Officially, perimenopause marks the transition into menopause. Unofficially? It ushers in a chapter that is physically and emotionally challenging for many women. During these years, hormones begin to fluctuate irregularly and impact almost every bodily function—especially sleep. Various resources estimate that somewhere between 39% and 72% of women experience perimenopause-related sleep disturbances, which can include sudden night-time awakenings, hot flushes, or anxiety. There’s got to be a better way.
Certified menopause specialist Dr. Christina Enzmann says there is. Below, she explains what happens to the body during perimenopause—and how we can find restful sleep even in its midst.
How the perimenopause affects sleep
During perimenopause, hormone production in the ovaries begins to fluctuate. Progesterone, and later estrogen, are affected by these fluctuations. The changes are gradual, but they affect central processes that, according to Enzmann, are directly linked to the sleep-wake rhythm.
For example, sleep and body temperature are closely connected. When estrogen levels fall, it “impairs thermoregulation,” which in turn promotes night-time hot flushes and sweats—and thus, fragments sleep. But that’s not all: according to Enzmann, hormonal changes often also lead to an increase in cortisol levels, the body’s most important stress hormone. This can lead to a dysfunction of the HPA axis (hypothalamic-pituitary-adrenal axis), which further disrupts sleep. Many women report that they are exhausted in the evening, only to lie wide awake once in bed. “We call this tired but wired,” says Enzmann. “Then you keep waking up in the middle of the night, often with racing thoughts, feelings of stress, or inner restlessness.”
Blood sugar also plays an important role. When it fluctuates greatly due to diet or stress, insulin can remain permanently elevated, which in turn raises the cortisol level. “This is a vicious circle which can massively disrupt the quality of sleep,” says Enzmann.
In short: progesterone, estrogen, cortisol, and insulin work closely together during this phase of life—and even small imbalances can have a major impact on sleep.
Perimenopause and the role of hormones
Progesterone is a natural sedative. It has a relaxing effect on the central nervous system and helps us to fall asleep. But when its levels drop, the calming effect disappears. Estrogen, on the other hand, influences the deep sleep and REM phases, stabilizes mood, and helps regulate temperature. “If these hormones fall or fluctuate greatly, problems falling asleep, night-time awakenings and episodes of night sweats occur, often accompanied by increased cortisol and unstable blood sugar,” Enzman says. All these fluctuations and changes in the body mean that women already have to struggle with severe sleep problems during the perimenopause.
