Sleep problems in perimenopause and menopause

Written by the Progyny Editorial Team. Reviewed by the Progyny Clinical Team – August 2026.

Consistent, quality sleep is vital for our energy, well-being, and overall health. Yet about half of people in menopause have trouble sleeping. Many struggle during perimenopause as well.

Let’s talk about what’s behind this and go over strategies that may help you sleep – and feel – better.

What causes poor sleep?

Many peri/menopause (perimenopause and menopause) symptoms can contribute to poor sleep. These include:

• Hot flashes and night sweats
• Mood changes, including anxiety or depression
• Urinary symptoms that cause nighttime waking

Estrogen and progesterone levels trend down and fluctuate in unpredictable ways during peri/menopause. These hormones help regulate our body’s temperature and mood, among many other things. When they drop or are out of balance, it may lead to a wide range of symptoms.

Along with hormonal changes and related symptoms, sleep may be affected by:

• Health issues such as sleep apnea or restless legs syndrome
• Life stress from work, relationships, family, caregiving, and more
• Sleep environment or routine that isn’t optimal

What can I do for relief?

There are a number of lifestyle and sleep strategies you can try. Also discuss your symptoms and sleep with your healthcare provider. Your personalized plan may include options such as therapy or medicine.

Cognitive behavioral therapy for insomnia (CBT-I)

A specialized type of therapy called CBT-I is the number one treatment for insomnia. It has shown promise for treating sleep issues in peri/menopause as well.

With CBT-I, a licensed therapist will work with you to:

• Build a strong association between your bed and sleep
• Follow a personalized sleep schedule that increases your drive for sleep
• Change thoughts and worries about sleep

Your provider may be able to refer you to a specialist or recommend a high-quality CBT-I program online.

Menopause hormone therapy

There are two types of menopause hormone therapy (MHT), and these may help symptoms that disrupt sleep.

• Systemic MHT (which travels through your body) is an effective treatment for hot flashes and night sweats.
• Local vaginal therapy (which is inserted into your vagina and does not travel through your body) is very effective for vaginal and urinary symptoms.

Many people use both forms of MHT together. But MHT is not right for everyone, so ask your healthcare provider what’s recommended for you.

MHT is available in many forms, including:

• Pills taken by mouth
• Patch
• Spray
• Gel
• Vaginal ring

Non-hormonal medicine options

Prescription sleep medicine may help some people, when sleep problems affect day-to-day life. Be sure to review the pros and cons with your provider.

In addition, please ask your provider before taking any supplements, including melatonin, for sleep.

Helpful sleep practices

There are many steps you can take to help promote better sleep.

Follow a sleep schedule

A consistent schedule will help train your body for sleep. This means:

• Wake up at the same time each day
• Go to bed at the same time each day
• Try not to sleep in on the weekends

If you wake up at night and can’t fall back asleep in 15 minutes, get up and do something relaxing (in very dim or no light). This way, you won’t associate your bed with lying there awake.

Relaxing sleep routine

Give yourself time to prepare for sleep. Some ideas:

• Turn off screens an hour before bed to limit blue light (and avoid doomscrolling, which may raise anxiety!).
• Try journaling or writing down any worries before bedtime, so they can live on paper and not in your head.
• Do a relaxation technique like deep breathing or meditation.
• Wind down by reading, listening to music, or taking a bath. A bath has the added benefit of raising your temperature – and afterwards when your temperature drops, that helps bring about sleep.

Be sleep-aware during the day

Our choices during the day can affect our ability to sleep at night. Here are a few things to consider:

• Get morning sunlight. This helps set your body clock.
• Get active (before evening). Exercise is great for sleep, but if it’s done too late, it can wake your body up.
• Cut afternoon caffeine. A cup or two in the morning shouldn’t affect your sleep.
• Limit alcohol and evening drinks. Alcohol may help you fall asleep, but it can lead to light, disturbed sleep. Limiting fluids before bed helps reduce trips to the bathroom.
• Aim for an early dinner. Try not to eat anything too heavy within 3 hours of bedtime. Digestion can wake up your body or cause discomfort.

Create a sleep-friendly bedroom

Your bedroom should be:

• Cool: Experts say 60°F to 67°F is best for sleep.
• Dark: Consider blackout curtains to help with this.
• Quiet: It’s OK to ask others in your home to support you.

Reach out for support

Sleep issues can be frustrating. But symptom relief is available, and other forms of sleep support have helped many people. Let your provider know about any bothersome symptoms you’re having. Your Progyny Care Advocate is also here to provide education, guidance, and help navigating peri/menopause care.

Explore related:

• Perimenopause: What can I expect?
• Hot flashes and night sweats in perimenopause and menopause
• Menopause hormone therapy: Is it right for me?

Disclaimer: The information provided by Progyny is for educational purposes only and is not medical advice. Always consult a qualified healthcare provider for medical guidance.