Sleep and Perimenopause - Are Your Hormones Keeping You Awake?
It is encouraging to see that interest, understanding and awareness of the menopausal transition has increased significantly in recent years. And we are now heading more confidently towards women feeling more empowered with knowledge on ways they can support as smooth a transition as possible. Thankfully this sea-change involves a shifting narrative too - from the menopause being referred to as a set of symptoms that need to be suppressed and more towards it being a journey that we can learn to embrace. This is a vast and important subject that we have developed a wealth of useful and actionable information for you to delve into. In this, our newest article on the subject, we shine a spotlight on how changing hormones can impact your sleep and take a closer look at 3 key nutrients and ingredients that may be particularly helpful during this time.
What is ‘perimenopause’?
The term ‘perimenopause’ describes the stage in a woman’s life when ovarian function starts to decline; this may be associated with physical changes and symptoms, and can last anywhere from a few months to many years. A woman’s last menstrual period is defined as the menopause. The stage from the last period onwards is post-menopause. During perimenopause levels of key sex hormones (oestrogen, progesterone & testosterone) begin to fluctuate and irregular periods are common (short cycles, long cycles or skipped periods altogether). A wide range of other possible symptoms may occur during perimenopause and often these can ‘come and go’. The menopausal transition is associated with an increased frequency of sleep disturbances and insomnia is one of the most reported symptoms by perimenopausal women. Other symptoms may include changes in mood, anxiety, brain fog, changes in cognitive function, vaginal dryness, changes in skin tone, joint pain and vasomotor symptoms such as hot flashes and night sweats. For many women, this can become a vicious cycle, whereby hot flashes and night sweats can cause sleepless nights, poor mood and increased stress, which in turn can increase the occurrence of hot flashes and night sweats. And so the cycle continues.
So, what’s happening during the menopausal transition that impacts sleep patterns?
Declining and fluctuating sex hormones (oestrogen, progesterone and testosterone)
During the perimenopause this may lead to an array of possible symptoms, and most of these may adversely affect sleep habits. These may include hot flashes, migraines, sleep apnea, circadian rhythm abnormalities, restless legs syndrome, low mood and anxiety.
Bi-directional relationship between vasomotor symptoms & disturbed sleep
In an analysis reviewing sleep concerns in various stages of menopause, it was found that vasomotor symptoms (hot flashes and night sweats) and sleep disturbances may work in a bidirectional relationship. In simple terms this means that vasomotor symptoms may increase sleep problems, and sleep problems may worsen vasomotor symptoms. The good news here though is that supporting either one of these issues has the potential to positively impact both.
Oestrogen levels drop sharply
The types of sleep disturbances most commonly noted during the perimenopause include difficulties getting to or staying asleep, as well as frequent night-time or early morning awakenings. During perimenopause, oestrogen levels can fluctuate dramatically and can drop sharply, corresponding to many of the symptoms associated with this transition period.
HPA axis imbalance
As ovarian function and sex hormone levels start to decline, particularly oestrogen, it is crucial to pay particular attention to the adrenal glands, since they can produce a form of oestrogen to help compensate for the decline in production from the ovaries. The adrenal glands are involved in progesterone production too. In a 2006 study published in Menopause, researchers found that increased cortisol levels during the late menopausal transition stage may influence the risk of vasomotor symptoms. Stress is known to affect sleep patterns and has also been identified as a determinant in some studies of factors associated with hot flashes. There are many good reasons to look after the hard-working adrenal glands during the menopausal transition and this is especially true for protecting and promoting good quality sleep.
Perhaps less well known is the potential involvement of another hormone whose levels decline during this time and no doubt play a key role in disrupted sleep patterns. That hormone is melatonin, which decreases during perimenopause (albeit more gradually than oestrogen). Robust melatonin production is an important hallmark of a healthy circadian rhythm and is crucial for sleep regulation.
Top 3 nutrients & ingredients to support sleep during perimenopause
1. Magnesium glycinate
Top of the list has to be magnesium – it is the relaxation mineral that helps to calm both mind and body before bed. This mighty mineral is commonly referred to as ‘nature’s tranquiliser’ and for good scientific reason. It is involved in regulating the central nervous system, supporting HPA axis balance, vitamin D activity, melatonin production and even helps to support GABA (Gamma-Aminobutyric Acid) too – the calming neurotransmitter that also helps to promote sleep. Magnesium is often low in typical Western diets and is used up rapidly during times of stress (such as sleepless nights!) so it’s vital to make sure you’re regularly getting enough. And if you’re considering taking a magnesium supplement, choose magnesium glycinate as this is the form that helps to support calm, relaxation and sleep. Read more about this here.
A member of the lamiaceae family and native to Mediterranean Europe, sage has a long history of traditional use in supporting a reduction in hot flashes, night sweats and associated climacteric complaints in menopausal women. Many clinical studies have now backed this long history of traditional use and have found sage to be safe and effective herbal support for reducing the severity and frequency of menopausal hot flashes. When considering supplementation with this valuable herb, it is important to note that fresh sage extracts are regarded as superior with respect to efficacy, and in menopausal complaints including hot flashes. Read more about this here.
An Ayurvedic herb with a long history of traditional use, ashwagandha is classified as an adaptogen, which describes its ability to stabilise the body's response to stress. The therapeutic effects of ashwagandha are often attributed, at least in part, to its regulatory effects on the HPA axis. Chronic stress is often characterised by elevated cortisol, lowered DHEA and increased levels of serum CRP (C-Reactive Protein) – all of which can impact sleep. Research has shown that supplementation with ashwagandha may help to bring all of these biochemical markers back into balance.
Understanding why these symptoms occur helps us to make effective changes
The menopausal transition is associated with an increased frequency of sleep disturbances and insomnia is one of the most reported symptoms by menopausal women. As research in this area gathers pace, so does our understanding of why these symptoms may be occurring and this is invaluable for helping to point us in the right direction of the changes and interventions that are likely to be most effective. Here we’ve highlighted 3 nutrients and ingredients that may be very helpful; and the good news is there are many, many more. Read more about the diet, lifestyle and perimenopause supplements that may help to support a smooth menopausal transition here in our carefully curated selection of resources below.
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