During menopause hormones fluctuate, causing symptoms1 like mood swings, hot flashes, and insomnia. If you’re experiencing menopause, you may take comfort in knowing there is a light at the end of the tunnel. Plus, understanding what’s going on with your body could help you find coping mechanisms during this somewhat unpredictable time.
In this article, we’ll go over what is happening internally during this shift, the difference between perimenopause and menopause, insomnia and other symptoms, and how to get better rest. We know this transitional period can be a lot, but our goal is to provide you with a detailed guide so that you feel informed and empowered while navigating this time in your life.
What’s Happening with My Hormones During Menopause?
Most of us are aware that menopause is characterized by changes in hormones much like puberty.1 However, rather than surges of new hormones like estrogen, testosterone, and progesterone, these hormones are instead gradually decreasing in the body.1 As they decrease, these hormones can be irregular and unpredictable, causing some of the typical menopausal symptoms we’re familiar with. The formal name for this transitional time period is “perimenopause.”1
During this menopausal transition, estrogen and progesterone begin to decline and become more unpredictable.1 Testosterone also declines2, but this has more to do with age than menopause (testosterone declines in everyone, regardless of sex, as we age). While the most obvious physical change during menopause may be the end of the menstrual cycle and fertility, these aren’t the only physical changes most people are likely to notice.
Hormones3 are integral to a normal sleep cycle, from helping us become drowsy to internal timekeeping. So it’s no surprise that during perimenopause and menopause, many people experience sleeping problems. You may be wondering, though, what reproductive hormones have to do with sleep.
According to Yale Medicine, progesterone has a mild sedative effect, and levels of this hormone, as well as estrogen, are higher throughout two-thirds of the menstrual cycle, helping some people sleep.3 Progesterone begins to increase after ovulation, during the second half of your menstrual cycle (the luteal phase), but before your period it drops to its lowest point.3 This change in progesterone levels can lead to some common PMS symptoms that can impact your rest.3
These common PMS symptoms are very similar4 to what people go through in the menopausal transition, due to low levels of estrogen and progesterone.
These hormones don’t solely affect sleep; they can also drastically affect mood and even cognition5. Because progesterone has a calming effect, as it decreases, many people experience mood swings and irritability.5 Some even begin to develop anxiety and depression that they didn’t experience prior to menopause according to the North American Menopause Society6. Additionally, decreased estrogen can impact sleep, mood, libido, cognition, and memory.5
So if you feel like you’re going crazy or becoming extra forgetful, the good news is that you’re in good company with everyone who has gone through menopause before you.
Perimenopause vs. Menopause
When most people talk about the discomforts of menopause – the hot flashes, sleepless nights, mood swings, irregular periods, vaginal dryness, and unpredictability – they’re actually talking about “perimenopause.”1 Perimenopause is the transitional period in which your hormones are slowly decreasing, leading to a variety of symptoms.1
Perimenopause, or “the menopausal transition,” can begin as early as your late thirties7 but usually begins somewhere in the forties. This period can last anywhere from several months to 15 years, but the average time spent in perimenopause is four years.7
During perimenopause, sex hormones like estrogen and progesterone rise and fall in an irregular fashion, meaning at some points in your cycle there may be more or less of these hormones than usual.7 So while you may have long spells without restful sleep or a period, these could come back suddenly in a confusing pattern.1
Menopause itself actually occurs on one day of your entire life, and it is the day that marks one year after you have completely stopped having periods.1 The transitional period before this is perimenopause, and the time after this day is post-menopause.
Is Menopause Causing My Insomnia?
If sleep disruptions are new to you and you have other symptoms of perimenopause, there’s a good chance this transition is a contributing factor to your lack of restful sleep. Insomnia is already much more common in women8 than in men. In fact, a CDC report9 on sleep quality in women aged 40-59 found that 56 percent of perimenopausal women and 40.5 percent of postmenopausal women report sleeping less than seven hours in a 24 hour period. According to the CDC, “Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.”9
A study10 performed at the Centre for Sleep Research at the University of South Australia found that perimenopausal people received less sleep and experienced more frequent arousals than those who were premenopausal, and were subsequently found to have more anxiety and depression than the group that received better sleep. This study suggests that mental health issues and perimenopause-induced insomnia could be related, meaning less sleep could worsen mental health issues and vice versa.10
If you find yourself struggling to fall or stay asleep during perimenopause, it is a good idea to address both your sleep and mental health. It might be a good time to see a therapist or psychiatrist to help you through the transition and any symptoms, or lean on any of your own personal self care practices. You can also talk to your doctor about treatment options.
How Long Does Menopause Last?
The average duration of perimenopause is four years, but this may vary from person to person and can be affected by other factors such as hysterectomy, tobacco use, and genetic factors.7 Perimenopause can last for up to 15 years, but this longer timeline is not common.1
During this time, your periods will likely become irregular, perhaps occurring more or less frequently, until eventually, toward the end of perimenopause, your periods become more spaced out and eventually stop altogether11.
After one year of no periods, the menopausal transition will be over and you’ll officially have reached menopause.1 For many, after the challenges that come with perimenopause, it is a welcome relief.
What About After Menopause?
Once you have gone 12 months without a period and are in menopause, many of the uncomfortable symptoms of perimenopause will likely fade away.12 However, there are still a few concerns you should be aware of.
A study13 in the Journal of Bone and Mineral Research found that women who sleep for less than seven hours per night are at a higher risk for low bone density and osteoporosis after menopause. While researchers aren’t positive about what causes the correlation, it’s clear that those who get enough sleep tend to have higher bone density while those who sleep less than seven hours have a lower bone density.13
Additionally, poor sleep can increase the risk for cardiovascular disease14. Since it can be harder to get as much sleep after menopause, the risk of heart disease can go up later in life.9
Practicing habits like a healthy diet and regular exercise can help with both osteoporosis and cardiovascular health after menopause, but it’s clear that finding a way to get enough sleep is also important.
One of the most common sleep interruptions in perimenopause is hot flashes15, which can make it difficult to fall and stay asleep.
Hot flashes are caused by a decrease in hormones– particularly estrogen– during perimenopause and after menopause. Essentially, this decrease in estrogen causes your body’s internal thermostat (your hypothalamus) to become more sensitive to temperature changes. When your hypothalamus thinks you are too warm, it tries to cool you down with lots of sweating, and an abrupt feeling of being flushed or overheated.15
While hot flashes can occur at any time during the day, when they happen at night, we’re likely to wake up sometimes drenched in sweat.
According to an Oxford study16, hot flashes are associated with changes in heart rate both when you wake up to them and when you don’t. The study suggests that sometimes when you have hot flashes in your sleep, your heart rate and blood pressure drop significantly to cool your body down, and thus don’t interrupt your rest.
However, at other times your heart rate and blood pressure may increase due to the hot flash, waking you up until you can cool yourself down. If you’re wondering why this matters, the study suggests both fluctuations (awake and asleep) can interfere with your cardiovascular restoration.16
Heart health is extremely important in women, as heart disease is the leading cause of death17 for women in the United States. So while hot flashes may be common, we don’t recommend ignoring them. Depending on how frequently your hot flashes occur, your doctor may prescribe a medication to help stop them, especially if they are preventing you from getting a good night’s sleep.
What Other Sleep Issues Are Common During Menopause?
While hot flashes and insomnia are some of the more common issues affecting sleep during perimenopause and menopause, there are plenty of other problems that can crop up during this time. Keep in mind that these may not affect you, but it’s always a good idea to be aware of potential issues.
Sleep apnea, specifically obstructive sleep apnea, is a common sleep disorder in menopausal people. A Massachusetts study18 of over fifty thousand females found that those who go through menopause early and those who surgically experience menopause via hysterectomy or oophorectomy (removal of one or both ovaries) are at a higher risk of developing sleep apnea. Additionally, those who are overweight tend to have a higher risk of developing sleep apnea.
For More Information: Best Mattress for Sleep Apnea
Depression might be common among those going through the menopausal transition, but that doesn’t make it something we should ignore or shrug off as normal, especially when it comes to sleep.
This shift toward depression could be due to the hormonal flux of perimenopause19, or it could be a result of the sometimes negative connotations of getting older and moving on to a new phase of life.
While some people find joy and relief in finally entering menopause, others may feel a sense of loss. Whatever the cause, your depression is valid, and we suggest talking to your doctor or therapist and finding ways to nurture your mental health.
If you’ve never dealt with anxiety before but suddenly you feel it coming on over seemingly small things, you aren’t alone. Anxiety is a common symptom of perimenopause, but when it comes to mental health issues, it’s important to remember that just because something is common doesn’t mean you should have to suffer through it.
The Cleveland Clinic20 says that while mild anxiety and depression may be expected during menopause, you shouldn’t be living with consistent panic attacks, suicidal ideation, or crippling anxiety. If you’re experiencing these symptoms, be sure to talk to a mental health professional like a therapist or psychiatrist.
Fatigue may be trickier to deal with than other symptoms associated with menopause because it can be caused by sleep interruptions like hot flashes and anxiety, but it can also result from waves of hormones2. This is especially true during perimenopause when you may have more progesterone than usual at some points.2
The sleep deprivation that comes with chronic insomnia could also cause mental fatigue21as sleep is vital for healthy cognitive function.
Some naturopathic doctors say energy and mental fatigue aren’t the only types of exhaustion your body experiences during the menopausal transition. “Adrenal fatigue” has become a buzzword surrounding menopause and, according to Dr. Martin Gleixner, MSc, ND at Moncton Naturopathic22, the condition could also lead to a myriad of other issues like hot flashes and memory changes.
Gleixner explains that when the ovaries begin to decrease in their hormone production, the adrenal glands kick into overtime to make up the difference. Over time, they can wear out without proper nutrition and support.22
While adrenal fatigue is commonly diagnosed by naturopaths, it’s important to note that the condition is not recognized by the Endocrine Society.
Diabetes & Menopause:
Is There An Added Risk?
For those with type 1 or type 2 diabetes, you could be at extra risk for health issues and sleeping problems during and after menopause because of the way sex hormones (or the lack thereof) affect blood sugar. According to the Mayo Clinic23, progesterone and estrogen can affect the way your body responds to insulin, so your blood sugar could become unstable and unpredictable.
In some cases, menopause can lead to weight gain, so if you have diabetes, you may require more insulin or oral diabetes medication to keep sugars controlled.23 This could mean you’ll need more alarms to check your sugars in the night hours and more adjusting of your insulin-to-carb ratio to account for your body’s changes. While most people with diabetes are accustomed to daily adjustments in care, during perimenopause and after menopause, people are at an increased risk for heart disease and sleep problems, so uncontrolled sugar could be more of an issue than normal.
If you are struggling to manage your diabetes, there is no shame in admitting you need some help. Even if you’ve successfully managed it yourself for years, recruiting a doctor to help you manage your case could be a good idea, especially when you start to notice some changes taking place. It may also be a good time to set up check-up appointments with your endocrinologist to ensure everything is running smoothly.
Questions to Ask Your Doctor
Once you know you’re experiencing symptoms of perimenopause, it’s probably a good idea to talk to your doctor, therapist, herbalist, or even dietician about ways to move through these symptoms comfortably. Remember, there is no “treating” menopause, as it is a natural transition, but you can get help in managing symptoms. Here are a few questions we think could be helpful at your next doctor’s visit.
Are there natural remedies for perimenopause symptoms?
Many people in perimenopause take adrenal support vitamins to help with their hot flashes in case they are caused by adrenal fatigue. When it comes to other issues like insomnia, you may want to take melatonin to help yourself fall asleep at the right hour, magnesium for anxiety and sleep, or some combination of the two supplements.
Other natural sleep remedies include chamomile tea and lemon balm. There are even several herbal remedies24 that can help regulate hormones during this time, but remember, just because they are herbs does not make them safe or right for everybody. Be sure to talk to a practitioner who knows your medical history before adding in any herbs or supplements. Supplements aren’t regulated in the same way medications are by the FDA and can cause problems if taken in the wrong dosage or for the wrong body.
Check Out Our Guide: Best Natural Sleep Remedies
Is there a way to balance these hormones?
Balancing hormones can be tricky in perimenopause because your body will cycle through waves of both high and low hormone estrogen and progesterone. Still, doctors often prescribe medications and lifestyle changes to try to balance out these hormones. From eating more protein-rich meals25 to increasing physical exercise26, there are a variety of natural ways to balance these hormones, though sometimes these efforts might not be enough.
In these cases, doctors may prescribe Hormone Replacement Therapy27, or HRT. Typically this includes supplemental estrogen, as well as progesterone.27 For people who have had their uterus removed, you may just be prescribed estrogen. HRT can help prevent bone density loss and reduce negative symptoms of menopause like hot flashes.27
Another commonly prescribed medication for hot flashes is Gabapentin28, which is typically an anti-seizure medication but off-label, it can be prescribed to reduce hot flashes. For the symptoms of vaginal dryness and sex-related discomfort, vaginal estrogen29 can be prescribed as well. Your doctor should know which option is best for you.
Does taking estrogen cause breast cancer?
Hormone replacement therapy (HRT) has been the subject of speculation for years regarding its link to breast cancer and other potential risks, and not without merit.
According to Breastcancer.org30, your risk level varies based on which type of HRT you choose to use.
Combination HRT, containing progesterone and estrogen, has the highest risk for breast cancer, increasing the likelihood of developing the disease by 75 percent even when it’s only taken for a short time. However, estrogen-only HRT does not seem to be linked to a higher risk of breast cancer.30
That said, for people who have a uterus (have not undergone a hysterectomy), there seems to be an increased risk in taking estrogen-only HRT and endometrial or ovarian cancer.29
Choosing to use HRT is a decision that should always be made after consulting a doctor and discussing the possible risks. If you decide to use HRT to combat menopause symptoms, your doctor will likely recommend the smallest dose possible to lower your risk of developing cancer.
Are there safe sleeping aids?
While there are plenty of natural remedies for sleep, like melatonin supplements, during the menopausal transition, you may be curious about trying something a bit stronger. Your doctor should be able to discuss the risks associated with developing a dependency on sleeping pills and advise you on the right decision for your individual needs.
One important factor to consider is how you feel after taking a sleeping pill. While some pills may increase the length of sleep you get, they might not always increase your restfulness31 and combat fatigue the way you hoped.
Sleeping pills may also leave you feeling groggy, confused, or hungover the next day, which may outweigh their benefits.31
Can my hormone replacement keep me up?
While HRT is often helpful for reducing hot flashes, in some cases, it could actually get in the way of good sleep. According to Yale Medicine, lower levels of progesterone may cause irritability and make it more difficult to fall asleep.3
This means if you’re taking HRT without this hormone, you might not be getting the sleep benefits you’re looking for.
Talk to your doctor about the way you’re responding to your hormone replacement therapy to resolve any sleep issues you may be experiencing.
Tips for Better Sleep
As you can see, there are a myriad of ways that menopause can affect your sleep and daily life. Of course, everyone goes through these symptoms differently, and some people avoid them altogether. However, if you’re dealing with any menopausal symptoms keeping you awake at night, here are some tips to help you sleep a little easier.
Establish a Sleep Routine
Having a good routine is one of the best ways to combat insomnia because our bodies tend to respond well to routines. If your body knows you reserve your bed for sleep only, and you go to it at the same time every night, you might have an easier time winding down and relaxing after a long day.
Exercise (But Not Too Late)
Exercise can be a great way to naturally balance your hormones and boost serotonin32 levels, helping with insomnia, anxiety, and depression. While this shouldn’t be the only solution you use to combat these issues, regular exercise is vital to good health and hormonal balance. Just be sure you’re not exercising vigorously one hour before bed, as this can disrupt your sleep33.
If you have underlying medical conditions that could make vigorous exercise dangerous, be sure to talk to your doctor before launching into a new workout routine.
Cut Down on Caffeine
If you’re experiencing fatigue, you’ve probably been using caffeine to help you make it through the day. While caffeine may make it easier to function in the morning after a rough night’s rest, it is a good idea to begin to taper off on the caffeine by the afternoon. Caffeine binds to adenosine receptors in the body, so it can prevent you from getting sleepy at the right time, and research from the Cleveland Clinic34 shows it can even cause hot flashes.
So while a mid-morning cup of coffee might help you work more efficiently, we recommend switching to decaf after lunch.
Be Mindful of Napping
After consistently not getting enough sleep, we start to turn toward whatever rest we can get, even if that means an hour or two of napping in the afternoons. However, these naps can throw off our sleep schedules when they become regular and could make it more difficult to sleep at night.
According to the Mayo Clinic35, taking too long of a nap could increase grogginess and worsen insomnia. If staying awake isn’t an option, the key is short naps lasting from 10 to 20 minutes.35
Invest in Bedding with Cooling Qualities
When it comes to hot flashes, having a mattress that doesn’t trap heat, as well as cool sheets and bedding will be helpful. Many mattresses now integrate cooling technology into their models, from heat-conducting copper infusions to actual fans built into a base. You can find the best mattresses for menopause here.
Additionally, cooling sheets made of breathable, cool fabrics like bamboo, jersey, or silk can help keep you cool and wick away moisture at night.
If you already have a cooling mattress and bedding, you can go one step further and attach a bed fan. Many bed fans have remote options for quick cooling and drying that shouldn’t disrupt partners.
Plan a Balanced Diet
Many doctors recommend a balanced diet as a healthy and safe way to balance hormones during perimenopause. This balanced diet36 may include eating more protein, vegetables, calcium, magnesium, and soy, and avoiding spicy foods, caffeine, and alcohol. A balanced diet can help naturally increase estrogen and reduce hot flashes.36
Additionally, it’s important to consider that weight gain can increase the risk for sleep apnea, and those going through menopause are at a higher risk for both weight gain and sleep apnea.36
Eating a healthy and balanced diet is a good way to reduce the risk of these health conditions.
The transition into menopause is different for everyone; some people will have a combination of all of the symptoms we’ve discussed, some will have just one or two, and others may have no symptoms at all. Whatever the case is for you, understanding what is happening within your body is a great first step so that you can talk to your doctor, OBGYN, therapist, acupuncturist, or whatever practitioner you trust, in order to move through the transition with as few bumps as possible.
Remember, there is no “treatment” for menopause because it is not something to cure. Menopause is a transition in life that all people with a uterus go through, and on the other side, many report feeling more at peace and settled – even more so than before perimenopause began.
- “What Is Menopause?”. National Institute on Aging. Last modified September 30, 2021.
- “Changes in Hormone Levels”. The North American Menopause Society. Webpage accessed July 3, 2024. Chen, Jennifer. “Women, Are Your Hormones Keeping You Up at Night?”. Yale Medicine. 2017.
- Silver, Nazanin E. “Mood Changes During Perimenopause Are Real. Here’s What to Know.” American College of Obstetricians and Gynecologists. Last modified April 2024.
- “Thinking and memory changes in women”. Cancer Research UK. Last modified October 14, 2022.
- “Going Mad in Perimenopause? Signs and Solutions”. The North American Menopause Society. Webpage accessed July 4, 2024.
- “Perimenopause”. Cleveland Clinic. Last modified October 5, 2022.
- Conroy, Deirdre. “3 Reasons Women Are More Likely to Have Insomnia”. University of Michigan Medicine. 2016.
- “Sleep Duration and Quality Among Women Aged 40–59, by Menopausal Status”. Centers for Disease Control and Prevention. 2017.
- Baker, Fiona C., et al. “Sleep and Sleep Disorders in the Menopausal Transition”. National Library of Medicine. 2018.
- “Menopause”. Mount Sinai. Webpage accessed July 4, 2024.
- “After the menopause”. NHS Inform. Last modified February 13, 2024.
- Ochs-Balcom, Heather M., Hovey, Kathleen M., et al. “Short Sleep Is Associated With Low Bone Mineral Density and Osteoporosis in the Women’s Health Initiative”. The American Society for Bone and Mineral Research. 2019.
- “Sleep Disorders and Heart Health”. American Heart Association. Last modified June 26, 2024.
- “Hot Flashes: What Can I Do?”. National Institute on Aging. Last modified September 30, 2021.
- Baker, Fiona C., et al. “Changes in heart rate and blood pressure during nocturnal hot flashes associated with and without awakenings”. Oxford Academic. 2019.
- “Women and Heart Disease”. Centers for Disease Control and Prevention. Last modified May 15, 2024.
- Huang, Tianyi., et al. “Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women”. National Library of Medicine. 2018.
- Bromberger, Joyce., Epperson C. Neill. “Depression During and After the Perimenopause: Impact of Hormones, Genetics, and Environmental Determinants of Disease”. National Library of Medicine. 2018.
- “Can Menopause Cause Anxiety, Depression or Panic Attacks?” Cleveland Clinic. 2019.
- Holding, Benjamin C., et al. “Quantifying Cognitive Impairment After Sleep Deprivation at Different Times of Day: A Proof of Concept Using Ultra-Short Smartphone-Based Tests”. Frontiers in Behavioral Neuroscience. 2021.
- Gleixner, Martin. “Understand the link between adrenal health, menopause”. Moncton Naturopathic. 2016.
- Kelly, Laurel. “Consumer Health: Diabetes and menopause”. Mayo Clinic. 2021.
- “Natural Remedies for Hot Flashes”. The North American Menopause Society. Webpage accessed July 4, 2024.
- “Prioritising protein during perimenopause may ward off weight gain”. The University of Sydney. 2022.
- “How exercise helps balance hormones”. Piedmont Health. Webpage accessed July 4. 2024.
- “Hormone therapy: Is it right for you?”. Mayo Clinic. 2022.
- “Gabapentin for Menopausal Symptoms”. Government of Western Australia: North Metropolitan Health Service. 2019.
- “Vaginal Dryness”. Cleveland Clinic. Last modified July 26, 2022.
- “Using HRT (Hormone Replacement Therapy)”. Breastcancer.org. Last modified January 4, 2024.
- “Sleeping Pills”. Cleveland Clinic. Last modified April 27, 2021.
- “Regular Exercise Benefits Both Mind and Body: A Psychiatrist Explains”. Permanente Medicine. 2021.
- LeWine, Howard. “Does exercising at night affect sleep?”. Harvard Health Publishing. 2019.
- “Hot Flashes”. Cleveland Clinic. Last modified March 21, 2022.
- “Napping: Do’s and don’ts for healthy adults”. Mayo Clinic. 2022.
- “Menopause Diet: What To Eat To Help Manage Symptoms”. Cleveland Clinic. 2022.
Katie writes content at Sleep Advisor, where she has finally found people who appreciate her true passion for sleep. Based in Austin, Texas, she graduated with a degree in Communications and enjoys combining creativity with research to improve the world’s sleep, starting with her sleepwalking husband.