How to sleep better during perimenopause, according to a hormone expert
Officially, perimenopause marks the transition into menopause. Unofficially? It ushers in a chapter that is physically and emotionally challenging for many women. During these years, hormones begin to fluctuate irregularly and impact almost every bodily function, especially sleep. Various resources estimate that somewhere between 39% and 72% of women experience perimenopause-related sleep disturbances, which can include sudden night-time awakenings, hot flushes or anxiety. There’s got to be a better way.
Certified menopause specialist Dr Christina Enzmann says there is. Below, she explains what happens to the body during perimenopause and how we can find restful sleep even in its midst.
How the perimenopause affects sleep
During perimenopause, hormone production in the ovaries begins to fluctuate. Progesterone and later oestrogen are affected by these fluctuations. The changes are gradual, but they affect central processes that, according to Enzmann, are directly linked to the sleep-wake rhythm.
For example, sleep and body temperature are closely connected. When oestrogen levels fall, it “impairs thermoregulation,” which in turn promotes night-time hot flushes and sweats, and thus, fragments sleep. But that’s not all: according to Enzmann, hormonal changes often also lead to an increase in cortisol levels, the body’s most important stress hormone. This can lead to a dysfunction of the HPA axis (hypothalamic-pituitary-adrenal axis), which further disrupts sleep. Many women report that they are exhausted in the evening, only to lie wide awake once in bed. “We call this tired but wired,” says Enzmann. “Then you keep waking up in the middle of the night, often with racing thoughts, feelings of stress or inner restlessness.”
Blood sugar also plays an important role. When it fluctuates greatly due to diet or stress, insulin can remain permanently elevated, which in turn raises the cortisol level. “This is a vicious circle which can massively disrupt the quality of sleep,” says Enzmann.
In short, progesterone, oestrogen, cortisol and insulin work closely together during this phase of life, and even small imbalances can have a major impact on sleep.
Perimenopause and the role of hormones
Progesterone is a natural sedative. It has a relaxing effect on the central nervous system and helps us to fall asleep. But when its levels drop, the calming effect disappears. Oestrogen, on the other hand, influences the deep sleep and REM phases, stabilises mood, and helps regulate temperature. “If these hormones fall or fluctuate greatly, problems falling asleep, night-time awakenings and episodes of night sweats occur, often accompanied by increased cortisol and unstable blood sugar,” Enzman says. All these fluctuations and changes in the body mean that women already have to struggle with severe sleep problems during the perimenopause.
But at what point do you know that these are symptoms of the perimenopause and not simply a period of restless sleep due to stress? When should you seek medical advice? Enzmann says that sleep problems should be taken seriously after three to four weeks at the least, especially if they are affecting everyday life. These include concentration problems, emotional instability or a feeling of being overwhelmed. “Sleep problems are often an early symptom of hormonal dysregulation or chronic stress,” she emphasises, “and not simply a natural part of getting older.”
Common mistakes
The problem is that many women are quick to turn to dietary supplements when they have sleep problems in order to restore their sleep to its usual restful state. However, Enzmann warns that not every sleep disorder is the same, “and what works for one person won't help another.” Although magnesium (300mg as glycinate), taurine (3g) and a B-vitamin complex can help, other women need targeted support, for example, with adaptogens such as ashagandha, especially when it comes to restlessness or anxiety. All of this should first be analysed and discussed with a doctor before seeking external support.
Another mistake is reaching for sleeping pills: “Not only can they lead to addiction, they can also worsen the quality of sleep,” warns Enzmann. An evening glass of wine “to relax” is also not a good idea: “Although alcohol helps you fall asleep faster, it has been proven to worsen the deep sleep phases and often leaves you even more tired the next morning.”
What really helps
According to the expert, there are far better and more sustainable solutions for better sleep during the perimenopause. Medically, bioidentical hormone therapy (HRT), for example, with progesterone in the evening, can have a sleep-promoting effect for many women, especially if cycle irregularities, mood swings, or hot flushes occur in addition to sleep problems. “It is equally important to stabilise cortisol levels through exercise, meditation, mindfulness and micronutrients,” Enzmann says.
Fixed evening routines such as warm foot baths, lavender, journaling, breathing exercises, or meditation can also help in everyday life, while avoiding late-night meals, alcohol, sugar and screen time supports the body’s own melatonin production. “Regular exercise in the fresh air also stabilizes the circadian rhythm and an anti-inflammatory, blood sugar-stable diet is also essential for better sleep,” Enzmann notes.
Certain dietary supplements, such as the magnesium glycinate mentioned above, taurine, L-theanine, or herbal adaptogens such as rhodiola, can also be helpful. But “a dark bedroom or a sleep mask can also work wonders,” advises Enzmann. Equally helpful: putting away the computer and cell phone in the evening.
Perimenopause and melatonin
And what role does melatonin, which is often attributed to good sleep, play? It can be particularly effective if the sleep problems are caused by a shifted sleep rhythm; "however, it should be taken in low doses; 0.3 to 1mg is often completely sufficient,” emphasises Enzmann. “Too much melatonin can paradoxically lead to waking up at night.”
According to the expert, herbal remedies such as valerian, passionflower, hops, or ashwagandha can also have a supportive effect, especially in cases of stress or inner restlessness. However, the individual selection and combination are crucial.
Remember, “sleep problems in perimenopause are not a sign of weakness, they are an indication that the body is recalibrating,” Enzmann says. Thus, it is worth getting to the bottom of the causes instead of just fighting symptoms. When you understand how hormones, cortisol, blood sugar and lifestyle interact, you can make the right adjustments. This can have a far-reaching effect: “When sleep is restored, many of the other symptoms of perimenopause and menopause often calm down all by themselves,” Enzmann notes.