Insomnia, PMS, and Menopause

Reviewed by: HU Medical Review Board | Last reviewed: June 2020

Women of all ages are more likely to experience insomnia than men. In fact, more than 1 in 4 women in the U.S. have insomnia while less than 1 in 5 men do. Studies show that women report lower quality sleep, take longer to fall asleep, sleep for shorter periods of time, and feel sleepier when awake.1

Doctors believe this may be caused by the many hormone changes a woman has throughout her life. This is especially true for women with premenstrual syndrome (PMS), perimenopause, and menopause.1

Why does PMS cause insomnia?

Many women report having trouble with sleep in the days leading up to the start of their menstrual cycle (period). And, women with premenstrual dysphoric disorder (PMDD), a more severe form of PMS, have even higher rates of insomnia. It is so common that insomnia is one of the symptoms used to diagnose PMS and PMDD.1-3

Each menstrual cycle releases hormones that influence sleep, along with preparing the body for pregnancy. Specifically, these hormones increase a woman’s stage 2 (lighter stage) sleep and reduce REM sleep, whether she has PMS or PMDD or not. Doctors do not fully understand how PMS makes sleep worse, but it may have to do with the female body releasing less melatonin and progesterone. Melatonin and progesterone are hormones that help encourage sleep.2

Other symptoms of PMS and PMDD can make sleep difficult, such as stomach pain, backache, depression, and anxiety.2

Why does menopause cause insomnia?

Perimenopause and menopause are known to cause problems with duration and quality of sleep. Doctors believe this is because the female body creates less estrogen, progesterone, and melatonin. All of these hormones impact sleep. Plus, hot flashes and night sweats, 2 of the most common symptoms of menopause make falling asleep and staying asleep difficult.4

Lower estrogen levels also make several conditions more common, such as joint aches and pains, anxiety, depression, and the need to go to the bathroom at night. All of these can get in the way of a good night’s rest.4

As a woman ages, sleep apnea and restless legs syndrome become more common or more severe. These other sleep disorders also may contribute to insomnia.4

Diagnosing insomnia in women

Insomnia is usually diagnosed when a woman discusses her sleep problems with a doctor. The doctor may suggest keeping a sleep diary for 2 weeks. The information in a sleep diary can give the doctor an idea of how severe the insomnia is and whether lifestyle issues may be making it worse. Your doctor may also want to run blood tests to check for thyroid problems and other health conditions that can lead to poor sleep.1

Treatment for insomnia during hormone fluctuations

Women going through PMS or menopause should follow the same treatment recommendations as other people with insomnia. Attention to good sleep habits and cognitive behavioral therapy for insomnia (CBT-i) are considered the first and best treatments. Sometimes hormone replacement therapy (HRT) can help but the risks must be balanced with the benefits.

Other chronic conditions and insomnia

Some health conditions seem to increase the chances a woman will develop insomnia. These conditions include:5,6

  • Depression and anxiety
  • Chronic pain
  • High blood pressure
  • Diabetes
  • Neurological disorders such as Parkinson’s and Alzheimer’s
  • Post-traumatic stress disorder (PTSD)
  • Cancer
  • Heart, kidney, and lung disease

Many of the drugs used to treat long-term health conditions can cause insomnia or make it worse, such as some antidepressants, sedatives, beta-blockers, steroids, and cold medicines.5

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