Getting a solid night’s rest may not only be an issue for you once your period stops and you’re officially in menopause. Sleep disturbances, and intertwined anxiety, can follow you through the perimenopause period, which could last anywhere from two to 10 years.
In hormone monitoring company Oova’s State of Perimenopause report based on research the team presented at the Menopause Society’s 2024 annual meeting, 80% of people surveyed, ranging from age 35 to 52, reported difficulty sleeping as a concern—92% of study respondents reported mood changes, and 90% reported anxiety, which are not small percentages, either.
The research also underscores the importance of sleep, suggesting there might be a positive correlation between estrogen levels and the amount of quality sleep women get—and, in turn, may potentially mitigate some hormone-related perimenopause symptoms.
Here’s what you need to know about the sleep-estrogen connection.
How Does Sleep Potentially Impact Estrogen Levels?
First of all, estrogen is a factor that affects sleep throughout most of our lives, starting with our menstrual cycles—not just leading up to menopause.
Estrogen spikes mid-cycle during ovulation and then declines for the rest of the cycle heading toward your period — which may lead to disrupted sleep, explains Dr. Kin M. Yuen, a sleep medicine specialist and spokesperson for the American Academy of Sleep Medicine.
But don’t forget about its counterpart in the menstrual cycle, progesterone.
“Progesterone is also a breathing driver and contributes to sleep stability,” says Yuen. “Therefore, it is also the balance and the interaction between these two hormones that may help maintain more continuous and refreshing sleep (amongst other biologically active hormones during the night, like melatonin and thyroid hormones).”
Both estrogen and progesterone fluctuate significantly during the perimenopausal period, which can contribute to trouble staying asleep and feeling rested the next day.
Oova’s research, led by founder and CEO Amy Divaraniya, PhD, analyzed data from over 500 users of the Perimenopause Hormone Kit, which measures levels of estrogen markers, progesterone markers and the ovulation-stimulating luteinizing hormone in urine (the most convenient way to measure hormone levels daily without having blood drawn). Participants also tracked and reported their sleep duration from the night before.
The results were somewhat surprising: Study participants who clocked more sleep, between six and nine hours, had significantly higher levels of E3G, an estrogen marker, than those who only slept between three and six hours, explains Divaraniya and her research team.
You may be familiar with the idea that higher estrogen levels, especially during menopause, seem to equate to better sleep, but this research is zeroing in on the idea that better quality sleep may be correlated with higher estrogen production and therefore help with overall perimenopause symptoms.
Don’t sleep on the stress and anxiety connection either.
“There is also a direct correlation between estrogen and cortisol levels,” says Divaraniya. “If cortisol levels are high, estrogen is negatively impacted.”
That might explain some of the high percentages of people reporting both sleep disturbances and anxiety and mood changes in the research.
This is all helpful information to know when it comes to diagnosing and treating perimenopause-related sleep changes.
Sleep researchers Poppy Gardiner, PhD, a postdoctoral research associate at the Elson S. Floyd College of Medicine at Washington State University Spokane and her colleague Kirsie Lundholm, MS, a graduate research assistant at the Sleep and Performance Research Center at Washington State University Spokane, consider the new findings by Divaraniya and her research team as promising, noting that improving sleep quality might be able to mitigate the impact of hormonal changes, like low estrogen, during perimenopause.
“However, we recognize that it is difficult for people to improve their sleep quality when experiencing hormonal fluctuations,” they add.
It can be a bit of a chicken-or-egg situation.
“Higher estrogen levels are often associated with better sleep quality, as estrogen plays a role in regulating serotonin and other neurotransmitters that influence sleep,” says Dr. Anna Cabeca, an OB-GYN and best-selling author of The Hormone Fix, Keto-Green 16 and MenuPause.
“It’s true that longer sleep duration can support estrogen production, but achieving those uninterrupted six to nine hours can feel like a tall order when you’re dealing with menopause-related sleep disturbances,” she continues.
There’s no quick fix, but there are a few things you can work on to improve your sleep quality and possibly your estrogen levels, too.
What Are Some Ways to Improve Your Sleep—and Maybe Boost Your Estrogen Levels, as a Result?
Continue to Track Your Sleep
Divaraniya recommends paying close attention to your sleep quality and any other important biomarkers you can, so that you can take that information into your medical provider’s office to help with diagnosing and treating any sleep and/or hormone-related issues.
“Arm yourself with as much data and information as you can, so you’re not just saying ‘I feel off’ or ‘I don’t feel like myself,'” she suggests.
It’s also important to consider all factors and stressors that could be affecting your sleep and carefully tracking your hormones. For example, could the main culprit be a hormonal imbalance that’s throwing your sleep off, is it stress at work, or could it be added anxiety due to your child waking up every few hours?
Make Your Bedroom Your Sanctuary
This may not seem revolutionary, but curating a sleep-friendly environment can make a difference in your sleep habits.
One way to do this is to make your bedroom a sanctuary of sleep: “dark, cool and free of distractions like electronics,” says Cabeca. “Avoid blue light exposure from screens at least an hour before bed, and consider using blue light-blocking glasses if needed.”
Winding down with deep belly breathing, meditation or stretching is always a good way to get your body in the right mood for rest, too.
Get Your Circadian Rhythms on Trac
Wearing blue light-blocking glasses in the evening hours can help with getting your body to realize it’s not time to wake up, and light therapy glasses can be helpful with the opposite problem in the morning.
Another easy way to regulate your body’s sleep-wake cycle, or circadian rhythms, is to try to catch the sunrise or sunset each day. “This simple practice can help reset your internal clock and improve sleep quality,” Cabeca says.
A set bedtime and wake-up alarm is always a plus.
Manage Chronic Pain When You Can
Try to take care of everything that could be waking you up in the middle of the night, if possible.
“Chronic pain should be addressed with a medical professional either through physical therapy or adequate control so that it is not preventing restful sleep,” advises Yuen.
Acupuncture may be a safe, useful tool for both chronic pain management in the general population and for fighting insomnia among people in perimenopause.
Consider CBT
Gardiner cites new research from the Journal of Clinical Medicine on perimenopause and sleep disturbances, which states that a specialized type of Cognitive Behavioral Therapy (CBT) for insomnia called CBT-I could be beneficial.
“The management of sleep disorders during these times requires an individualized approach which takes into consideration the multifactorial nature of the sleep disturbances,” Gardiner says.
It’s always key to zero in on all the life factors that could be impacting both your sleep and mental health simultaneously.
Look Into Hormone Replacement Therapy (HRT) as an Option for Your Symptoms
“With peri- or postmenopausal women whose estrogen levels are rapidly declining… for those that are appropriate candidates for hormonal replacements, there are often improvements in both hot flashes, night sweats and sleep duration and quality,” says Yuen.
If you have significant sleep disturbances that are consistently disrupting your ability to stay asleep, hormone replacement therapy might be right for you to boost both your estrogen levels and your sleep quality.
It’s just one option to add to your toolbox, and you should discuss it in detail with your clinician first, as there are many factors that need to be considered with that decision, Divaraniya adds.
This study is just scratching the surface of the sleep-hormone connection during perimenopause, and much more research needs to be done.