Factors Affecting Sleep Quality in Middle-Aged Women by Menopausal Stage: A Cross-Sectional Study

Purpose: This study aimed to compare the perceived health status, health-promoting behaviors, resilience, and sleep quality of middle-aged women according to menopausal stage and to identify factors associated with sleep quality.Methods: This descriptive cross-sectional study was conducted among 390 women aged 40–64 years residing in cities J and S in South Korea. Participants were classified into the premenopausal (n=135), perimenopausal (n=123), and postmenopausal (n=132) groups. Data were collected through an online survey from January 8 to February 6, 2025 and were analyzed using descriptive statistics, chi-square or Fisher exact tests, analysis of variance, Pearson correlation coefficients, and binary logistic regression analysis.Results: Significant differences among the different menopausal groups were found in perceived health status, health- promoting behaviors, resilience, and sleep quality. Perimenopausal women had lower perceived health status, health-promoting behaviors, and resilience than both premenopausal and postmenopausal women, and showed the poorest sleep quality (F=35.87, p<0.001). Further, the prevalence of poor sleep quality was highest among perimenopausal women (78.9%). In all three groups, sleep quality was significantly correlated with perceived health status, health-promoting behaviors, and resilience. In premenopausal women, a higher resilience was associated with greater odds of good sleep quality (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.21–6.77; p=0.017). No significant factors were identified in perimenopausal women. In the postmenopausal group, women without chronic diseases had greater odds of good sleep quality than those with chronic diseases (OR, 2.28; 95% CI, 1.04–4.98; p=0.040).Conclusion: Sleep quality and its associated factors differed by menopausal stage. Stage-specific approaches that consider the characteristics and needs of women at different menopausal stages are required to improve sleep quality.