Insomnia in Perimenopause and Menopause

Insomnia in Perimenopause

Chronic Insomnia Was My Personal Piece of Perimenopause Hell.

I am now through menopause, and estrogen therapy has made a world of difference in my ability to sleep. Insomnia can be one of the most debilitating symptoms of the menopause transition for many women.

There’s nothing worse (IMHO) than lying awake staring at the clock while your hormones are having a PAR-TAY! What’s a girl to do???

Lack of sleep makes you cranky…that’s bad enough. But long-term insomnia can lead to other problems like obesity, diabetes, hypertension, heart disease, depression, and impaired immune function.

Why Do So Many Women Suffer from Insomnia in Perimenopause?

Low levels of progesterone (the first hormone to drop in perimenopause) are one of the main contributors to sleep problems. Progesterone is calming, and lack of it leads to a LOT of staring at the ceiling.

In addition to an imbalance of sex hormones during perimenopause, many women suffer from high cortisol levels. Cortisol is one of your “fight or flight” chemicals. In a perfect world, your cortisol levels are high in the morning and gradually decrease during the day to very low levels at bedtime. But in our over-stressed world, many women have a bedtime RISE in cortisol.

This rise interferes with restorative REM sleep and interrupts sleep rhythms. That’s why so many women in perimenopause say they can fall asleep but can’t stay asleep. High cortisol levels can cause racing, panicky thoughts, heart palpitations, and even panic attacks. If you have high levels of cortisol, you will not be able to sleep even if you are exhausted. Women often describe this feeling as “tired but wired.”

And last but not least, low estrogen levels can cause insomnia, which is more likely the closer you are to menopause. Low estrogen levels can also cause hot flashes and night sweats, compounding the problem.

How to Balance Hormones and Lower Cortisol Naturally

The most obvious way to control cortisol is to reduce stress. That’s easier said than done for most of us. You can’t just press an “OFF” button on your life! But some changes can help. 

Consider These Ideas:

  • Learn to say NO. It’s a complete sentence.
  • Sometimes “good enough” is good enough. Be willing to accept some imperfection.
  • Get regular exercise…but not too close to bedtime.
  • Avoid caffeine and alcohol. Both elevate cortisol levels. Alcohol also increases estrogen levels which may worsen imbalances with progesterone.
  • Unplug at least an hour before bedtime. Screen light interferes with melatonin production.
  • Don’t skip meals. Doing so increases cortisol.

Treat the Root Cause of Insomnia

It may be tempting to resort to over-the-counter sleep aids (they contain antihistamines) or prescription sleep medications. But these don’t treat the root cause of insomnia and may make you dependent. Over time, they work less effectively…which means you need higher and higher doses to do the job. As someone who has done that, I don’t recommend this approach. Get to the root cause of the problem. We’ll look at this in more depth next week.

Supplements and hormone replacements can help with balancing hormones and controlling cortisol. However, it’s best to target these to your specific imbalance. Dried urine testing is an easy, non-invasive way to find out exactly what’s going on. 

Schedule a consultation with me if you’re tired of sleepwalking through your days. We’ll talk about your options and your next best steps. 

Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Dr. Anna is the author of Perimenopause: The Savvy Sister’s Guide to Hormone Harmony. Order your copy at

Dr. Anna is available for 1-1 consultation. Find out more at

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Perimenopause: The Savvy Sister’s Guide to Hormone Harmony

This book gives you the tools you need to navigate this transition without losing your mind or your mojo.

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