Why perimenopause can cause insomnia
Perimenopause is typically associated with hot flashes, but another common symptom is insomnia. Garden-variety insomnia can be helped with natural remedies such as herbs, magnesium, or melatonin. Some women also report the indica strain of THC ensures a good night’s sleep.
However, for other perimenopausal women, insomnia is so severe that even heavy-duty pharmaceuticals like Ambien barely make a dent. They report waking up every hour to go to the bathroom, not being able to fall asleep, or not being able to stay asleep for more than a few hours. Insomnia to this degree becomes debilitating, making it near impossible to function after a while, and leads some women to consider suicide.
While several metabolic disorders can cause insomnia—such as blood sugar imbalances (most common), chronic inflammation, or Hashimoto’s hypothyroidism—for the perimenopausal woman, it may be due to estrogen levels that have declined too drastically. The female brain needs estrogen to function, which includes being able to sleep.
How estrogen deficiency causes severe insomnia
Estrogen helps a woman maintain sleep throughout the night. Researchers have clues as to why estrogen is necessary for sleep, although the mechanisms aren’t entirely understood. Estrogen is associated with stress hormones and brain chemicals that play a role in sleep, and regulating body temperature (many women wake up having a hot flash).
Low estrogen also causes mood disorders, such as anxiety and irritability, that can provoke insomnia.
We also need estrogen to breathe normally during the night. Low estrogen is associated with the development of sleep apnea as the areas in the brain that control nighttime breathing become compromised in an estrogen-deficient state.
Progesterone and insomnia
Progesterone is another hormone that declines in perimenopause. Progesterone is well known for its calming and sleep-promoting effects.
Can hormone replacement therapy help you sleep better?
If you are perimenopausal and your body refuses to sleep, you may find relief with hormone replacement therapy (HRT). Some women only need to use a natural progesterone cream for the relief they need. You can even buy good quality progesterone creams online.
Some women also need estradiol (the most active form of estrogen in the body) in order to sleep. It’s best to test your serum estradiol and progesterone first, which you can do yourself from one of the many online DIY lab test companies if you are under insured or uninsured.
While estradiol creams are available online and benefit many women (according to Amazon reviews), you may want to work with a doctor experienced in bioidentical HRT and get your HRT from a compounding pharmacy.
Transdermal bioidentical HRT creams are preferred to oral tablets or capsules to reduce risks and not place any burden on the liver.
While HRT can deliver almost immediate relief, it can also take some trial and error to find the right dose of estradiol and progesterone for you.
If you are forced to work with a standard MD, be prepared to confront ignorance and stigmatization around HRT, holdovers from old studies that have since been disproven. If possible, work with a doctor who specializes in HRT instead. You can ask your local compounding pharmacy for suggestions.
How to cure insomnia if you have perimenopause
Even with HRT, you may still need additional help with insomnia. Women who struggle with severe perimenopausal symptoms typically arrive at midlife fighting other health battles that deplete the endocrine system and raise the risk of insomnia. These can include:
- Metabolic or autoimmune disorders, adrenal fatigue, PTSD from childhood abuse, a history of eating disorders/disordered eating, mental health struggles, or a history of being in abusive relationships.
- Childbirth and child rearing are often exhausting.
- All of us have grown up in an extremely polluted environment; these toxins pummel the female endocrine system.
- Plus, throw in routine sexual harassment, sexual assault, and discrimination that women routinely encounter.
It’s no wonder you’re depleted by the time you hit your mid-40s, throw yourself some love!
However, this means you may need additional support to sleep well during perimenopause. Here are some common causes of insomnia and what to do about them:
Blood sugar imbalances. High blood sugar makes it hard to fall asleep. Low blood sugar makes it hard to stay asleep. Either way, you need to reduce carbs. If you have low blood sugar, make sure you eat regularly throughout the day; don’t let yourself starve. If you wake up early and can’t fall back asleep, keep some protein and fat by your bed and eat a few bites. You are waking up from a blood sugar crash, which releases adrenal hormones. Get a glucose monitor, test your HbA1c, and try and keep your blood sugar in healthy ranges.
Chronic inflammation. This is a common reason for insomnia. It’s usually triggered by regularly eating food that is inflaming your system, the most common being gluten and dairy. Do a dairy-free paleo diet for a while and see if you notice a difference.
Sleep apnea. Sleep apnea hits a lot of women in midlife, independent of weight. This is because of the effect of declining hormones on the sleep centers of the brain. If you are under insured or uninsured and a sleep study is out of the question, you can order an at-home sleep test, buy a refurbished CPAP machine online, and experiment with pressure settings.
Supplements that can help insomnia
I offer a hearty 25% discount on supplements through Emerson Ecologics, to set up an account just use the contact form to send your first and last name and email address.
All of Emerson’s supplements are high quality so look for these ingredients and use trial and error to find what works best for you:
- Sleepy herbs such as valerian, hops, passion flower, and magnolia bark.
- Amino acids such as theanine or GABA. 5-HTP or tryptophan may also help.
- Anti-inflammatory support such as vitamin D, fish oil, liposomal glutathione, n-acetyl-cysteine, turmeric, or resveratrol.
- Herbal formulas that support estrogen and progesterone.
Many women are depleted and hormone-deficient by mid-life
Women deal with multiple metabolic stressors that exhaust the female endocrine system. This means your body has a hard time compensating for declining hormone levels as nature intended. Nature did not intend for the millions of tons of pollution pumped into the environment that we grow up in, nor having to exist in a world ruled by toxic male brutes (which harms most men too!). Long-time hormone docs will tell you their patient population is getting younger and younger as stressors and toxins increase (and who knows what effects EMFs are having).
HRT is still socially and medically stigmatized. Many women think the noble path is to “tough it out.” And true, if you’re not too bad off, you can dramatically impact your hormonal health through dietary and lifestyle strategies so that you don’t need HRT. It’s best to start there.
However, if you have tried all that and are still suffering tremendously, be kind to yourself and seek qualified bio HRT help from a doctor who will listen to you and won’t shame you.
(Lee J, Han Y, Cho HH, Kim MR. Sleep Disorders and Menopause [published correction appears in J Menopausal Med. 2019 Dec;25(3):172]. J Menopausal Med. 2019;25(2):83-87. doi:10.6118/jmm.19192)