Could your trouble sleeping be due to menopause?

Insomnia, sleep apnea or stress concept. Sleepless woman awake and covering face in the middle of the night. Lady can't sleep. Nightmares or depression.

Perimenopause is a transitional period before menopause which may cause a variety of symptoms. This time period can be a difficult time for most women and their loved ones because their hormones are changing so dramatically. We don’t usually like to think that our overall feeling of wellness is so dependent on our hormones, but hormones play a large role in our sleep-wake cycle.

During perimenopause or menopause, the normal balance of hormones begins to change and there is a decrease in overall hormone production. Women starting menopause may experience difficulty falling or staying asleep. These hormonal changes can lead to disruption in sleep due to1:

  • Hot flashes, chills and night sweats leading to waking during the night
  • Restlessness
  • Sleep apnea, or airway obstruction leading to waking and fatigue the next day
  • Circadian rhythm disruption
  • Physiological changes

Hormone Triad – Why You Need to Balance Your Adrenal, Thyroid and Sex Hormones

When women start menopause, the ovaries and uterus start to produce fewer hormones and then adrenal glands start to be the main hormone producers for the body. However, there is a large percentage of women who have severe and long-standing menopausal symptoms due to adrenal fatigue. Adrenal fatigue can be due to prolonged mental, physiological, or physical stress. Supporting the adrenal gland function is the first step in helping women with menopausal symptoms.

In addition, the endocrine (or hormone) system is intricately related. Any disturbances or changes in sex hormones lead to increased burden and stress on the thyroid and adrenal glands. The thyroid gland will start to diminish in function if the adrenal glands or sex hormones are disrupted for an extended period of time.

Hormone Optimization & Sleep Improvement2

Estrogen is indirectly associated with sleep. A decrease in estrogen leads to vaginal dryness, mood swings, and depression. When estrogen was prescribed to menopausal women, the amount of waking during the night decreased. In comparison, progesterone has an important role in the sleep cycle. Once progesterone is metabolized in the body, it stimulates receptors involved in regulating anxiety and sleep. Progesterone promotes calmness and improves sleep.

Furthermore, suboptimal or abnormal thyroid and adrenal hormones will affect the quality of sleep. Cortisol is an important hormone produced by the adrenal glands. Cortisol is known as the “stress hormone.” Cortisol should be relatively higher in the morning and lower at night. Women with chronic stress have an abnormal release of cortisol, which leads to difficulty falling or staying asleep. Testing your cortisol levels through saliva testing throughout the day is very important in balancing hormones in menopause. In addition, thyroid balance is critical as thyroid disturbances such as hypothyroidism may lead to sleep apnea, leading to difficulties in breathing and nighttime waking; similarly, high thyroid or hyperthyroidism leads to insomnia.

Relieving menopausal symptoms is possible through hormone optimization. Ask our doctors how we can help you get the right lab tests to address your sex hormones, adrenal function, and thyroid function.

1 Winkelman, J.W. Overview of the treatment of insomnia in adults. Sept 10, 2018
2 Jehan S, Masters-Isarilov A, Salifu I, et al. Sleep Disorders in Postmenopausal Women. J Sleep Disord Ther. 2015; 4(5), pii: 1000212

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