Why you’re waking at
3 am in Peri-menopause

What’s happening hormonally

During perimenopause - the transitional phase before menopause -hormone levels become irregular and increasingly unstable.

Particularly:

  • Oestrogen (also known as estradiol) fluctuates and declines, which affects the brain’s ability to regulate sleep and temperature.

  • Progesterone also drops, and this hormone normally has calming, sleep-supportive effects.

  • Levels of follicle-stimulating hormone (FSH) rise as ovarian function changes - and this rise is associated with more frequent night-time awakenings.

  • Melatonin production decreases with age, and this can further disrupt your circadian rhythm (your internal sleep/wake clock).

These hormonal changes don’t just affect cycles - they impact the neurobiology tied to sleep regulation. That’s why you might be waking up at 2–4 am with a racing mind, even if you were sleeping well a few years ago.

Research estimate: 40–60 % of women experience sleep disturbances during perimenopause.

Read more:
Sleep Disturbance and Perimenopause – Narrative Review (PubMed) Sleep disturbances in perimenopause (PubMed)

Association between hormone levels and nighttime awakenings (J Clin Endocrinol Metab) Hormone profiles & sleep continuity

How Perimenopause imacpts sleep - Stanford Lifestyle Medicine - How Perimenopause Affects Sleep

Disruption of Sleep Continuity During the Perimenopause (PubMed) - Disruption of Sleep

Sleep, Melatonin, and the Menopausal Transition: What Are the Links? (PubMed) - Sleep, Melatonin, and the Menopausal Transition

Common sleep disruptors

Even beyond hormones, several factors that come with this transition can upset your sleep:

🔹 Nighttime hot flushes & night sweats

Sudden body temperature changes disrupt deep sleep and cause awakenings. Read more.

🔹 Circadian rhythm changes

Hormonal shifts can shift your internal clock and reduce melatonin output, leading to lighter, fragmented sleep. Read more.

🔹 Stress and mood fluctuations

Hormones influence neurotransmitters linked to mood - anxiety or low mood can make sleep harder. Read more.

🔹 Frequent nighttime waking (WASO)

Many women report waking multiple times after they initially fall asleep - a pattern understood in sleep research. Read more.

🔹 Other sleep disorders

Risk of sleep-disordered breathing (like sleep apnea) and restless legs can increase in midlife. Read more.

5 things that can help

While every woman’s experience is unique, research and clinical experience suggest these practical strategies:

1. Consistent Sleep Routine

Going to bed and waking up at the same times daily strengthens your circadian rhythm.

2. Cool, Dark, Calm Bedroom

Lowering room temperature and reducing light exposure helps melatonin production and comfort.

3. Mindful Wind-Down Habits

Slow breathing, gentle stretching, or meditation before bed can reduce nighttime brain activity.

4. Limit Evening Stimulants

Avoid large meals, caffeine, and alcohol close to bedtime - they raise core temperature or disrupt sleep cycles.

5. Speak to a Healthcare Provider if Needed

For persistent or severe sleep problems, a clinician can help rule out other sleep disorders, assess whether hormone therapy is appropriate, and guide treatment.

(No single tip works for everyone, and you may need a combination.)

Please note:

This page is intended for general educational purposes only and does not replace personalised medical advice. Individual experiences vary, and if your sleep problems are severe or last more than a few months, consult a qualified healthcare professional.

Medical research on perimenopause and sleep is evolving, and we encourage further discussion with your doctor.

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