Insomnia in Perimenopause and Menopause

Insomnia in Perimenopause

Are you losing sleep in perimenopause?

Chronic insomnia was my own personal piece of perimenopause hell. Still is, even though I am now through menopause. It can certainly be one of the most debilitating symptoms of the menopause transition for a significant number of 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 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) contribute to sleep problems. Progesterone is calming and in perimenopause lack of ovulation leads to dramatic drops in progesterone. Which then leads to a lot of staring at the ceiling.

In addition to an imbalance of sex hormones during perimenopause, a lot of women suffer from high levels of the stress hormone cortisol, which can contribute significantly to chronic insomnia. 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 interferes with restorative REM sleep and interrupts sleep rhythms. That’s why so many women in perimenopause say they are able to fall asleep, but can’t stay asleep. High cortisol levels can also 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 levels of estrogen can also cause insomnia. This is more likely to be the problem the closer you are to menopause. Low estrogen levels can also cause hot flashes and night sweats which just compound 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 there are changes that 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.
If you have high cortisol levels you will not be able to sleep even if you're exhausted. #cortisol #insomnia #perimenopause #stress #DrAnnaGarrett #AnnaGarrettAsheville Click To Tweet

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’s been there and 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.

There are supplements and hormone replacements that 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. If you’re suffering from insomnia and want to know more, let’s talk.

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

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