Women and Sleep: Hormones, Menopause, and Unique Challenges

By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living

Why Women’s Sleep Deserves Special Attention

Sleep problems affect women disproportionately compared to men. Women report higher rates of insomnia, nighttime awakenings, and non-restorative sleep, especially during times of hormonal transition—puberty, pregnancy, perimenopause, and menopause. These patterns aren’t simply cultural or behavioral; they’re deeply rooted in biology and hormones.

Hormones and Sleep Across the Lifespan

1. Menstrual Cycle

   • Follicular phase (first half): Rising estrogen tends to support sleep stability.
   • Luteal phase (second half): Progesterone has sedative effects, but when levels drop right before menstruation, women often experience worse sleep.
   • PMS/PMDD: Insomnia and poor sleep efficiency are common due to hormonal fluctuations and mood changes.

2. Pregnancy and Postpartum

   • Pregnancy: Progesterone promotes sleepiness, but nighttime discomfort, reflux, and frequent urination disrupt sleep.
   • Third trimester: Increased risk of sleep apnea due to weight gain and airway changes.
   • Postpartum: Hormonal crashes, breastfeeding demands, and infant care result in fragmented sleep. Sleep debt is nearly universal.

3. Perimenopause and Menopause

   • Estrogen decline: Leads to hot flashes and night sweats that fragment sleep.
   • Progesterone decline: Removes its natural sedative, GABA-enhancing effect.
   • Melatonin decline: Natural circadian rhythms become less stable with age.
   • Result: Insomnia is reported in up to 60% of women during perimenopause/menopause.

Unique Challenges for Women

• Insomnia prevalence: Women are nearly twice as likely as men to develop insomnia.
• Mood disorders: Depression and anxiety, which are more prevalent in women, further disrupt sleep.
• Sleep apnea underdiagnosis: Often missed in women because symptoms present as insomnia, fatigue, or mood changes rather than classic snoring.
• Caregiving demands: Women often juggle multiple roles (work, childcare, elder care), leaving less time for restorative sleep.

Evidence-Based Solutions

1. Hormone Replacement Therapy (HRT)

   • Estrogen and progesterone replacement can reduce hot flashes, improve sleep continuity, and restore some of the hormonal balance that supports sleep.
   • Micronized progesterone is particularly helpful due to its sedative effect.

2. Behavioral Strategies

   • CBT-I (Cognitive Behavioral Therapy for Insomnia): Gold-standard treatment, highly effective in women with chronic insomnia.
   • Sleep hygiene: Consistent schedule, cool/dark environment, limiting caffeine/alcohol.
   • Wind-down routines: Meditation, journaling, or stretching before bed.

3. Nutritional and Lifestyle Support

   • Limit alcohol (especially during menopause) to reduce hot-flash-related sleep disruption.
   • Avoid late heavy meals that can worsen reflux or sleep fragmentation.
   • Exercise regularly—both resistance training and Zone 2 cardio improve sleep quality and reduce menopausal symptoms.

4. Medical and Supplement Options

   • Melatonin: May help regulate circadian rhythms, especially in postmenopausal women.
   • Magnesium and glycine: Modest evidence for promoting sleep depth.
   • Targeted medications: Only when necessary and ideally short-term.

Beyond Health’s Perspective

For women, sleep challenges aren’t just about “bad habits.” They are the product of complex hormonal transitions, biological differences, and social demands.
At Beyond Health, we:

• Screen for hormone-related sleep issues (menstrual cycle, perimenopause, menopause).
• Use targeted therapies—from hormone optimization to vitamin deficiencies—to address root causes.
• Integrate lifestyle medicine (exercise, nutrition, mindfulness) into long-term solutions.

We view sleep as a vital sign for women’s health, a reflection of hormone balance, metabolic health, and stress resilience.

The Bottom Line

Women face unique and under-recognized challenges when it comes to sleep. Hormonal shifts—from the menstrual cycle to menopause—directly affect sleep quality and recovery. While culture often normalizes women’s sleep struggles, the science is clear: sleep optimization is possible, and it’s a key pillar of health and longevity.
Investing in sleep is investing in resilience—at every stage of life.

References

1. Krishnan V, Collop NA. “Gender differences in sleep disorders.” Curr Opin Pulm Med. 2006;12(6):383–389.
2. Baker FC, et al. “Sleep problems across the menstrual cycle in young women.” J Womens Health. 2008;17(7):1189–1197.
3. Mindell JA, et al. “Sleep patterns and sleep disturbances across pregnancy.” Sleep Med. 2015;16(4):483–488.
4. Polo-Kantola P. “Sleep problems in midlife and beyond.” Maturitas. 2011;68(3):224–232.
5. Clark AJ, et al. “Cognitive behavioral therapy for insomnia in women: A meta-analysis.” Sleep Med Rev. 2015;19:51–60.