If you’re one of the many women who begin to struggle with sleep in your mid-late 40’s or early 50’s it’s important to know that hormonal shifts may be playing a role and that sleep can be significantly improved with the right treatment! If changes to your sleep are coming along with other symptoms such as longer or shorter cycles, mood changes, hot flashes or night sweats they’re more likely to be hormonally related.
Many women accept that struggling with sleep is a part of the ageing process. However, sufficient and restful sleep is incredibly important for our overall health and should be a priority. Sleep supports memory consolidation and stress responses, plays a role in immune system balance, energy production and is essential in controlling inflammation within the body. Accepting poor sleep as an inevitable part of ageing can impact our overall health and should always be properly worked up and treated to support optimal health and wellbeing.
One of the most evidence-based ways to support sleep in a perimenopausal or menopausal woman is by using micronized progesterone (bioidentical progesterone).
How Does Progesterone Support Sleep?
Progesterone is most well-known for its action in supporting a healthy uterine lining in pregnancy, but it also has mood promoting and sleep-enhancing effects. Progesterone can be converted in the brain into a metabolite known as allopregnanolone which is known to bind to GABA receptors and produce sedative-like effects1.
Studies looking at using progesterone to support sleep have found it can reduce the time to fall asleep1, increase total sleep time, and increase time spent in REM sleep2.
In comparison to traditional sleep medications, progesterone seems to promote normal sleep patterns rather than hypnotics which can inhibit them. Progesterone also doesn’t seem to be associated with early morning drowsiness like some sleep medications.
Progesterone needs to be taken orally to have a positive effect on sleep. Only oral progesterone will be broken down into the important metabolites that have the sleep-promoting effects we’re looking for. Taking progesterone as a cream or as a vaginal suppository is unlikely to confer any benefits to sleep.
Is Progesterone Safe?
There are many different categories of ‘progestogens’ or progesterone-like molecules, but micronized progesterone (bio-identical progesterone) seems to be more effective at improving sleep than progestins such as medroxyprogesterone acetate (Provera)3.
Micronized progesterone also has a better safety profile than progestins and is associated with fewer side effects like vaginal bleeding, breast tenderness and headaches4. Micronized progesterone also isn’t associated with the same mood symptoms that are seen with progestins.
Other Benefits of Progesterone
Progesterone can also be used to reduce the intensity and frequency of hot flashes and night sweats as well as heavy and flooding periods making it a great option for women experiencing multiple hormonal symptoms during perimenopause.
Other Considerations for Sleep
Progesterone isn’t the only consideration when it comes to sleep. If you’re struggling with sleep, you also want to consider your:
- Alcohol and Coffee Intake:
- Both of these can negatively impact sleep quality and quantity
- Avoid coffee within a 12-hour window of your bedtime
- Try avoiding alcohol for the next month and see if your sleep improves
- Stress levels:
- High cortisol in the evening impacts the bodies endogenous melatonin production
- Try meditation, deep breathing or stretching before bed and avoid intense exercise
- Sleep hygiene
- Getting into and out of bed at the same time can support a healthy circadian rhythm
- Turning off devices in the hour before bed reduces blue light exposure which can negatively impact melatonin production
- Reducing the temperature of your home in the evening can support deep and restorative sleep
Next steps
If you’re struggling with sleep, talk to your practitioner about the best options for you! We know that sleep has an enormous impact on our brain health, heart health and hormonal health so getting sufficient sleep is an important goal for both short- and long-term health.
References
- Nolan, B., Liang, B. and Cheung, A., 2020. Efficacy of Micronized Progesterone for Sleep: A Systematic Review and Meta-analysis of Randomized Controlled Trial Data. The Journal of Clinical Endocrinology & Metabolism, [online] 106(4), pp.942-951. Available at: <https://pubmed.ncbi.nlm.nih.gov/33245776/>.
- Schüssler, P., Kluge, M., Yassouridis, A., Dresler, M., Held, K., Zihl, J. and Steiger, A., 2008. Progesterone reduces wakefulness in sleep EEG and has no effect on cognition in healthy postmenopausal women. Psychoneuroendocrinology, [online] 33(8), pp.1124-1131. Available at: <https://pubmed.ncbi.nlm.nih.gov/18676087/>.
- Montplaisir, J., Lorrain, J., Denesle, R. and Petit, D., 2001. Sleep in menopause: differential effects of two forms of hormone replacement therapy. Menopause, [online] 8(1), pp.10-16. Available at: <https://pubmed.ncbi.nlm.nih.gov/11201509/>.
- Leeangkoonsathian, E., Pantasri, T., Chaovisitseree, S. and Morakot, N., 2017. The effect of different progestogens on sleep in postmenopausal women: a randomized trial. Gynecological Endocrinology, [online] 33(12), pp.933-936. Available at: <https://pubmed.ncbi.nlm.nih.gov/28609128/>.
