Poor sleep during menopause: what helps

Around the age of 40, the first hormonal changes may begin to occur gradually. This often starts with a decline in progesterone levels, while oestrogen levels remain relatively stable for a time. This imbalance can result in symptoms such as poor sleep or mood swings. You might not yet notice changes in your menstrual cycle, but you may experience these subtle shifts.

When your menstrual pattern begins to change, this is known as perimenopause. This phase typically starts around the age of 45 and can last for several years. As you move through this stage, your hormone levels gradually decrease — and this can have an impact on your sleep quality.

The role of hormones in sleep

• Progesterone has a calming effect. It helps your body relax and supports falling asleep. When this hormone decreases, you may find it harder to unwind.
• Oestrogen (particularly oestradiol) influences your circadian rhythm, which is your body’s natural sleep-wake cycle. Fluctuations in this rhythm can cause disruptions.
• A disrupted hormonal balance also makes you more sensitive to stress. This is because the stress hormone cortisol is less effectively broken down in the evening. Normally, cortisol levels drop in the evening, allowing your body to produce melatonin — the hormone that makes you feel sleepy.
• When it gets dark, your body converts serotonin into melatonin — the hormone that helps you fall asleep. Less serotonin = less melatonin = poorer quality sleep.

And then there are the hot flushes, which you may already experience in this early stage of menopause. These can wake you up multiple times during the night.

You can’t control everything, but there’s plenty you can do to improve your sleep. Below are practical tips from a hormone therapist to support your body during menopause.

Support Your Circadian Rhythm

• Spend at least 15 minutes outside in daylight within an hour of sunrise. Repeat this a few times throughout the day. This sends the right light signals to your brain to produce melatonin in the evening.
• Avoid blue light from screens after sunset or use blue light-blocking glasses.
• Stick to a consistent bedtime and wake-up time, even on weekends.
• Ensure your bedroom is dark, cool, and quiet.

Calm Your Stress System

• Practise a short breathing exercise 2 to 3 times a day: inhale for 4 counts, hold for 7 counts, exhale for 8 counts — for 2 minutes. This lowers your cortisol levels.
• Opt for relaxing evening rituals such as a warm shower, meditation, or reading.

Adjust Your Diet

• Avoid eating at least four hours before bedtime. This signals your body that it’s time to rest rather than digest.
• Avoid coffee and alcohol later in the day.
• Eat more fats and proteins, and fewer fast carbohydrates. Choose complex carbohydrates like oats, sweet potatoes, or brown rice. This helps stabilise your blood sugar levels, which benefits your sleep.

Sometimes, you need a little extra support. These supplements may help:

• Magnesium (such as magnesium citrate): promotes relaxation, reduces stress, and helps produce melatonin. Take it about an hour before bedtime.
• Herbs like valerian, passionflower, ashwagandha, and saffron are often used for sleep issues. There is growing scientific evidence supporting their effectiveness, though results may vary from person to person.
• Melatonin supplements (0.1 mg) can support your body’s natural rhythm — especially if you have trouble falling asleep.

In some cases, medication may provide temporary relief. Consider:

• Sleep medication as a short-term solution to quickly address insomnia. Note: this is not a long-term solution.
• Melatonin tablets (e.g., 1 to 2 mg with extended release) for women whose natural production has been disrupted.Are you considering medication? Always consult a doctor to determine the best option for your situation.

Poor sleep is not a “minor issue,” and it’s not something you should simply “put up with.” It’s your body’s way of signalling that something is changing — and you should take it seriously. Schedule an intake appointment, and a doctor will work with you to find the right treatment.