Hormones and Sleep During the Menopause
Why Sleep Gets Harder During Midlife
If you’re finding that your once-dependable sleep has become restless or unpredictable during your 40s or 50s, you’re not alone. Up to half of women report disturbed sleep during the menopause transition. For some, this means trouble falling asleep; for others, it’s frequent waking or early-morning alertness.
Sleep disturbance in menopause is multifactorial — usually caused by a blend of hormonal changes, temperature dysregulation, mood shifts, and other health factors. Understanding which of these are affecting you helps to guide treatment.
The Hormone Connection
Falling levels of oestrogen and progesterone play a central role in menopausal sleep problems.
Oestrogen supports temperature regulation, serotonin, and melatonin — all key for restorative sleep. When oestrogen levels fall, hot flushes, mood changes and night sweats can fragment sleep.
Progesterone, particularly in its natural micronised form, has a mild sedative and anxiolytic effect. It converts into a neurosteroid called allopregnanolone, which calms the brain’s GABA receptors.
For this reason, micronised progesterone taken orally at night can not only protect the womb lining during HRT, but also improve sleep quality. Micronised progesterone may therefore be preferable to synthetic progestogens for women troubled by insomnia or anxiety.
Beyond Hormones: Other Causes of Sleep Disruption
Sleep changes in midlife are often compounded by other factors:
Nocturia (night-time urination), often linked to lower oestrogen.
Joint pain or restless legs, which become more common with age.
Sleep-disordered breathing, including mild sleep apnoea.
Mood and anxiety changes, which affect the ability to fall or stay asleep.
Identifying the root cause is key — treating flushes or mood symptoms alone may not be enough if another sleep disorder is present.
What the Evidence Says About HRT and Sleep
HRT can improve sleep both directly and indirectly.
Directly, by stabilising oestrogen and progesterone fluctuations.
Indirectly, by easing hot flushes, sweats, and mood changes that wake women at night.
Transdermal oestradiol (patch, gel, or spray) often helps maintain more stable sleep patterns, while oral micronised progesterone enhances relaxation when taken in the evening.
If HRT isn’t suitable or desired, non-hormonal medications such as SSRIs, SNRIs, gabapentin, pregabalin, or the new fezolinetant (a neurokinin-3 receptor antagonist) can reduce vasomotor symptoms and indirectly improve sleep quality.
Complementary and Nutritional Options
While hormone therapy is the most effective treatment for menopause-related sleep problems, some women prefer a more natural or adjunctive approach.
The evidence for herbal and nutritional supplements is mixed — but some may offer gentle benefit when used safely and consistently:
Valerian root has mild sedative effects and may reduce the time it takes to fall asleep. It acts on the same GABA receptors as progesterone metabolites, producing a calming effect without dependence.
Magnesium supports relaxation, muscle function, and nervous system stability. Deficiency can contribute to restlessness or night cramps. A supplement providing 200–400 mg of magnesium glycinate in the evening may improve sleep quality.
Chamomile, passionflower, and lemon balm teas can promote relaxation as part of a calming bedtime routine.
Isoflavones (soy-based phytoestrogens) may modestly improve sleep in some women, though the benefit is small compared with HRT.
As with all complementary therapies, product quality and consistency vary — and not all are safe for every medical history. Always check with a clinician before combining supplements with prescribed medication.
Prescription Sleep Aids: When They’re Needed
For persistent insomnia that doesn’t improve with HRT, CBT, or lifestyle measures, short-term medication may be considered.
Melatonin can help reset circadian rhythm, particularly in women whose sleep pattern has shifted forward (early waking) or backward (delayed sleep). It’s available on prescription privately and best taken 1–2 hours before bedtime for short courses.
Daridorexant (a new dual orexin receptor antagonist) is an effective option for chronic insomnia. It works differently from traditional sedatives — quieting the brain’s “wakefulness” signals without suppressing natural sleep stages. Studies show it improves sleep onset and duration with less next-day grogginess than older hypnotics.
Older hypnotic medications such as zopiclone or temazepam may still be used very short-term, but I advise against long-term use due to dependence risk.
The Role of Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy for Insomnia (CBT-I) remains the first-line treatment for chronic insomnia — whether menopause-related or not.
It helps retrain unhelpful thought patterns and restores confidence in the ability to sleep. Menopause-specific CBT also targets anxiety about flushes or waking episodes, improving both symptom perception and overall quality of life.
Online options such as Sleepstation or The Better Sleep Clinic provide structured CBT-I programmes backed by good evidence and are recommended within NHS menopause services.
Practical Steps to Rebalance Sleep
Keep regular bed and wake times — routine anchors your body clock.
Keep your bedroom cool, dark, and quiet; consider breathable bedding for night sweats.
Avoid caffeine after midday and limit alcohol near bedtime.
Move every day — strength training and walking improve hormone metabolism and sleep quality.
Try gentle relaxation: breathing exercises, yoga nidra, or progressive muscle relaxation.
Good sleep is not a luxury — it’s essential for hormone regulation, mood stability, cardiovascular health, and long-term cognitive function.
When to Seek Specialist Help
If you’ve struggled with poor sleep for over three months or it’s affecting your daily life, it’s time to seek help.
A menopause-trained clinician can assess whether your sleep issues stem from hormonal changes, another sleep disorder, or both — and create a plan that may include HRT, CBT, nutritional strategies, or targeted medication such as daridorexant or melatonin.
At Sirona Health, I work with women to identify the root causes of sleep disruption and restore confidence in their ability to rest and recover.
FAQ
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Hormones such as oestrogen, progesterone, testosterone, cortisol and melatonin all influence how easily you fall asleep and how restful your sleep is. When these fluctuate—during the menstrual cycle, pregnancy, postpartum, perimenopause or menopause—sleep can become lighter, more fragmented, or harder to achieve.
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Perimenopause causes unstable levels of oestrogen and progesterone, which disrupt temperature regulation, increase night sweats, and reduce deep sleep. Drops in progesterone also remove its natural calming, GABA-enhancing effect. Many women notice sleep changes years before their first missed period.
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Yes. Transdermal oestrogen improves temperature stability and reduces nocturnal vasomotor symptoms, while progesterone (especially micronised progesterone) can improve sleep quality through its mild sedative, GABA-modulating effect. Many women see meaningful improvements within 6–12 weeks.
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Not always, but it can contribute. Progesterone supports the brain’s calming pathways. When levels fall—during the late luteal phase or perimenopause—women may feel wired at night or wake frequently.
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Yes. Chronic stress or dysregulated cortisol patterns can cause early waking, difficulty switching off at night, or feeling “tired but wired.” Perimenopause can amplify this because oestrogen normally buffers the stress response.
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Many women experience lighter sleep in the days before a period due to lower progesterone, higher core temperature, and increased sensitivity to stress. PMDD and PMS can also cause sleep disruption, often linked to serotonin and GABA sensitivity.
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Hormone testing isn’t always necessary, but can be useful in selected cases—particularly in suspected perimenopause, adrenal dysfunction, thyroid imbalance, or premature ovarian insufficiency. Treatment decisions are mainly guided by symptoms, age, and clinical context.
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Some evidence supports magnesium glycinate and valerian can be helpful. Melatonin can be helpful in women 55+ but should be used carefully alongside other medications.
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If sleep disruption is persistent, impacts daytime function, and coincides with hot flushes, night sweats, mood swings or cycle changes, HRT is often a highly effective treatment. Women in their 40s can start HRT based on symptoms alone.
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Consistent sleep timing, morning light exposure, resistance training, reducing alcohol, improving stress regulation, and cooling the bedroom all make a significant difference. Cognitive behavioural therapy for insomnia (CBT-I) is also highly effective.