Sleep disturbance is a very common symptom of the perimenopause* (*the transition leading to the menopause, which is a woman’s last natural period) and menopause. Sleep disturbance includes the inability to go to sleep, waking during the night, waking early or a combination of these.

According to scientific data, up to 57% of women suffer from sleep disturbance during the perimenopause and menopause. Dr Kalentzi, who specialises in menopausal problems and is a member of the Sleep Council Advisory Board, affirms that in her experience up to 90% of women in the perimenopause and menopause have some degree of sleep disturbance.

Among her patients who present with sleep problems, for about half of them, it is a very significant issue. On the symptoms chart that Dr Kalentzi gives her patients, when there is a sleep issue, it is among the symptoms that bothers them most. A woman may feel she can cope with menopausal symptoms such as hot flushes but lack of sleep seems unacceptable, and is a problem that often brings women to the clinic. Sleep disturbance can have a very negative impact, making you fatigued and irritable, and causing disruption in many areas of your life.

Direct effect of hormones on brain

Dr Kalentzi explains that there are a number of factors that can cause or contribute to sleep disturbance during the perimenopause and menopause. Among these are the hormonal changes that take place during the menopause transition, such as the falling levels of oestrogen, progesterone and testosterone. The hormones act on particular neurotransmitters in the brain, and this can affect sleep. However, since everyone is different biologically, these hormonal changes will impact women in different ways.

There is a particular HRT (hormonal replacement therapy) product that contains natural progesterone. It is the only progesterone that has an effect on sleep. The synthetic progesterones (progestogen) do not do this. Natural progesterone has the brand name Utrogestan and the actual hormone is called micronized progesterone. This hormone has a proven effect on neurotransmitters and can consequently improve sleep. In Dr Kalentzi’s experience, 50% of women who use this HRT product experience an improvement in their sleep patterns.

Menopausal symptoms and issues that can disrupt sleep

Physical symptoms

Menopausal symptoms can indirectly disrupt sleep. Night sweats are a very common symptom of the menopausal journey and can be very frequent, intense or both. If a woman wakes three or four times a night because of night sweats, and has to change her nightwear, use a towel etc, inevitably she will suffer from sleep disturbance.

Some women don’t have night sweats but can feel very hot. Feeling your legs are on fire or suffering from restless legs can be a hormonal symptom. Some women experience skin changes, for example, a crawling feeling on the lower legs. At night, with nothing to distract you, these symptoms can stop you from sleeping.

Bladder symptoms, for example, getting up at night to pee (nocturia), can start very early in the perimenopause. The urogenital area (vaginal and bladder area) is very rich in oestrogen receptors and when these hormone levels start fluctuating and / or falling, this can give rise to a number of symptoms in the area, including nocturia. Women may need to pee once or twice a night on average but for some it can be three or four times. Nocturia can be very disturbing. Many women think nocturia is simply due to getting older rather than another symptom of the menopause that could be reversed.

Emotional symptoms

Psychological symptoms such as low mood, mood swings, depression and anxiety are common during the menopause, and can be triggered by or linked to the changing levels of hormones. A woman will often tell Dr Kalentzi that she feels low and anxious for no reason. Both anxiety and depression can create all the sleep problems outlined above.

Life issues

For Dr Kalentzi, ‘life’ issues are another area to be mindful of when assessing sleep problems. Mid-life is a period when many things are happening, with personal, family, sociological and professional issues all affecting a woman’s life. Her children may be leaving home, her parents may be ageing badly. For some women, the fact that they are losing their youth can cause a mid-life crisis. Managing the transition to the next stage of life can be challenging and women may worry about their fertility, especially if they haven’t had children. Also, external issues, such as COVID-19, can be very concerning. For those working from home, the office/home boundary is no longer present and this can make it difficult to switch off. All these factors can cause sleep disturbance.

How can I sleep better during menopause?

Dr Kalentzi’s role is to help women through the often difficult time of the perimenopause and menopause and explain how these difficulties may relate to your changing hormones. If your hormonal levels can be improved, other things may well improve too. Dr Kalentzi also considers CBT (cognitive behavioural therapy) as a powerful method of managing one’s thoughts. Managing your thoughts better can lead to behavioural changes. These in turn can lead to managing your emotions better and sleep improves as a result.

‘Sleep hygiene’ is not to be underestimated as simple measures can help a lot: no electronic devices in the bedroom; going to bed at the same time each night; not watching a screen before you go to bed; doing something relaxing, for example, having a bath, and not eating a heavy meal just before bedtime.

Dr Kalentzi emphasises the fact that alcohol is not a helpful sleep aid. Women sometimes tell her that they use alcohol to calm themselves. But while alcohol can relax you to start with, after a while it can become a stimulus and prevent sleep. It is also a known trigger of hot flushes and night sweats. It’s also wise to avoid drinking a lot of caffeinated drinks, including tea and cola, as they can prevent sleep. Regular exercise helps you sleep but exercising too close to bedtime can have the opposite effect.

Dr Kalentzi sees sleeping tablets as something to be avoided as they can lead to addiction. They may have a place as a short-term tool only. Similarly, the use of marijuana to manage menopausal symptoms can trigger other problems, including mental health issues. Like sleeping tablets, marijuana is a risky choice.

Addressing the basics can help a lot. For psychological symptoms, CBT can be very beneficial. For sleep disturbances, resulting from the hormonal changes of the perimenopause and menopause, advice from a GP or a Menopause Specialist could be the best solution.