Perimenopause Can Disrupt Your Sleep. Here’s What You Can Do about It

Written by: Taz Bhatia, MD


Published on: September 21, 2023


Reviewed by: Denise John, PhD

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Taz Bhatia, MD, is a board-certified integrative medicine physician and bestselling author. She writes here about the hormones that notoriously disrupt sleep during menopause and some potential solutions. As always, consult your doctor for individualized medical advice.

While there’s no shortage of things that can disrupt your sleep, hormonal imbalances are at the top of the list. And there’s no time in a woman’s life where hormones tend to cause more problems than during perimenopause and menopause.

Perimenopause is a transition time when hormones begin to shift before the onset of menopause. Hormone shifts during perimenopause often create a vicious cycle, causing sleep problems, which then circle back around to make symptoms of those hormone shifts feel even worse.

The first thing I always check when a woman (around 35 or older) comes to me with sleep complaints is her hormones: DHEA, cortisol, progesterone, estrogen, testosterone, and thyroid hormones. I also check the gut, because the stress of not getting sleep often causes inflammation in the gut, which impacts the nervous system, making sleep even harder.

Knowing this, if you’re having trouble sleeping and you’re in your 30s or 40s, here’s how hormones, stress, and gut health may be playing a role.

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How Hormones Affect Sleep

Estrogen isn’t just a reproductive hormone. It wields influence over the sleep-wake cycle. It’s involved in the production of serotonin, a neurotransmitter that promotes relaxation and mood stability. Leading up to menopause, during the time known as perimenopause, the ovaries gradually produce less estrogen. When estrogen levels decline, serotonin production can also take a hit, affecting sleep quality. It’s also often the culprit behind other issues that can keep you awake, like hot flashes, heart palpitations, and racing thoughts.

Progesterone calms the mind and helps put the brakes on anxiety, and it decreases sharply with perimenopause. Since it normally surges after ovulation to provide calming effects, its absence may lead to increased restlessness and sleep disruptions.

Stress hormones can become dysregulated with adrenal fatigue, which is increasingly common for modern women. And while adrenal fatigue isn’t recognized as a diagnosis by the conventional medical community yet, I do see success with patients when I approach treatment from this position. Adrenal fatigue—or cortisol dysfunction, as it’s sometimes called—is fixable.

Resolving adrenal fatigue requires you to rest more, stop pushing yourself so hard, and do less, which is hard for many people. In my practice, I routinely see women who have asked too much of their bodies, especially around the age when hormones begin to shift. They’re working too hard, exercising too much, sleeping too little, or otherwise exceeding the demands of what they can personally handle in their day-to-day life. (I talk more about the stages of adrenal fatigue during perimenopause in The Hormone Shift.)

Leaky gut is basically a kind of intestinal malabsorption, where the gut lining is no longer intact or healthy, creating low-grade chronic inflammation. This inflammation then leads to microbiome and nutritional changes that directly impact hormone production and therefore sleep as well. Inflammation also causes systemic stress in the body, leading to an overproduction of cortisol, which can then trigger a tired-but-wired feeling, where you’re up all night but exhausted during the day.

About 90 percent of your body’s neurotransmitters, including serotonin, dopamine, and calming GABA (gamma aminobutyric acid), are also made in the gut; this directly impacts mood and sleep, too.

5 Ways to Get Better Sleep during Perimenopause

Perimenopause and menopause are phases of transformation, but they need not be synonymous with sleep deprivation. By understanding the delicate interplay between hormones and sleep and by implementing what I call EastWest strategies—a holistic medical approach that considers a patient’s emotional, spiritual, physical, hormonal, and mental bodies—you can pave the way for restful nights and vibrant days.

So what’s the best plan of action? First, I recommend working with a good functional medicine provider to test your hormones and determine the best course of treatment for you. The overall goal is to restore balance to your body so it can get through this transition with ease—and better sleep. In the meantime, though, I recommend the following things.

  1. Limit screen time before bed. Exposure to blue light from electronic devices like phones, tablets, and computers massively disrupts your body’s production of melatonin. Plus, the mere action of scrolling social media also increases cortisol, keeping your nervous system in a heightened state of arousal. Aim to avoid screens at least an hour before bedtime.
  2. Try 4-7-8 breathwork at bedtime. Breathwork is perhaps the quickest and easiest way to combat an overactive mind and body. Try inhaling for four counts, holding for seven, and exhaling for eight to reduce stress and promote better sleep.
  3. Go to sleep earlier. In traditional Chinese medicine, the hours between 11 p.m. and 1 a.m. are considered the calmest of the day. About 11 p.m. to 5 a.m. is key meridian time, when hormonal processes during sleep keep the body harmoniously functioning. Applying this Eastern philosophy—going to bed before 11 p.m.—can help you better sync to a more calming biological rhythm. And foundational sleep hygiene still applies: Limit caffeine and alcohol (especially later in the day), create a comfortable sleep environment, and stick to a regular sleep schedule as much as possible.
  4. Consider taking maca root, melatonin, and magnesium. A superfood native to the highlands of Peru, maca is considered an adaptogen, but it’s especially helpful for women’s hormones in perimenopause and menopause. One four-month study of perimenopausal women (ages 41 to 50) who supplemented with maca found that the herb acted as a hormonal “toner” to balance estrogen, progesterone, and other hormones. Plus, it eased night sweats, insomnia, anxiety, depression, and heart palpitations. Other supplements I like for sleep support are melatonin and magnesium, both of which are especially beneficial during perimenopause.
  5.  Consider hormone replacement therapy. Under the guidance of a health care professional, HRT can help balance hormone levels and alleviate sleep disruptions. Bioidentical hormone replacement (BHRT) was part of my healing journey as well, until I could resolve other symptoms. HRT is not the one-size-fits-all approach that many providers currently use it as. But there’s no reason to fear hormone therapy when it’s used correctly. I always recommend testing your hormones first so you know where you’re starting from. I talk about HRT in detail in The Hormone Shift, including a 30-day plan to rebalance your hormones and info to help you make the best decision.



This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.