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Research is examining the link between sleep and perimenopause symptoms. Melanie DeFazio/Stocksy
  • Cisgender women typically experience perimenopause four to eight years before entering menopause.
  • Past studies show about 47% of perimenopausal women experience sleep disorders.
  • New research says there may be a link between estrogen levels and sleep in perimenopausal women.

Perimenopause marks the time when a cisgender woman’s body is preparing for menopause.

For most women, perimenopause starts in their early 40s, however, it can start as early as their mid-30s. This phase prior to menopause can last anywhere between four to eight years.

During this time, a woman’s ovaries stop producing as much of the hormone estrogen, causing the menstrual cycle to become irregular or stop.

Because the body is changing, it is not uncommon for women to experience perimenopausal symptoms such as hot flashes, night sweats, tiredness, low sex drive, sudden shifts in moods, and sleeping issues.

Past research shows that about 47% of perimenopausal women experience sleep disorders.

“Difficulty sleeping is one of the most common symptoms women experience during the perimenopausal transition; however, understanding of the underlying physiology and, more importantly, treatment options, remains limited,” Amy Divaraniya, PhD, founder and CEO of Oova — a company focused on using biomarkers for women’s health — told Medical News Today. “Addressing this issue can lead to significant improvements in sleep quality, which can have a positive ripple effect on a woman’s overall well-being.”

Divaraniya is the lead author of a new study recently presented at the 2024 annual meeting of the North American Menopause Society (NAMS) that reports there may be a link between estrogen levels and sleeping issues in perimenopausal women.

The study is yet to be published in a peer-reviewed journal.

For this study, researchers recruited 503 study participants who self-identified as perimenopausal with an average age of about 44 years.

According to Divaraniya, each participant used Oova’s at-home hormone monitoring perimenopause hormone kit to track their sleep patterns.

“Each kit includes urine-based, multi-hormone tests that measure key biomarkers such as luteinizing hormone (LH), progesterone (PdG), and estrogen (E3G), along with a platform for real-time data tracking,” she explained. “Oova users can monitor their actual hormone fluctuations throughout the month and track their progress over time.”

“For perimenopause, users can confirm hormone activity related to perimenopause, track unique physical symptoms, identify fertile windows, confirm ovulation when trying to conceive, and monitor hormone patterns when undergoing hormone replacement therapy (HRT),” Divaraniya continued.

“Users can enter their symptoms daily, and we noticed that an overwhelming number of them were tracking their sleep on our platform. This observation was the primary reason we chose to evaluate whether there was a hormonal correlation with the hours of sleep women were reporting.”

At the study’s conclusion, scientists found that study participants who reported sleeping between six to nine hours a night showed significantly higher levels of E3G compared to those who slept between three to six hours.

Researchers reported no noteworthy differences in levels of LH and PdG across different sleep durations.

“We were surprised to see such a significant correlation between E3G levels and the hours of sleep women were getting each night,” Divaraniya said.

“[O]nce we examined the results, it made a lot of sense. When estrogen levels are low, cortisol levels are typically higher. Cortisol, often referred to as the stress hormone, is released in response to stress. Elevated cortisol levels can lead to difficulty sleeping and increased anxiety.”
— Amy Divaraniya, PhD

“While this seems like a logical pathway, it hasn’t been extensively evaluated,” she continued. “The results from this analysis suggest a potential pathway, but it requires further investigation. If validated, this finding could drastically improve the lives of women experiencing sleep difficulties during this transition.”

Divaraniya said she believes these findings may one day lead to interventions aimed at improving sleep to manage and potentially mitigate the impact of perimenopausal hormone changes.

“The first step in developing an intervention is to fully understand the physiological pathway associated with sleep disturbances,” she explained. “Once this pathway is identified, interventions can be developed to address specific points within it to support women. Our study highlights a critical step in a potential pathway, bringing us closer to creating effective solutions.”

“We plan to conduct similar analyses across the many other symptoms tracked on Oova’s platform to see if similar hormonal patterns can be identified. If we can uncover hormonal relationships with these symptoms, it could open the door to better support for perimenopausal women,” Divaraniya continued.

For now, Divaraniya advised if a woman suspects she is navigating the perimenopausal transition and is experiencing difficulty sleeping, she should start tracking her sleep hours and hormone patterns.

“Noticing a reduction in estrogen during restless nights could help explain her sleep difficulties,” she added.

MNT also spoke with Sherry Ross, MD, a board certified OB/GYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, about this study, who said it was about time to look at sleep disruption in perimenopause and better understand the connection to estrogen fluctuations during this typical hormonal cycle.

“It’s been said, ‘a night without sleep is a day without perspective,’ so understanding why sleep problems occur in perimenopause and how they can be avoided or treated should be a priority of medical researchers and healthcare providers,” Ross continued.

“Much more research, with larger numbers of patients, needs to be done for all of the perimenopausal symptoms while addressing other variables including diet, exercise, stress, and medications, along with more treatment options. The time is now to take perimenopause seriously!” he said.