The vast majority of women who come to my clinic complain that their sleep has changed. Many perimenopausal and menopausal women wake several times in the night with sweats – often even waking up before the actual sweating occurs.
Our hormones have important effects on our mood, energy, memory, cognitive and emotional abilities. In addition, the hormones oestrogen and testosterone both have important effects on our brain – including helping the quality and duration of sleep.
Oestrogen helps our bodies use serotonin and other important chemicals in our brains that help with sleep. Low oestrogen levels can be associated with fatigue, difficulty concentrating, headaches and migraine, weight gain and disrupted sleep. One of common early symptom of the perimenopause and menopause is insomnia.
The hormone progesterone can also be beneficial for sleep. This hormone increases the production of GABA, another chemical in our brains that works to help sleep. Progesterone can also improve relaxation and mood too. Lower levels of progesterone occur during the perimenopause and menopause and this can lead to symptoms such as anxiety, restlessness and trouble sleeping, including a tendency to wake up frequently.
Low testosterone levels can also have a negative effect on sleep duration and quality in women.
There are many ways to improve sleep:
Keep to a strict bedtime routine
Most women need around 7-8 hours of sleep a night. It is really important to go to bed at the same time each night and also wake at the same time each morning – even at the weekends! Our circadian rhythms (body’s internal clock) are individual, so it is important to work out the optimal time for you.
Avoid caffeine in the afternoon
Caffeine containing drinks and food (including chocolate) can be stimulating a prevent a good night’s sleep. They should be avoided several hours before going to bed.
Switch off all screens
Devices such as smartphones and tablets emit short-wavelength blue light, which can disrupt the sleep hormone melatonin. Ideally they should not even be switched on in the bedroom.
Sleep in a dark room
Many women find it much easier to sleep in complete darkness – so black out blinds can be very useful. Also, having as much daylight as possible during waking hours also helps to regulate your circadian rhythm.
Think about your alcohol intake
Many women drink more alcohol to try and help them sleep but alcohol is actually a stimulant and can lead to very poor quality sleep. Cutting back or even stopping alcohol should be considered.
Consider ways of reducing stress
Night times are often when we worry more and our mind can race. Finding ways to be calm and relax before going to sleep can be hugely beneficial. Many women find meditation or even allowing a few minutes to completely “empty” your brain of all thoughts really beneficial before going to sleep.
Lavender is a fabulous smell at helping us relax – using a lavender pillow spray each evening can be wonderful.
Magnesium is a very important mineral which is actually responsible for over 300 enzyme reactions and is found in all of our tissues, especially in our bones, muscles and brain. Our cells need magnesium to make energy, for many different chemical pumps to work, to stabilise membranes and also to help muscles relax.
Many people have magnesium deficiency as they are eating diets that contains practically no magnesium. Processed foods, meat and dairy food contain very little or no magnesium. Drinking alcohol and coffee, certain medications such a water tablets and antibiotics and also stress can all reduce magnesium absorption.
There are different types of magnesium available as supplements - the most absorbable forms are magnesium citrate, glycinate taurate, or aspartate. Other beneficial types are magnesium malate, succinate and fumarate.
Taking a magnesium supplement with vitamin B can improve its absorption. Many people find that taking a good quality magnesium supplement can improve sleep as well as lowering stress levels.
How can taking HRT improve sleep?
Adequate levels of oestrogen can often make a dramatic improvement to sleep. Women often notice that they can fall asleep quicker and also wake up during the night far fewer times (or even not at all).
In addition, higher levels of oestrogen are associated with a more positive mood, improved energy levels greater energy and mental sharpness.
Many women take micronised progesterone (Utrogestan) as the progestogen part of their HRT. This is a body identical type of progesterone derived from yams, the root vegetable. Utrogestan is a natural sedative so can cause drowsiness in some women which is a beneficial side effect for many women.
Last updated: March 2019