Why do I wake up at 3am every single night?

Declining oestrogen and progesterone make your sleep lighter and more easily disrupted. Many women find themselves waking at roughly the same time each night. Sometimes it coincides with your bladder filling or a night sweat, but often there's no obvious trigger. Your brain's just more prone to waking because of hormonal changes.

Will HRT definitely fix my sleep?

HRT helps many women, especially those with night sweats and hot flushes. Natural progesterone (Utrogestan) specifically improves sleep. But it doesn't work for everyone. Some women need CBT alongside HRT. A menopause specialist can work out what combination might help you.

Should I wait to see if it gets better on its own?

If sleep problems are affecting your quality of life, work, or relationships, that's reason enough to see a menopause specialist now. While sleep problems often peak in late perimenopause and can improve after menopause, sleep deprivation has cumulative effects on your health. The sooner you address it, the better. There's no prize for suffering through without help.

Can I have sleep problems without hot flushes?

Absolutely. While hot flushes often disrupt sleep, hormonal changes affect sleep directly. Your declining oestrogen and progesterone change how you cycle through sleep stages, even if you're not waking up sweating. Many women have sleep problems as their main or only menopause symptom.

What if my GP says my sleep isn't related to menopause?

Ask for a referral to a menopause specialist. Sleep disturbance is a well-established menopause symptom, backed by extensive research. If your GP isn't recognizing this, a specialist will. Menopause specialists have specific training in how hormonal changes affect sleep that most GPs don't have.

Is it worth trying lifestyle changes before getting treatment?

Lifestyle changes (cool bedroom, consistent sleep schedule, no screens before bed) help, but they're rarely enough on their own when hormones are the underlying cause. Try them if you want, but if you're still struggling after a few weeks, don't delay seeing a specialist.

What if I slept fine before perimenopause started?

Good news: if you had good sleep before perimenopause, you're less likely to develop severe sleep problems during the transition. Many women who slept well before perimenopause continue to sleep reasonably well throughout. But if you do notice changes, it's still worth addressing them rather than assuming they'll pass.

Does everyone's sleep improve after menopause?

Not everyone, but many women do see improvement. Sleep problems typically peak in late perimenopause and then often stabilize or improve once you're postmenopausal. However, around 35-60% of postmenopausal women still experience some sleep issues. This is why getting treatment during perimenopause rather than waiting it out can be important.

Can't Sleep? This Might Be Perimenopause

2:47am. Again.

You've been awake since just after 2am, lying here trying not to look at your phone, trying not to spiral, trying to remember your neighbor's name because you blanked on it completely today and you've lived next door to her for six years. Last night it was 3:22am. Night before, 1:58am. You're so tired your eyes physically ache but your brain won't shut off.

Three months of this now. Maybe longer. And you're starting to properly panic because what if something's actually wrong with your brain?

We see you. And we get why you're scared.

Sleep problems are one of the most common symptoms during perimenopause and menopause. Not "a bit of trouble sleeping." Proper, can't-function-during-the-day exhaustion that affects your work, your relationships, your mental health. Around half of women going through experience this. The not-knowing is often the worst part, isn't it? Is this menopause, is it something else, will it ever stop?

Why Your Hormones Are Wrecking Your Sleep

Your ovaries make oestrogen and progesterone. These don't just control your periods. They affect your body temperature, your mood, and yes, your sleep.

Perimenopause is when these hormones go haywire, bouncing up and down wildly before your periods stop completely. That's when sleep often goes to pieces. Oestrogen helps you reach deep sleep and stay there. Progesterone calms you down, makes you sleepy. When both start declining and ping-ponging around, your sleep becomes lighter and more easily disrupted.

Your brain's temperature control stops working properly too. Your hypothalamus, the bit that regulates body temperature, doesn't respond to oestrogen the way it used to. This causes hot flushes. At night, those become the drenching night sweats that wake you up freezing.

But here's what's interesting: many women wake up just before the hot flush actually happens, not because of it. Your brain chemistry is changing in ways that directly affect sleep, not just through sweating.

Your melatonin drops too. That's the hormone that tells your body when to sleep. Less melatonin means your sleep-wake cycle gets disrupted. Which is partly why you're suddenly wide awake at 3am when you've always been able to sleep through anything.

We know you're probably worrying this means something's seriously wrong with your brain. And we get why. When you can't remember basic things and you're exhausted, it's terrifying. But hormonal changes alone can cause all of this.

The Sleep Problems You're Actually Having

Waking multiple times during the night is the most common complaint. Not once or twice. Four, five, six times. You fall asleep fine, but you can't stay asleep.

Some women can't fall asleep in the first place. Your mind won't stop, your body feels wired, you're aware of every single noise, and you're lying there catastrophizing about everything.

Or you wake at 4am, wide awake with absolutely no hope of getting back to sleep, even though you're knackered.

Up to 26% of women in perimenopause have actual clinical insomnia. Not just "a bit of trouble sleeping" but a genuine sleep disorder lasting six months or longer.

Sleep apnoea becomes more common too. This is when your breathing stops and starts repeatedly while you sleep (which sounds terrifying, we know). Postmenopausal women are two to three times more likely to have it than before menopause. Before menopause, hormones seemed to protect you. After, that protection's gone.

Thing is, symptoms in women can be really subtle. You might not snore loudly or gasp for air. You might just feel absolutely exhausted all day, get morning headaches, struggle to concentrate. Because these overlap with menopause symptoms anyway, it often goes undiagnosed.

Restless legs syndrome gets worse for many women. That horrible sensation in your legs when you lie down, the overwhelming urge to move them, the temporary relief that doesn't last. Maddening.

And sometimes you need to pee. Oestrogen affects your bladder too. When it drops, you're up once, twice, three times a night. Some women assume this is just ageing. It's actually another hormonal symptom that can often be helped.

It's Not Just Night Sweats (Though They Don't Help)

Night sweats definitely don't help. Around 70% of women get them. When you wake up soaked, having to change your nightwear, that obviously disrupts sleep.

But even women without severe night sweats still report sleep problems. Your hormones are affecting the structure and pattern of your sleep directly.

Anxiety and depression make sleep worse too. And we're not about to tell you "it's all in your head" or "you just need to relax." Anxiety and depression are common mental health symptoms of menopause itself, caused by the same hormonal changes affecting your sleep.

There's a cycle. Poor sleep makes your anxiety worse. Anxiety makes sleep worse. Feeling exhausted all the time affects your mood. Low mood makes sleep harder. And you're stuck in it, night after night, which is exhausting just to think about.

Life stress doesn't help either. Menopause often hits when you're caring for ageing parents, supporting teenage or adult children, dealing with increased work pressure, relationship changes.

How Long Does This Actually Last?

This is probably what you most want to know. Honestly? It varies massively.

Here's something that might actually reassure you: if you slept well before perimenopause started, many women don't see their sleep get worse during this transition. Your good sleep might protect you.

But about half of women do report sleep problems during perimenopause, compared to around 30% before it starts. Sleep problems typically begin worsening in early perimenopause, hit their worst point in late perimenopause, then often stabilize or even improve once you're postmenopausal.

Research from the SWAN study followed women for years and found completely different patterns. Some had persistent problems throughout. Others improved after menopause. There wasn't one simple trajectory.

Women who have trouble falling asleep, early morning waking, and frequent hot flushes or night sweats are more likely to have persistent problems even after menopause ends.

Between 35-60% of postmenopausal women still experience sleep disorders. But for many others, sleep does get better once hormones settle at their new lower level.

Not the answer you wanted, is it? But understanding what you're dealing with helps you make decisions about whether to get treatment now, rather than waiting years to see if it improves on its own.

What Actually Helps

Things genuinely help. Proper treatments with actual evidence behind them, not just "have you tried lavender?"

HRT works for improving sleep in women who have hot flushes and night sweats. By replacing the oestrogen your body's stopped making, it addresses the hormonal cause.

The type of progesterone matters for sleep specifically. Natural progesterone (brand name Utrogestan in the UK) actually helps you sleep. The synthetic versions don't have the same effect. In one study, around half of women using Utrogestan saw improved sleep patterns.

HRT works best when you're having night sweats and hot flushes. If you're not (and we know you're probably wondering whether you should take it anyway), a menopause specialist can work out whether it makes sense for you specifically.

CBT for insomnia has strong evidence for improving sleep during menopause. This isn't just "relaxation techniques." It's a structured approach that changes the behaviours and thought patterns that keep insomnia going. CBT can help your sleep even if it doesn't improve your hot flushes. It's available on the NHS. You can refer yourself directly without seeing a GP first.

Lifestyle changes help, though they're not usually enough on their own. Your bedroom wants to be around 18°C. Cooler than you think. Go to bed and wake up at the same time every day, even weekends. No screens for an hour before bed. Regular exercise improves sleep, but not right before bed.

Avoid alcohol, caffeine, heavy meals close to bedtime. Yeah, you've heard this before. But caffeine has a half-life of five hours. That 3pm coffee is still affecting you at 10pm.

Sleep apps like Sleepio have been shown to work for poor sleep in menopause. Some NHS areas offer these free.

What doesn't work long-term: sleeping pills. They might help initially, but they don't address the underlying cause. They work best combined with CBT.

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When to See a Menopause Specialist

If sleep problems are wrecking your daily life, get help now. Not in six months. Now.

A menopause specialist has specific training in hormone health that many GPs don't. They can assess whether HRT might help your sleep, work out which type and dose would suit you, and monitor how you respond.

They can also investigate whether you might have sleep apnoea, especially if you're experiencing daytime fatigue, morning headaches, or concentration problems alongside the sleep disruption.

If you can't access a menopause specialist directly in your area, ask your GP for a referral.

Poor sleep has long-term effects on your health. It increases your risk of cardiovascular disease, diabetes, cognitive problems. It affects your immune system, your mental health, your relationships, your ability to function at work. You don't have to accept terrible sleep as just part of menopause.

DisclaimerAt Voy, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

References

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Kravitz, H.M., Janssen, I., Bromberger, J.T., Matthews, K.A., Hall, M.H., Ruppert, K., Joffe, H. (2017). Sleep Trajectories Before and After the Final Menstrual Period in The Study of Women's Health Across the Nation (SWAN). Current Sleep Medicine Reports, 3(3):235-250. https://pmc.ncbi.nlm.nih.gov/articles/PMC5604858/

^²

Toffol, E., Kalleinen, N., Himanen, S-L., Partonen, T., Haukka, J., Polo-Kantola, P. (2021). Nighttime melatonin secretion and sleep architecture: different associations in perimenopausal and postmenopausal women. Sleep Medicine, 81:52–61. https://doi.org/10.1016/j.sleep.2021.02.011

^³

Baker, F.C. et al. (2018). Sleep and sleep disorders in the menopausal transition. Sleep Medicine Clinics. https://pmc.ncbi.nlm.nih.gov/articles/PMC6092036/

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