Why PMS-Related Sleep Disruption Is Common in Perimenopause

Perimenopause |
5 min read

Published

March 09, 2026

Medically reviewed by

Alyssa Dweck MS, MD, FACOG, MSCP, Chief Medical Officer

Has falling asleep – or staying asleep – started to feel more difficult during perimenopause or menopause? Many women notice that their sleep becomes more disrupted during the menopause transition, especially at the start of their menstrual cycle during perimenopause. Unpredictable rises and dips in estrogen may lead to a range of uncomfortable symptoms, including PMS-related symptoms like cramps and breast tenderness.

You may have noticed sleep changes before your period, even before perimenopause, as hormone levels naturally shift during the luteal phase.¹ During perimenopause, the transitional stage leading up to menopause, hormone shifts may feel less predictable than they used to, first becoming more volatile and then sharply declining.

Read on to learn more about what’s happening in your body during perimenopause and for some tips that may help support better sleep.

Why Does Perimenopause Cause Sleep Problems?

Estrogen and progesterone both play important roles regarding sleep, and both change dramatically during perimenopause.² These hormonal shifts may affect body temperature, mood, clarity, and how resilient you feel against everyday stress.³

Estrogen helps support the production of serotonin, a neurotransmitter found in the brain that is connected to your mood.⁴ Serotonin helps the body create melatonin, the hormone that lets your body know when it’s time to rest. Since serotonin helps regulate melatonin, shifts in estrogen may interfere with this signaling, making it harder for your body to recognize when it’s time to sleep.⁵

As noted above, progesterone and sleep are also connected. This specific hormone promotes relaxation by calming the nervous system and slightly lowering body temperature, which supports both falling asleep and staying asleep.⁶

During perimenopause, progesterone levels become unpredictable, reducing the calming effect of the hormone and contributing to lighter, more fragmented sleep.⁷ Together with estrogen changes, these hormonal shifts help explain why you might be noticing sleep problems during the menopause transition.

For a quick video from Bonafide Chief Medical Officer, Dr. Alyssa Dweck, on the connection between sleep issues and PMS, check out the below:

Luteal Phase Sleeplessness and Perimenopause

Does sleeplessness ever increase before your period? Even before perimenopause, you might have noticed increased sleep disruptions during the luteal phase of each menstrual cycle. The luteal phase refers to the time between ovulation and the start of your period. For those who track their menstrual cycle, you may have heard the luteal phase referred to as your body’s “Inner Autumn.”⁸

Metaphorically think of the way the seasons change from summer to autumn. During this transitional time, women may notice an internal sense of slowing down, similar to the qualities of the changing seasons. Research also shows that your stress sensitivity may increase during this time as compared to the follicular stage.⁹

During the luteal phase, progesterone levels also rise to promote relaxation, while estrogen levels decline.¹⁰ In perimenopause, however, ovulation may occur less regularly and this causes hormones to fluctuate more significantly. When ovulation changes, the relaxing effects of progesterone may lessen, which may make PMS symptoms and associated sensations in the body more noticeable.¹¹

Feeling Hormonal?

When sleep becomes inconsistent and moods start to shift, you may start to feel more emotionally sensitive. Your fatigue may affect your motivation, confidence, and patience, making normal stressors more impactful than usual. Many women may find themselves needing more understanding from their partners and loved ones, along with greater self-compassion, as they navigate this stage of life.

You may also notice a greater need for rest and balance. Remember, these needs aren’t signs of weakness or that something is wrong – they’re signals from your body asking for care and space to adjust to all the changes.

3 Practical Ways to Sleep Better During Perimenopause

There are some practical ways to help your body wind down to promote better sleep during perimenopause and PMS.

Create a Consistent Wind-Down Routine

Going to bed and waking at similar times each day can help to reinforce your internal clock, otherwise known as our circadian rhythm.¹² Trying out gentle rituals, like dimming the lights, stretching, reading, or limiting screen exposure before bed, signal to your nervous system that it’s time to settle down.¹³

Support Temperature and Physical Comfort

Since hormonal shifts may affect symptoms like hot flashes and night sweats, keeping your sleep environment cool and breathable may help.¹⁴ Consider adjusting your environment by adding lightweight bedding, breathable clothing, or more airflow (like from a bedside fan), all of which can help reduce discomfort that might otherwise interrupt sleep.

Track Patterns and Respond with Self-Compassion

Noticing when sleep disruptions occur during your cycle can help you better anticipate your needs.¹⁵ Instead of pushing through fatigue, consider adjusting your expectations around work and other responsibilities. Try to incorporate calming practices like journaling or breathing exercises to give yourself space to digest the new experiences.¹⁶

This, Too, Shall Pass

Sleep disruptions before your period may feel frustrating, especially during perimenopause. Keep in mind that these shifts are driven by natural hormonal changes that may influence your body and mood. Understanding what’s happening should help you see the changes as part of this life stage transition. With awareness and self-compassion, you can respond to your body’s signals and acknowledge that, like all transitions, this phase is temporary.

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