Why Sleep Gets Worse in Perimenopause
Perimenopause is the transitional time leading up to menopause, and it's defined by shifting and declining levels of estrogen and progesterone, two hormones that have a profound effect on sleep.
Here’s how they affect your rest:
Progesterone: The Calming Hormone
Progesterone has sedative properties. It increases GABA (gamma-aminobutyric acid), a neurotransmitter that promotes relaxation and reduces anxiety. As progesterone declines, many women experience more anxiety and find it harder to fall and stay asleep. A study published in the Journal of Neuroendocrinology found that progesterone supplementation improved sleep quality in menopausal women due to its effect on GABA receptors.
Estrogen: The Temperature Regulator
Estrogen helps regulate body temperature, serotonin, and REM sleep. When levels drop, women can experience hot flashes, night sweats, and disruptions in the sleep cycle. These symptoms can jolt you awake multiple times a night. According to the Sleep Foundation, 40–60% of women in perimenopause report sleep problems, often directly related to vasomotor symptoms like night sweats.
Cortisol & Circadian Rhythm Disruption
When estrogen and progesterone fall, cortisol (your stress hormone) can become dysregulated. This leads to a heightened fight-or-flight response and poor melatonin production, making it harder to fall asleep and stay asleep. Hormonal shifts can alter the hypothalamic-pituitary-adrenal (HPA) axis, which affects cortisol rhythms. Irregular cortisol levels are associated with insomnia and frequent nighttime awakenings.
Why It’s So Often Dismissed
Sadly, many women are told their sleep issues are simply due to anxiety, aging, or stress, especially if their labs look “normal.” The problem? Conventional testing often doesn’t pick up on hormonal fluctuations, which can be the real disruptors. Even healthcare professionals may lack proper education on how perimenopause affects the brain, nervous system, and sleep architecture.
It’s not in your head, and it’s not just stress.
What Can Help
If you're struggling with sleep during perimenopause, know that there are science-supported strategies that can help:
Hormone therapy (especially bioidentical progesterone) may improve sleep quality.
Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to be effective in midlife women.
Lifestyle support like stress reduction, magnesium, and sleep hygiene can help, but rarely work alone if hormonal imbalance is the root cause.
What You Can Do at Home to Support Sleep (With or Without HRT)
While hormone therapy can help restore balance and reduce many sleep-disrupting symptoms, it works even better when combined with supportive lifestyle tools. Here are evidence-based remedies that can enhance your rest:
Keep your room cool, dark, and quiet
Stick to a consistent sleep-wake cycle
Try magnesium glycinate for calming the nervous system
Sip chamomile or passionflower tea in the evening
Avoid alcohol and caffeine late in the day
Use guided meditation or yoga nidra
Do a short stretching routine or evening walk
Journal to clear your mind before bed
Perimenopausal sleep struggles are complex, but with a personalized combination of hormone balance, environmental changes, and intentional calming practices, you can sleep well again.
Final Thoughts
Sleep is not a luxury; it's necessary for your mood, metabolism, brain health, and hormones. If your sleep has suddenly gone off the rails and no one is listening, trust your gut and seek answers. It’s time we stopped telling women to “just relax” and started giving them the science-backed care they deserve.
