Around menopause, many women have at least occasional difficulties when it comes to sleep. Experts often attribute this to changing hormones or to the stress and anxiety that may accompany midlife.

A new study adds another potential factor to the mix: endocrine-disrupting environmental chemicals (EDCs), especially phthalates.

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This study is important because endocrine-disrupting chemicals are everywhere, says Stephanie Faubion, MD, a womens health physician at the Mayo Clinic in Jacksonville, Florida, and the medical director for the North American Menopause Society (NAMS). It provides additional evidence of potential sex differences in endocrine disrupting chemical exposure (in this case, phthalates) and impact on health.

The study was published on July 29, 2020, in the NAMS journal Menopause.

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Researchers at the University of Illinois used information from the Midlife Womens Health Study. This major clinical trial was conducted between 2006 and 2015 with women ages 45 to 54 in the Baltimore region, to assess risk factors for hot flashes in women not taking hormone therapy. Because the women were tracked closely for so many years, others researchers have subsequently mined its health data to shed light on other issues surrounding menopause.

For this study, data from 760 premenopausal and perimenopausal women were assessed. Questions the women had answered about sleep, among other things, were matched with concentrations of chemical phthalates in their urine.

The scientists focused on phthalates because a previous study had suggested increased exposure to the chemicals significantly increases a womans risk of hot flashes. Animal studies have also shown its influence on hormones associated with sleep.

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The results confirmed that the frequency of sleep disruptions in midlife women is associated with higher concentrations of phthalates in the body.

The relationship proved to be complex, however, and may be affected by other factors, especially smoking. Because smoking is known to impact both sleep and hormones, women with the same levels of chemicals who were former smokers reported different effects on their sleep than nonsmokers. This suggests that smoking history influences the relationship between phthalates and self-reported frequency of disrupted sleep, the authors write.

Still, anything that sheds light on possible reasons for sleep disturbances will be welcomed by many midlife women.

Up to 60 percent of women in their menopause transition report sleep issues, the study authors note. They also point out that women who have trouble falling asleep are at increased risk of developing depression.

Because this was an observational study and not a randomized clinical trial, and because of the confounding influence of smoking, additional study is needed investigating the complex relationship between endocrine disrupting chemicals, hormones, and sleep, mood, and menopause symptoms, Dr. Faubion says.

She also notes that other factors known to impact sleep were not measured in the study, including caffeine intake and stress, which may have influenced the results.

Whats more, the underlying mechanisms by which EDC exposure impacts sleep in midlife women still need to be uncovered, the researchers write.

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Even before that research is done, though, experts say its smart for all women, including those in midlife, to minimize phthalate exposure as much as possible. The chemicals appear to concentrate more in women than men, the study authors note.

Phthalates are common EDCs that are used in a wide array of industrial products to increase their performance, explains Nneka Leiba, MPH, vice president of healthy living science at the nonprofit Environmental Working Group in Washington, DC.

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They can be found in plastics and food packaging, Leiba says. A key way midlife women come into contact with them is through skin-care products.

Phthalates are used as ingredients in personal care products, including skin-care products, perfumes, and colognes, she says. And since they are typically part of any products fragrance mixtures, you are also likely to encounter them in anything with an aroma, from candles to detergents to trash bags, she says.

Black women may be at higher risks than white women for exposure to these chemicals. EWGs research indicates that Black women use more personal care products than other demographics, and there are fewer productsmarketed specifically to Black womenthat are free from chemicals, Leiba says.

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Due to their pervasiveness, it isnt possible to avoid phthalates completely. Even limiting your exposure would mean knowing which products theyre hiding in, something that is difficult because manufacturers are not required to label these ingredients, Leiba says.

Given that phthalates are often used in fragrances, Leiba suggests avoiding products that bear the catch-all label of fragrance. Instead choose products that disclose specific fragrance ingredients. You can even contact a manufacturer to ask about their use of phthalates in your favorite products, she advises.

EWGsSkin Deep database identifies many skin-care options without these and other ingredients of concern.

For any product, if you come across a brand labeled phthalate-free, choose it to help lower your risk of EDCs, advises the medical organization the Endocrine Society.

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