchronization, endogenous melanin loss, or sleep problems that lead to repeated hormonal dysregulation of reproductive dysfunction [63]. Table 2 summarizes emerging sex-specific findings in female sleep research [64-78].

Integrative approaches: nutrition, exercise, and stress management

The neuroendocrine interaction between sleep and the ovarian functional system represents a complex bidirectional network in which sleep quality, circadian rhythm dynamics, and ovarian hormone regulation are interrelated. There is increasing evidence that lifestyle factors, including nutrition, physical activity patterns, and stress management, are essential for hormonal equilibrium, reproductive health, and overall holistic homeostasis. Intervention and management strategies involve focusing on “modifiable” variables that have the potential to affect this balance, with dietary behavior being a key starting point due to the direct relationship with nutrition and/or poor sleep quality and hormonal profile.

They could be due to that with optimal nutrition, ovarian development and recovery would be proportionately better and also provide protection of ovarian tissue against oxidative stress. Perhaps the kind of food consumed—rich in phytoestrogens, omega-3 fatty acids, vitamins D-B-complex, magnesium, and antioxidants—may influence ovarian steroidogenesis, oxidative stress at the ovarian level, as well as circadian rhythm stabilization/melatonin production. Conversely, sugar (refined) and trans fats that are also present in ultra-processed refined sugar could affect insulin signaling, leading to an increase in average pro-inflammatory cytokines and worse sleep disturbances, but not their multiple degrees depending on HPO axis imbalance [79].

EMERGING RESEARCH AND FUTURE DIRECTIONS

Neuroimaging and biomarker-based studies

The relationship between sleep and the corticotropic axis is a complex and evolving narrative, poised for elucidation through advanced neuroimaging technologies and investigative methodologies, supported by novel insights into the precise cell and molecular processes regulating hormonal balance, thereby informing future therapeutic strategies and precision medicine. Neuroimaging studies, including functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and high-resolution structural MRI, have started to identify the brain regions and neural networks implicated in this crosstalk dynamic [80]. Functional connectivity studies have indicated that dysfunctional resting-state networks in sleep disorder patients, e.g., insomnia and circadian misaligned subjects, might be responsible for the abnormal activity and connectivity of these networks, which are related to abnormal pulsatility of GnRH release, LH/FSH levels, and menstrual irregularity. These findings have provided hitherto unknown neurobiological evidence supporting existing clinical evidence on the relationship between central sleep regulation and peripheral ovarian function.

New multi-omics approaches, such as transcriptome, proteome, and metabolomics, in both CNS and peripheral blood, are now delivering further molecular signature patterns underlying the interactions of sleep-hormone revealing on energy metabolism (e.g., oxidative stress, mitochondrial function) and neuro-inflammation associated with impaired ovarian functions to reproductive aging occurring due to sleep disruption [81]. Such integrative neuroimaging and biomarker approach also allows for precision phenotyping of individual differences in circadian phase, hormonal sensitivity, and reproductive stage that may enable us to personalize therapeutics on a subject-specific basis and begin to predict high-risk populations susceptible to sleep-related reproductive misregulation.

Role of artificial light and digital exposure

The neuroendocrine crosstalk of sleep and reproductive function is tightly regulated by environmental contingencies, with perturbing agents recently acknowledged as key circadian synchronizers, hormonal modulators, and therefore gatekeepers of reproductive well-being in human physiology, yet with no clear mechanisms or therapeutic approaches. Neuroimaging and biomarker research are starting to elucidate the neural and molecular underpinnings of these effects, aiding in the identification of the mechanisms by which evening exposure to artificial light is closely associated with melatonin suppression, increased nocturnal cortisol levels, increased sympathetic activity, alterations in prefrontolimbic brain networks related to sleep/wake regulation, and inflammatory markers; all of which likely disrupt the ovarian steroidogenesis HPO axis feedback loop [82].

Chronic and frequent exposure to artificial digital light is associated with a delayed bedtime, reduced sleep duration, elevated wake after sleep onset, and modified hormonal levels related to energy balance (leptin, ghrelin), which may ultimately influence reproductive health through metabolic signaling pathways [83]. The current article suggests prospective avenues for research, highlighting the necessity for large-scale, high-density longitudinal studies employing objective measurements of light exposure and sleep.

Precision medicine in sleep and reproductive health

Exploring the potential of individualized medicine through neuroendocrine interactions between ovarian function and sleep provides exciting possibilities in fields other than reproductive medicine, like sleep medicine. Individual biological or genetic differences will be valued and used to keep the hormones in balance, which will lead to better health. Wearables and digital health platforms could make personalization more possible by tracking variables like light exposure, physical activity, and stress levels in real time [84].

CONCLUSION

An intriguing field for future research pertains to the HPA axis, which is influenced by sleep, gynecological, or sexual functioning, as these are highly responsive to the activity of this axis. Additional research is necessary in this domain, encompassing studies on circadian physiology, sex steroid feedback regulation, and the development of personalized treatment modalities that provide patients with specific options. Molecular and systemic connections illuminating the relationship between sleep architecture or reproductive endocrinology are likely based on chronobiological principles aligned with individual chronotype styles that influence hormonal credibility. Melatonin exhibits pleiotropic properties, encompassing anti-inflammatory and antioxidant effects, as well as an inhibitory influence on steroidogenesis. It is probably good for the quality of oocytes, the regularity of the menstrual cycle, and the support of the luteal phase because sleep is important for controlling female reproductive functions; it makes sense that sleep research would shift more in line with chronobiology. However, more direct collaboration between disciplines is needed for this to function effectively in instances of female health and physiology that look at the whole lifespan.

NOTES

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

Availability of Data and Material

Data sharing not applicable to this article as no datasets were generated or analyzed during the study.

Author Contributions

Conceptualization: Tanima Saha, Gargi Ray Chaudhuri. Data curation: Deepthi Devadas, Harry Mary Samantha, Vadhtyavath Anusha, Sonal Grace. Formal analysis: Gargi Ray Chaudhuri. Investigation: Tanima Saha, Gargi Ray Chaudhuri. Methodology: Deepthi Devadas, Harry Mary Samantha, Vadhtyavath Anusha, Sonal Grace. Project administration: Gargi Ray Chaudhuri. Resources: Deepthi Devadas, Harry Mary Samantha, Vadhtyavath Anusha, Sonal Grace. Software: Sonal Grace, Kasaragod Palla Shreyas. Supervision: Gargi Ray Chaudhuri. Visualization: Gargi Ray Chaudhuri. Writing—original draft: all authors. Writing—review & editing: Tanima Saha, Gargi Ray Chaudhuri.

Funding Statement

None

Acknowledgments

This paper was edited and proofread by seeking professional services from Probecell Scientific Pvt. Ltd., India.

Figure 1.

Neuroendocrine regulation of melatonin synthesis across the circadian cycle. The neurochemical and anatomical regulation of melatonin production across the circadian cycle is illustrated, with distinct pathways operating during daytime and nighttime. During the day, light signals perceived by retina are sent through the retinohypothalamic tract to the suprachiasmatic nuclei (SCN)—the master circadian clock. The SCN secretes glutamate, the stimulation on paraventricular nucleus (PVN) and descending autonomic centers such as the intermediolateral cell column (ILC) or superior cervical ganglion (SCG). This whole cascade process suppresses melatonin production in the pineal gland, which is responsible for wakefulness and suppression of nocturnal physiology. The same daytime signaling is also modulated by acetylcholine. During the night, when there is no light, SCN activity decreases, which removes the inhibition of melatonin synthesis. This mechanism is mediated by norepinephrine released from the SCG, acting on β-adrenergic receptors and activating an intracellular signaling cascade through adenosine triphosphate (ATP) and cyclic adenosine monophosphate (cAMP). The resulting melatonin is released in the circulation to help sleep and synchronize peripheral clocks. The diagram depicts this light-driven switch in neuroendocrine output, highlighting that the SCN and pineal gland are pivotal to circadian timekeeping. HIOMT, hydroxyindole-O-methyltransferase; NAT, N-acetyltransferase.

Figure 2.

Schematic representation of bidirectional communication between the brain, endocrine, and immune systems. Stress-induced hypercortisolemia further exacerbates these effects, notably through the inhibition of GnRH release and ovarian steroidogenesis, thus linking poor sleep quality with stress and subfecundity. The sleep–ovary connection changes over the lifespan that is to say amplified nocturnal GnRH drive during sleep is an element of copeptin regulation on folliculogenesis, and menstrual cyclicity during puberty, consolidated calorific fenetine regular cycling ovarian cyclicity across adult hood, hypo-thyroid states with high progesterone levels further drive sleep endometric corpora ludenicum and placental formation during pregnancy; absences of estrogen androgen at menopause or surgical ovariectomy leads to cycle/sleep disturbance underline the quality all a fundamental role for ovary hormones. FSH, follicle-stimulating hormone; LH, luteinizing hormone; AVP, arginine vasopressin; TNF-α, tumor necrosis factor-α; IL, interleukin; LPS, lipopolysaccharide; GnRH, gonadotropin-releasing hormone.

Figure 3.

Hormonal regulation of the female reproductive axis via neuroendocrine control. LH, luteinizing hormone; FSH, follicle-stimulating hormone; KISS, kisspeptin; NKB, neurokinin B; DYN, dynorphins.

Table 1.

Studies linking sleep and ovarian hormones

Study	Hormones analyzed	Key findings	References
Estrogen and sleep across lifespan	Estradiol, progesterone	Estradiol enhances REM; progesterone promotes NREM; hormone loss worsens sleep in menopause	[23]
Sleep patterns and reproductive hormones	Melatonin, cortisol, LH, FSH, estradiol	Sleep disruption lowers ART success; shift work alters LH/FSH and melatonin levels	[24]
PCOS: sleep and hormonal imbalance	LH, FSH, testosterone, melatonin	PCOS linked to poor sleep, reduced melatonin, elevated LH/androgens	[25]
Melatonin and oocyte quality in IVF	Melatonin, estradiol	Higher follicular melatonin improves oocyte quality and fertilization rates	[26]
Sleep duration and menstrual regularity	Cortisol, estradiol	Short sleep increases cortisol and disrupts menstrual cycles	[27]
Shift work and hormonal rhythms	Melatonin, LH, FSH	Night shifts blunt LH surge and alter melatonin secretion	[28]
Menopause: sleep and hormone therapy	Estradiol, progesterone, cortisol	Hormone therapy improves sleep and reduces cortisol in postmenopausal women	[29]
Kisspeptin and sleep quality	Kisspeptin, LH	Poor sleep lowers kisspeptin, impairing GnRH stimulation	[30]
Progesterone metabolites and sleep depth	Allopregnanolone	Enhances sleep via GABA-A modulation; critical during luteal phase	[31]
Leptin, sleep loss, and fertility	Leptin, ghrelin	Sleep deprivation lowers leptin, affecting GnRH and menstrual cycles	[32]
Melatonin therapy in endometriosis	Melatonin, estradiol	Reduces pain and estradiol; improves sleep and quality of life	[33]
Pregnancy: sleep and hormonal shifts	Progesterone, cortisol, melatonin	Sleep fragmentation increases cortisol; melatonin supports fetal development	[34]
Adolescents: sleep and pubertal hormones	Estradiol, LH, FSH	Sleep restriction delays pubertal hormone surge and menstrual onset	[35]
Circadian genes in ovarian tissue	CLOCK, BMAL1, PER1	Disrupted circadian genes impair folliculogenesis and steroidogenesis	[36]
Prolactin secretion and sleep fragmentation	Prolactin	Reduced nocturnal prolactin impairs luteal support and fertility	[37]

REM, rapid eye movement; NREM, non-rapid eye movement; LH, luteinizing hormone; FSH, follicle-stimulating hormone; ART, assisted reproductive technology; PCOS, polycystic ovary syndrome; IVF, in vitro fertilization; GnRH, gonadotropin-releasing hormone.

Table 2.

Trending sleep research: sex-specific differences in females

Study	Subject	Key findings	Reference
Female sleep fragmentation in rodents	Animal model (C57BL/6J mice)	Females sleep less and awaken more frequently; reduced NREM restorative sleep.	[64]
Sex differences in circadian rhythms	Human and animal studies	Females show greater circadian misalignment under stress; estrous cycle influences timing.	[65]
Sleep onset latency across menstrual phases	Clinical sleep tracking	Longer sleep latency during luteal phase; linked to progesterone fluctuations.	[66]
OSA impact by sex	OSA	Women with OSA and ESS have higher mortality risk.	[67]
Sleep quality in PCOS	Endocrine disorder	PCOS patients report poor sleep, increased sleep apnea risk, and altered melatonin levels.	[68]
Menopause and sleep architecture	Hormonal transition	Decline in estrogen is linked to reduced REM and increased sleep fragmentation.	[69]
Pregnancy sleep disruption	Gestational changes	Increased awakenings and cortisol; melatonin supports fetal circadian development.	[70]
Sleep and estradiol in adolescents	Pubertal development	Estradiol surge improves sleep consolidation; restriction delays hormonal maturation.	[71]
Chronotype differences by sex	Circadian preference	Females are more likely to be morning types; greater sensitivity to light and melatonin phase.	[72]
Sleep and emotional regulation in women	Neuroendocrine stress	Poor sleep amplifies emotional reactivity; oxytocin and cortisol show sex-specific patterns.	[73]
Sleep and cognitive decline in aging women	Neurodegeneration	Sleep disruption linked to faster cognitive decline in postmenopausal women.	[74]
Hormone therapy and sleep restoration	Menopausal intervention	Estrogen therapy improves sleep efficiency and reduces nighttime cortisol.	[75]
Sleep and immune function in females	Inflammatory markers	Females show stronger IL-6 and TNF-α response to sleep loss; linked to autoimmune risk.	[76]
Sleep and reproductive timing	Fertility outcomes	Poor sleep is linked to delayed ovulation and reduced ART success in women.	[77]
Sex bias in sleep drug trials	Pharmacological studies	Female mice are underrepresented; estrous cycle alters drug efficacy and sleep outcomes.	[78]

NREM, non-rapid eye movement; OSA, obstructive sleep apnea; ESS, excessive daytime sleepiness; PCOS, polycystic ovary syndrome; REM, rapid eye movement; IL-6, interleukin-6; TNF-α, tumor necrosis factor-α; ART, assisted reproductive technology.

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