Summary
Things you should know:
- Hormonal changes affect the quality of sleep of many women.
- There is a link between hot flushes, night sweats, and not sleeping well.
- Other issues may also affect sleep quality at this time of life (e.g., sleep apnoea and depression).
- There is no proof that hormone treatment helps sleep.
How does sleep change during the menopause?
Around 40-60% of women experience sleep disturbance during peri- and post menopause, higher rates than for pre-menopausal women. Women report having trouble getting to sleep, staying asleep and waking too early. The main reasons for disturbed sleep at this stage in life include: changes in hormones, other sleep related problems (e.g. higher rates of sleep apnoea, restless legs syndrome, circadian rhythm changes), vasomotor symptoms (hot flushes and night sweats), life stress (e.g. financial pressures, caring roles, job stress), and mood changes (e.g., depression and anxiety).
What about hot flushes, cold sweats and night sweats?
During the menopause transition, hormones levels in the body change. Around 36-87% of women experience hot flushes, and night sweats. While the biological cause of a hot flush is not known, researchers believe that this is due to a rapid drop in oestrogen causing a sudden temperature changes in the body which can trigger the body to start sweating to cool down. These hot flushes happen during the day or at night. Women tend to wake up just before a hot flush occurs suggesting there may be an alerting process occurring in the body at this time, causing both the hot flush and the awakening.
Does this happen to all women as they go through menopause?
Before menopause, around 30% of women report some type of sleep problem more than three times a week. However, for women in the menopausal transition, this prevalence rate doubles. Unfortunately women with a higher severity of other menopausal symptoms also tend to have higher rates of sleep disturbance.
Is poor sleep at this time of life always due to hormonal changes?
While changing hormones play a significant role in the increase in sleep problems during the menopause transition, there are many cause of sleep disturbance. General ageing plays acritical role (see Ageing and Sleep), higher rates of anxiety and depression during the menopause (see Depression and Sleep),and an increase in other sleep disorders (see Obstructive Sleep Apnoea and Restless Legs Syndrome). Women are also likely to be facing greater life stressors at this stage in life, typically with greater work responsibilities, caring for children and/or ageing parents, facing financial pressures, relationship tensions, changes in social supports, and may be facing other health problems, all of which can affect sleep.
What can help?
Meeting with your GP to evaluate all contributing factors will assist with creating a sleep management plan. The plan may include a combination of medication, including hormone therapy, lifestyle and behavioural therapy and a referral for assessment for sleep disorders if that is needed.
The Australasian Menopause Society information sheet on sleep (2025) states that “the use of oestrogen, alone or in combination with a progestogen, has been shown to improve the subjective quality of sleep” and that “Women with hot flushes treated with menopausal hormone therapy (MHT) show a marked improvement in sleep quality” and that “the newer body-identical micronised progesterone may cause somnolence. For this reason, it is suggested to be taken at night and may therefore, also help improve sleep” For more information on hormone therapy. please refer to AMS information sheets on Oestrogen only therapy and Combined Menopausal Hormone Therapy.
To manage hot flushes, try keeping the room cool and using a fan if possible. Avoid heavy bedclothes or tight bedspreads, and instead try light cotton sheets, with layers of covers that can be easily thrown off with body temperate changes.
Evidence shows that Cognitive behavioural therapy for insomnia (CBT-I) and mindfulness training improve sleep during the menopause transition.
Where do I go for more help?
Psychologists trained in CBT-I and mindfulness interventions can work with you to help you improve your sleep. A referral to a psychologist from your GP with a mental health care plan will allow you to access a Medicare rebate for psychology sessions.
Plus, there are a range of online sleep resources that can offer CBT-I or mindfulness interventions for better sleep:
- A Mindful Way offers cognitive behavioural therapy (CBT-I) and mindfulness courses for better sleep in the menopause transition.
- This Way Up offers a low cost online course offering CBT-I for insomnia.
- Bedtime Window is a free 5-session interactive digital CBTi program with scientific support (free through research studies)
References
- 1 Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018Sep;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011. PMID: 30098758; PMCID:PMC6092036. https://pmc.ncbi.nlm.nih.gov/articles/PMC6092036/
- McCurry SM, Guthrie KA, Morin CM, et al. Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women With Vasomotor Symptoms: A MsFLASH Randomized Clinical Trial. JAMA Intern Med.2016;176(7):913–920. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hall MH, Kline CE, Nowakowski S. Insomnia and sleep apnea in midlife women: prevalence and consequences to health and functioning. F1000 Prime Rep.2015;7:63–63. eCollection 2015. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Garcia MC, Kozasa EH, Tufik S, Mello LEAM, Hachul H. The effects of mindfulness and relaxation training for insomnia (MRTI) on postmenopausal women: a pilot study. Menopause. 2018 Sep;25(9):992-1003. doi: 10.1097/GME.0000000000001118. PMID:29787483.