Sleep Quality In Perimenopause

This used to describe my sleep quality in perimenopause:

I jolt awake at 2 am. I don’t look at the clock.

Rule #1 of sleep club: We don’t talk about sleep club.

Rule #2: We don’t look at the clock. Ever.

I Know What Time It Is

I don’t look, but I know what time it is. Every fiber of my being knows it’s 2 am on the nose. Okay, maybe 2:02 am. And I feel like I could run a marathon. Getting out of bed to read, meditate, stretch or work out – I’ve tried it all. The best I’ve achieved is falling back to sleep just before the alarm goes off at 6:30 am.

Maybe I don’t need that much sleep?

I so wish that were the case. Fact is, by 10 am I am wiped out. Barely stringing sentences together. Hard to keep your job, never mind get the promotion that is your destiny when you are so sleep deprived. And the kids, oh the poor kids. My partner? Well, he knew what he was getting into when he married me. Kidding. He is empathetic and just stays out of my way.

At home my title is CVO: Chief Vegetable Officer.

Let’s Clear the Holistic Air

I eat a Mediterranean style diet. In my house we joke that my title is CVO: Chief Vegetable Officer. I watch my sugar intake and it’s pretty limited. So much so that my kids now check the labels on their snacks to see if the sugar content will push them over the 25 mg daily limit generally advised for added sugar in one’s diet – yet more discussion topics for their therapy sessions later in life.

I cut out almost all alcohol 3 years ago. Stopped caffeine 4 years ago. I’ve been careful about avoiding certain foods for the last 5 years, which coincided with the resolution of several health issues including a skin condition, a mysterious tooth ache and suddenly looking like I was 4.5 months pregnant on a regular basis. And I’m very careful about how and when I introduce changes, particularly when it comes to diet. You can easily land in disordered eating if you aren’t careful about the advice you’re taking and the way you implement that advice.

Despite My Best Efforts, Poor Sleep Is Still A Problem

Almost daily exercise and a killer bedtime routine are musts. I try to meditate every day, emphasis on try. And all of the tips and tricks for a good night’s sleep are in my brain. And yet, I still often had trouble sleeping past 2 am.

Medications for Poor Sleep Quality in Perimenopause

Oh the things I’ve tried. Sleeping pills on the rare occasion where the 2 am waking causes me to end up in what I call a sleep-stress spiral. CBD and THC oil. And all kinds of doses and formulations of melatonin. The supplements – too many to list.  Suffice it to say that while some things may have helped, none were ever a long-term solution for my sleep problems.

For the majority of my 2 am waking problem I’ve not taken any medications, other than the following supplements: vitamin C, D, B complex, omega 3s, and magnesium.

The supplements – too many to list.

My Efforts Didn’t Improve Sleep

I practice what qualified professionals preach. I’m all about the gold stars. And I was still regularly waking up at 2 am like there was a lion in my bedroom ready to pounce. I could fall asleep, no problem. I just couldn’t stay asleep.

So Why The Constant Sleep Disturbances?

For years I assumed I could no longer handle the demands of the wonderful life I’d created. Turns out it wasn’t that I couldn’t handle the stress of the work/life juggle. For the record: there is no balance, but that is for another time. I had menopausal symptoms that gradually had become very disruptive. It was the hormonal roller coaster of perimenopause.

Is It Estrogen?

At this point I’m blaming estrogen. Based on tracking my menstrual cycle and my sleep, I have a theory. When I have an estrogen surge, my body does crazy things; one being to react like it has been plugged into an electrical socket.

Couldn’t Someone Have Mentioned Menopausal Sleep Problems?

The other important thing I’ve determined: perimenopause can cause sleep disturbances. Not exactly earth shattering, but it would have been really helpful if one of the many medical professionals I’ve consulted over the last 7 years had told me this was a possibility. They were able to rule out all kinds of thing but no one thought, or perhaps knew, to mention that sleep disturbance if often a symptom of perimenopause.

I didn’t think I needed to worry about menopause and sleep until I had actually achieved menopause. Turns out sleep quality can be impacted long before your last menstrual period.

Without an explanation for my middle-of-the-night waking I was left to believe that I couldn’t handle the demands of my life. So much so, that this thinking significantly contributed to the decision to end my banking career.

Sleep Problems and Other Menopause Symptoms – A Slow Burn

The 2 am waking started as very occasional and got progressively worse. Unexplained night waking and extremely itchy skin that would come and go, gastrointestinal issues, and a return of an anxiety issue that I had previously learned to manage all came on in a slow, creeping way.

Despite my discomfort, I had started to think it was all in my head, especially when there was no explanation for why any of these things were happening.

My Sleep Problems and Other Symptoms Got Worse

All of these issues got worse for me and needed medical attention. None of them could be explained. I believe all of them were perimenopause symptoms.

Let me be very clear: perimenopause and menopause are not diseases. They are a phase of life that should be embraced and celebrated. Achieving menopause is a natural process that will happen to anyone with ovaries, provided they live long enough. And yet menopause and its associated phases are not properly researched, funded, or understood. This is not acceptable.

I was battling something I knew nothing about.

Sleep Problems Impact Many Menopausal Women

Just knowing that my sleep disruption was because of perimenopause would have been a tremendous boost to my ability to cope and my self-esteem. I wouldn’t have blamed myself for not being able to manage the stress in my life.

No wonder I felt shame; I was battling something I knew nothing about, instead of embracing the changes happening to my body and finding solutions that might actually address the root cause.

Thank you, perimenopause?

I sometimes imagine what might have been had I been given the knowledge, advice, or treatment that would have allowed me to be well rested. Then I remember the amazing things that have happened as a result of my courage to step away from a career that was not a passion. Thank you, perimenopause?

Progesterone – Sleeps Little Helper

I started taking progesterone. First I was using a compounded oral micronized progesterone product that was recommended by my functional medical practitioner. This did seem to help, though the 2 am waking would still occur and sometimes my anxiety would get really intense.

Recently, some scary and rather significant symptoms prompted me to seek out a new doctor. (You can read about those symptoms here.) That doctor recommended some changes, and ultimately she suggested we change my progesterone from a compounded product to a pharmaceutical one. They contain the same hormones, but have different non-medical ingredients. The compounded product is made in a pharmacy, the other is made by a pharmaceutical company.

Oral Micronized Progesterone

My doctor does prescribe compounded products when they make sense, but did point out to me that the dosage in compounded products is not always reliable. And guess what? 200 mg of pharmaceutical oral micronized progesterone has me sleeping well.

I have had one night where I woke at 2 am in the 6 months since I started taking the pharmaceutical product. It used to be a regular occurrence when I was on 400 mg of compounded oral micronized progesterone.

Progesterone For Sleep Is Off-label

The North American Menopause Society’s 2022 position statement does say that 300 mg of micronized progesterone nightly significantly decreases hot flashes and night sweats, and improves sleep. However, no long-term study results are available (sigh), and use of progestogens without estrogen for either hot flashes or sleep is off-label. I’ll take the off-label option and sleep, thank you.

Confused about the difference between progesterone and progestins? This post might help.

Women Leaving Work

I’m not the only person whose life and career have been significantly impacted by undiagnosed perimenopause symptoms. And while my reasons for leaving my career were many, there are a lot of statistics popping up about the number of women who do leave their jobs, or don’t apply for the promotion, or reduce their hours, because of unmanageable symptoms in perimenopause and postmenopause.

I suspect this is an underreported event, not just because of the shame of being past your prime, or whatever bullshit trope you want to insert here, but because most of us have no idea what perimenopause actually is and the significant impact it can have on some people’s lives. This must change.

Call to Action

See your doctor at least once a year to set a baseline and be able to monitor any changes to your health. It’s always important to discuss symptoms with your doctor, not only to get the appropriate support and solutions, but also to rule out other medical conditions that can mirror the signs and symptoms of perimenopause and postmenopause.

Be The Hero of Your Own Health Story

Remember that your care needs to be a priority. Sounds simple, but it’s very easy to forget. Understanding your body and the changes that happen in perimenopause and postmenopause is incredibly empowering. Talk to your friends, join a Facebook group, follow us, and start building your health care team. Your story will be written. Will you be the author, or will you leave the unfolding to chance?


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.