2:58 a.m. Snap – suddenly you’re awake. No loud noise, no nightmare. Your eyes open and you just know: falling asleep again won’t be easy. Your mind starts racing – sheep counting, tomorrow’s presentation, that last conversation with your daughter. Around five, you slowly drift off again – just before the alarm goes off at six. Welcome to the new sleep rhythm experienced by many women during menopause.
What many don’t realize: sleep disturbances are often one of the very first signs of hormonal changes. Long before periods stop or hot flashes begin, sleep becomes lighter, more restless, more fragmented. But what’s behind it – and what can you do to finally sleep through the night again?
When the Night Turns Restless – Why Sleep Suffers During Menopause
Almost one in two women during menopause sleeps worse than before. A recent meta-analysis shows that over 50% of women at this stage report a noticeable decline in sleep quality. Symptoms are especially common during perimenopause – the time when menstruation still occurs, but hormones are already out of balance.
Common complaints include suddenly waking up in the middle of the night – often around 3 a.m. – difficulty falling asleep, or waking up too early. And not just occasionally, but often over weeks. The body feels tired, but the mind is wide awake. That’s no coincidence.
Sleep and Hormones – What’s Happening in Your Body
At the start of menopause, three key hormonal systems change significantly – all of which directly affect sleep:
Progesterone, also known as the “nesting hormone,” promotes relaxation and sleep. As levels drop, falling asleep becomes harder.
Estrogen stabilizes mood and regulates body temperature. When it decreases, hot flashes and night sweats can disrupt sleep.
Melatonin, the natural sleep hormone, declines with age – and this drop is especially pronounced in menopausal women.
These changes directly affect falling asleep, sleep structure (e.g. reduced deep sleep), and the ability to stay asleep – explaining why many women feel exhausted even after a full night in bed.
“I woke up almost every night at three. It was like an internal alarm. I was completely alert – but my body was exhausted.”
The Consequences of Poor Sleep – More Than Just Fatigue
Lack of sleep rarely comes without consequences. It impacts more than just energy levels. Irritability, mood swings, and concentration problems are common. Studies show that chronic sleep disturbances increase the risk of high blood pressure, cardiovascular disease, diabetes, and depression.
Many women also fall into a mental trap: the fear of another sleepless night creates stress – which in turn makes sleep even harder. A cycle that can be difficult to break without support.
What Really Helps – Treatment Options
Sleep Hygiene – the Foundation of Better Sleep
Good sleep starts with the right environment and consistent habits. It may sound simple – but it makes a big difference. Pay attention to the following:
Regular bedtimes – try to go to bed and wake up at the same time every day, even on weekends
Cool room temperature – ideally around 18–19 °C (64–66 °F)
Use the bed only for sleeping – no reading, no watching TV, no scrolling on your phone
Avoid screens – especially smartphones, which disrupt melatonin production through their light. This can be hard – try to gradually reduce evening screen time
No caffeinated or alcoholic drinks in the hours before bedtime
Light evening meals – and at least three hours between dinner and bedtime
These simple but effective measures help your body wind down and support your internal sleep rhythm.
Changing Behavior – with Proven Effectiveness
In addition to sleep hygiene, scientific studies show: targeted behavioral changes can significantly relieve sleep disturbances during menopause.
Particularly effective:
CBT-I – cognitive behavioral therapy for insomnia is one of the most well-researched methods
Regular physical activity – ideally during the day and outdoors
Mindfulness, meditation, and breathing techniques – these help calm the nervous system and make it easier to wind down in the evening
Even small rituals – like a short evening walk or focused breathing before bed – can make a noticeable difference.
Plant-Based Support
Many women turn to herbal remedies – with valerian, hops, passionflower, or St. John’s wort. These can have calming effects and aid sleep. Lemon balm, yam root, or Schuessler salts are also popular.
But: these remedies should not be used without guidance – and may not work the same for everyone.
Hormone Therapy – An Effective Option
Menopausal hormone therapy (MHT) can significantly improve sleep – even if, in Germany, sleep disturbances alone are not yet an official indication according to guidelines. However, studies show clearly: especially the combination of estrogen and micronized progesterone has a positive effect on both sleep onset and sleep quality.
Hormone therapy is particularly effective in transdermal form – such as gels or patches. Micronized progesterone (e.g. in tablet form) has also proven beneficial, especially in reducing time to fall asleep【Sources 4 & 5】.
Whether MHT is right for you depends on your personal situation – professional medical advice is essential. Importantly: even mild sleep problems should be taken seriously and discussed early on. You don’t have to wait until symptoms become severe.
Over 50% of women in menopause experience poorer sleep – often as an early sign.
A very common symptom: waking suddenly in the middle of the night.
Behavioral strategies and hormone therapy are both proven to help.
What You Can Do
Take your sleep problems seriously – they’re not a “luxury issue,” but an important signal from your body.
Keep a sleep journal to track patterns and triggers
Establish a calming bedtime routine
Talk to your doctor – even if your periods are still regular
Ask about MHT – it can be highly effective
You don’t have to face sleepless nights alone. Sleep issues during menopause are common – and treatable.
Sources:
Jia Y et al. Prevalence of poor sleep quality during menopause: a meta-analysis. Sleep Breath. 2024;28(6):2663-2674. doi:10.1007/s11325-024-03132-y
Troìa L. et al. Sleep Disturbance and Perimenopause: A Narrative Review. J Clin Med. 2025;14(5):1479. doi:10.3390/jcm14051479
Lam CM et al. Behavioral interventions for improving sleep outcomes in menopausal women: a systematic review and meta-analysis. Menopause. 2022;29(10):1210-1221. doi:10.1097/GME.0000000000002051
Nolan BJ et al. Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab. 2021;106(4):942-951. doi:10.1210/clinem/dgaa873
Pan Z et al. Different regimens of menopausal hormone therapy for improving sleep quality: a systematic review and meta-analysis. Menopause. 2022;29(5):627-635. doi:10.1097/GME.0000000000001945