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I Can’t Sleep

Hormonal fluctuations may be the culprit, but there could be other causes, too.

Photo credit: Getty Images/Vladimir Godnik

Q: I’ve always been a great sleeper, but recently I’ve started having problems. Some nights, it takes me forever to fall asleep; other times, I have no problem drifting off but then I wake up and can’t get back to sleep. I’m 43, and my period is starting to get irregular. Could hormones be what’s causing the problem, and if so, what can I do about it?

Sincerely,

“Sleepless in Syosset”

Dear Sleepless:

Sleep issues are a common problem when you’re in perimenopause—the period of time in a woman's life before menopause. One study showed that up to 60 percent of perimenopausal women have insomnia. The average age for menopause in the United States is 51.4, and perimenopause can start up to 10 years before that, so yes, hormones could be the cause of your sleep problems.

But it’s a good idea to step back and think about some other possible culprits.

First, are you sure you aren’t pregnant? That might sound crazy, but many of the symptoms of early pregnancy can mimic the symptoms of perimenopause. A missed period is one symptom, of course, but others can include feeling bloated, gaining weight, trouble sleeping, and hot flashes.

Another possible cause for sleep troubles could be a sluggish thyroid, which is known as hypothyroidism. This can make you tired, and also give you sleep issues. Or it could be a sign of early diabetes. So, it's important to make sure, first and foremost, that you don’t just label everything as due to perimenopause, and see your primary care doctor for a thorough checkup.

If it turns out that your sleep issue is related to perimenopause, there are a lot of simple things you can do that can help. First, I’d consider turning down the heat or even using a fan or an air conditioner to cool the air and increase the circulation in your bedroom. Also, avoid heavy blankets, and dress in lightweight layers to improve your sleep efficiency.

There’s also some good evidence that complementary and alternative medicine therapies—things like aromatherapy, acupuncture, yoga and massage—can help improve your sleep. Women who are fully in menopause might also talk to their doctor about the risks and benefits of hormone replacement therapy, as well as the medication Effexor. This is an antidepressant that, at a low dose, has been approved for women who have hot flashes and can’t or won’t take hormone replacement therapy.

The most important thing you can do is establish a good relationship with a doctor you trust, and one who will listen to you and work with you to find solutions.

“One study showed that up to 60 percent of perimenopausal women have insomnia.”
Jill Maura Rabin, MD
Dr. Jill Maura Rabin, Urogynecologist | Photo credit: The Well

Next Steps and Useful Resources

Published May 8th, 2018