Perimenopause and Menopause and Sleep: A Patient’s Guide

An estimated 13 million people in the UK1 are experiencing perimenopause or menopause. The hormonal changes can affect many aspects of health, including sleep.

Knowing what to expect and understanding the symptoms and causes of different sleep problems can help, and with the proper treatment (replacing your hormones) you can get a better night’s rest! Read our short blog below for more information…

Sleep: A Vital Process

Sleep is an essential part of life. During sleep, your body and mind can rest and repair after a busy day or week. You typically cycle through different stages of sleep2 throughout the night. 

REM (rapid eye movement) sleep helps you store memories and process information.

Non-REM sleep (also called slow wave sleep3) helps the body rest and repair.

When you don’t get enough of either one, you can feel sleepy during the day and have difficulty concentrating.

Sleep Problems During Perimenopause and Menopause

Perimenopause and menopause can cause a wide range of sleep disturbances4, with 40-50% of women5 in perimenopause and 35-60% of those in menopause listing sleep issues as their most significant symptom. Over 25% of women6 report severe symptoms that affect their daily lives! 

Symptoms may include:

  • Difficulty falling asleep
  • Waking up during the night
  • Waking up too early in the morning
  • Trouble staying asleep once asleep
  • Feeling unrested during the day
  • Difficulty concentrating during the day


What are the causes of sleep problems during perimenopause and menopause?

A variety of factors can cause sleep disturbances during perimenopause and menopause. Movement disorders, sleep apnoea, and hormone imbalances are all potential causes of sleep disruption in this stage of life.

Understanding the underlying causes can help you create an effective treatment plan that works best for you.

Movement disorders like restless leg syndrome are common during perimenopause and menopause7. These conditions cause you to move your legs or arms involuntarily throughout the night, disrupting your ability to sleep soundly. Treatment may involve lifestyle changes, medications, or physiotherapy.

Sleep Apnoea is a severe sleep disorder8 that can occur during perimenopause and menopause. It causes you to stop breathing while you sleep because your airway is blocked or constricted, leading to interrupted sleep and daytime fatigue. Women don’t often recognise sleep apnoea as a potential symptom of perimenopause and menopause, but it is essential to be aware of it. Also, women experience Sleep Apnoea differently than men—they may have more subtle symptoms that can be harder to recognise. Treatment can involve lifestyle changes, medications, or a CPAP machine.

Fluctuating hormone levels can also lead to sleep disruption9 during perimenopause and menopause. Night sweats or hot flashes prevent you from falling asleep or cause you to wake up during the night.

These related sleep disturbances can make perimenopause and menopause a difficult time for many women. But understanding the causes of your sleep problems can help you find the proper treatment to get the restful sleep your body needs. With help and support, you can manage these symptoms and enjoy life again.

What treatments are available?

The good news is that there are treatment options to help you manage your sleep problems. Treatments may include lifestyle changes, medications, hormone therapy, herbal supplements, or a combination of these approaches.

The most common lifestyle changes to improve sleep include:

  • Establishing a regular bedtime routine
  • Creating an environment conducive to sleep (e.g. a dark, cool room)
  • Reducing stress and anxiety
  • Exercising regularly
  • Avoiding caffeine, nicotine, and alcohol
  • Limiting napping during the day
  • In some cases, medications may be used to help improve sleep.

What about Hormone Replacement Therapy?

Hormone replacement therapy (HRT) is a treatment that helps people with perimenopause and menopause get the hormones their bodies need. HRT can help improve your sleep, reduce night sweats and hot flashes, and make you feel better. It can also help improve your mood and energy levels throughout the day. These benefits can lead to a better quality of life and improved overall health. In addition to reducing the risk of chronic diseases, HRT can also treat osteoporosis, improve sexual libido and even help relieve depression and anxiety.

Like any medical treatment, there are some risks associated with oral hormone replacement therapy. However, the new transdermal HRT that absorbs through the skin provides all the benefits without the risk. These include oestrogen gels, patches, and sprays. If you’re under 60, the benefits of transdermal oestrogen HRT outweigh the risks. The treatment uses micronised progesterone, which is a mild sedative at night. Natural progesterone also has a good breast safety profile. However, if you’re over 60, that doesn’t mean you can’t use transdermal HRT. Your clinician will review your medical history to make an informed decision on the risks vs benefits.

Menopause can bring about a number of changes to the body, including sleep problems. Hormone replacement therapy is an effective treatment for menopausal women that can help alleviate symptoms like sleep issues as well as provide additional benefits such as reducing the risk of chronic diseases and improving sexual libido. However, talking to your clinician before starting hormone replacement therapy is crucial, so you know of any potential associated risks.

Further Reading & Sources