If you've entered perimenopause, then it’s very likely you are experiencing a wide variety of symptoms, ranging from mood swings, to irregular periods to joint or muscle aches.1 There are currently a total of 34 recognized symptoms associated with this transitional period that stem from hormone fluctuations, primarily estrogen and progesterone.
With age comes the natural progression toward perimenopause (and menopause), which comes along with notable changes in hormones, life circumstances and potential sleep disturbances.2 And while it’s perhaps not as commonly associated with perimenopause, poor sleep quality can certainly become more prevalent during this time for many reasons. In fact, it’s been found that up to 47% of perimenopausal women report sleep disturbances, like trouble falling or staying asleep during this stage of menopause.3
During the menopausal transition, many women may experience symptoms that contribute to poor sleep, such as anxiety, restlessness, and night sweats. As women notice more of these symptoms in their everyday lives, they may also be experiencing a gradual decrease in melatonin, alongside a more abrupt decline in estrogen and progesterone.4 This fluctuation in reproductive hormones along with the gradual reduction in melatonin can ultimately contribute lost hours of much-needed sleep.
To learn some quick ways to improve your sleep during this transitional time, check out the below clip from Chief Medical Officer, Dr. Alyssa Dweck:
What many may be unaware of, however, is the impact that perimenopause and these hormonal fluctuations can have on your circadian rhythm. In this article, we’ll explore what your circadian rhythm is, how it's potentially disrupted during perimenopause, and what you can do to combat any resulting sleep disturbances.
What Are Circadian Rhythms?
Circadian rhythms are the physical, mental, and behavioral changes experienced over a 24-hour cycle – one of which involves the management of sleep patterns.5 Our circadian rhythm responds to light changes in the environment, so when darkness sets in at night, it triggers our brain to produce melatonin, the hormone in our bodies that regulates sleep.6 When morning comes, our body suppresses that melatonin production and produces more cortisol, a hormone that helps to make us more alert.7
How Does Menopause Disrupt Our Circadian Rhythm?
As mentioned, when women begin perimenopause, they typically experience volatile changes in their estrogen and progesterone levels, in addition to a more gradual decrease in melatonin levels. This can result in poorer sleep duration and depth, which is why so many women experience insomnia throughout the menopausal transition. Additionally, vasomotor symptoms – more commonly known as hot flashes and night sweats – are believed to play a major role in sleep disruption during perimenopause and beyond. These symptoms are notorious for preventing women from getting to sleep as well as staying asleep.8
Because of this inadequate quality of sleep, women may also experience reduced alertness and exhaustion throughout the day; this all stems from disruptions in the circadian rhythm.9 For women going through perimenopause, the result of an unbalanced circadian rhythm can be reduced quality of life, as many may experience chronic fatigue, difficulty concentrating, and even depression.
How to Support Your Circadian Rhythm During Perimenopause
There are a number of things you can do to minimize the impact that perimenopause has on your circadian rhythm.
Get More Natural Light Exposure
While it may seem like a basic concept, being proactive about exposing yourself to natural light during the day can help your body naturally regulate its secretion of melatonin.
Consider going on a walk in the morning or opening the curtains to expose yourself to natural sunlight as much as possible throughout the day. It may also be helpful to stay mindful of the amount of natural light you expose yourself to in the evening, especially as you get closer to bedtime – as too much could be detrimental to your sleep cycle.10
Try Incorporating More Exercise
Movement and exercise can have a positive impact on your body's circadian rhythm. In fact, research shows that the timing of exercise can be beneficial in shifting your circadian rhythm in the event it's misaligned.11 In addition to its benefits to sleep, exercise can also help you to manage stress levels and prevent the loss of bone and muscle mass – both of which become more common during menopause.12
Consider Medications or Dietary Supplements
Many women experiencing hormonal fluctuations and related menopausal symptoms often resort to hormone replacement therapy (HRT) to support their changing hormone levels. As mentioned, it’s thought that hormonal declines experienced during menopause often play a role in sleep disturbances, and some studies have reported that HRT is an effective way to moderate these symptoms – especially those associated with disruptive vasomotor symptoms, which are likely interrupting sleep.13 There may be some risks and side effects associated with using HRT, however, so be sure to discuss this option thoroughly with your healthcare provider to see if it’s right for you.
Low dose SSRIs (selective serotonin reuptake inhibitors) are another prescription medication your healthcare provider may recommend to help manage menopausal symptoms, like hot flashes, which could be impacting your sleep quality. It’s important to note, however, that SSRIs may contribute to insomnia, so again, it’s important to discuss all of your options with your healthcare provider to weigh the benefits and downsides.14
If you’re unable to take or would prefer to explore symptom management options that don’t involve hormones or prescription medications, you could consider other hormone-free solutions that can be purchased over-the-counter.
Over-the-counter remedies and other non-prescription options can be both safe and effective, often alleviating many of the discomforts associated with menopause – including those that may interrupt your sleep. Melatonin, Tylenol PM or Unisom are some options often considered to help with occasional sleep issues that you can consider.15
If you're experiencing problems with your circadian rhythm and you're going through perimenopause or are postmenopausal, there's no need to suffer from troublesome symptoms that are causing you to lose sleep. While over-the-counter products can bring relief, and enable you to fall asleep and stay asleep, sometimes something more powerful is necessary. Never hesitate in speaking with your healthcare provider, as they can provide you with the necessary support to make managing sleep disturbances experienced during menopause easier and get you back on track to more restful nights.
Resources:
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718648/
- https://www.sleep.com/sleep-health/why-40-year-old-women-have-trouble-sleeping
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/
- https://www.nigms.nih.gov/education/fact-sheets/Pages/circadian-rhythms.aspx
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/
- https://www.healthline.com/health/healthy-sleep/circadian-rhythm#how-it-works
- https://gremjournal.com/journal/0203-2022/therapeutic-approaches-for-vasomotor-symptoms-and-sleep-disorders-in-menopausal-women/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9905778/
- https://nunm.edu/2019/02/circadian-rhythms-womens-health/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098792/
- https://www.sleepfoundation.org/women-sleep/menopause-and-sleep
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718648/
- https://www.medicalnewstoday.com/articles/menopause-and-insomnia#treatment
- https://www.sleepfoundation.org/sleep-aids/over-the-counter-sleep-aids
