Why Estrogen Can Help You Sleep in Menopause

Talk to any woman in menopause and you’ll hear the same thing: sleep is a struggle. Many women find themselves waking up multiple times a night, rising far too early and not being able to get back to sleep, or simply unable to fall asleep at all—often after a lifetime of sleeping just fine.

One key reason for menopause insomnia? Estrogen. As this hormone declines during menopause, it can trigger a cascade of changes that interfere with sleep, from night sweats and anxiety to shifts in brain chemistry that regulate circadian rhythm.

Since hormones are behind so many sleep issues in menopause and perimenopause, can taking estrogen help you sleep? The short answer: maybe.

About the Experts

Natalie M. Kunsman, M.D., MS, FAARM, ABAARM, has been practicing for 30 years and is dual board-certified in anti-aging and regenerative medicine and family medicine.

Fariha Abbasi-Feinberg, M.D., FAASM, FAAN, is a spokesperson for the American Academy of Sleep Medicine. She’s a board-certified sleep medicine physician, neurologist, and medical director of Sleep Medicine at Millennium Physician Group.

Can Low Estrogen Cause Insomnia?

Declining estrogen is a driver of menopause insomnia because it triggers symptoms like night sweats and anxiety that typically disrupt sleep. ¹

Severe hot flashes are associated with chronic insomnia in midlife women. ² One 2025 study of women in menopause published in the American Journal of Obstetrics and Gynecology found 63 percent of women woke due to hot flashes at least twice a night. ³

Low estrogen causes insomnia and affects sleep in both direct and indirect ways. One mechanism: it may reduce the density of 5HT2A receptors, which in turn decreases serotonin—a key neurotransmitter tied to sleep, hot flashes, night sweats, and depressive or anxious feelings, says Natalie Kunsman, M.D., a functional medicine doctor who specializes in hormone health ⁴.

Those symptoms can kick off a vicious cycle of insomnia. “Often, sleep disruptions start with some menopausal symptoms, but then we get so concerned about lack of sleep that the worry worsens insomnia significantly,” says board-certified sleep medicine physician Fariha Abbasi-Feinberg, M.D.

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Does Estrogen Therapy Help With Sleep?

Research is mixed about whether taking estrogen helps you sleep, but initial results are promising.

Estrogen therapy may help improve sleep by relieving the symptoms that disrupt sleep, including night sweats, anxiety, joint pain, heart palpitations, and mood swings. ^{5 6 7}

Hormone replacement therapy (HRT, also called menopause hormone therapy or MHT) often combines estrogen and progesterone to supplement the hormones that your ovaries are no longer producing. Combined HRT has been shown to support sleep, but that may be largely attributable to progesterone, not estrogen.

Progesterone enhances the brain’s use of gamma-aminobutyric acid (GABA), a neurotransmitter that calms the nervous system and promotes relaxation. Since GABA levels can decline during menopause, progesterone may help restore that calming effect and make it easier to fall and stay asleep. ⁸

Reduces night wakings

Estrogen helps you sleep soundly by stabilizing body temperature and balancing neurotransmitters like serotonin and norepinephrine that regulate your circadian sleep cycles. One study found that weakened circadian signals in menopausal women cause alertness and wakefulness. ⁹

Other research shows that estrogen may calibrate REM sleep, a lighter stage of sleep in which the central nervous system prepares you to wake up. When REM sleep is poorly regulated or fragmented, as it can be during menopause, you’re more likely to wake up during the night or too early in the morning.

Eases night sweats

Night sweats and hot flashes are classic signs of low estrogen—and major sleep disruptors. ^{10 11} “When estrogen declines in the peri- and menopausal time, hot flashes and heat intolerance can completely disrupt falling asleep and staying asleep,” Kunsman explains.

Hormone therapy containing estrogen and progestogens (synthetic progesterone) can help reduce these vasomotor symptoms, helping you sleep better, says Abbasi-Feinberg. ¹²

Improves sleep quality

Estrogen helps regulate serotonin, which affects both mood and sleep. In perimenopause and menopause, when estrogen is declining, so may serotonin. “This may lead to depressive or anxious symptoms, which in turn, may affect sleep,” Kunsman says.

One study found that women on estrogen therapy reported falling asleep more easily, waking less during the night, and feeling more rested overall. ¹³

Reduces stress

Estrogen therapy may help calm your body’s stress response, which can boost sleep. One study found that estradiol can lower cortisol levels in response to mental and physical stressors. ¹⁴ The impacts of stress on sleep have been widely studied, with research showing that stress creates difficulty in both falling and staying asleep and that high levels of stress are linked to insomnia. ¹⁵

Taking HRT to Treat Insomnia

If menopause is stealing your sleep through night sweats or hot flashes, you may want to explore replacing your estrogen through hormone replacement therapy.

A 2022 study published in Menopause found that certain estrogens, like 17β-estradiol (E2) and conjugated equine estrogens, improve sleep quality. It also found that transdermal delivery (estrogen patches or creams) may be more effective for sleep than oral estrogen. ¹⁶

Your doctor will tailor the therapy to your symptoms and health history. Estrogen can be delivered via patch, pill, cream, troche, or vaginal suppository.

Find the right dose

Too much or too little estrogen can negatively impact your sleep. “There is a zone of optimal estrogen,” said Kunsman. “Estrogen loss or excess can affect some neurotransmitters and thermoregulation, which in turn can affect sleep.” ¹⁷

Providers typically start you on the lowest effective dose of HRT to ease your symptoms. For women who lose estrogen before age 40, a higher dose may be prescribed. Your doctor can help you find a dose that works for you—balancing hormones can look different from person to person.

When to take estrogen for sleep

Estrogen can be taken anytime to reduce symptoms like hot flashes that disrupt sleep. Consistency and dose are more important than timing, says Kunsman. Progesterone, which supports sleep directly, is usually taken at night.

Other Ways to Improve Sleep During Menopause

If estrogen therapy isn’t an option—or you’re looking for additional strategies—there are plenty of evidence-based tools to improve sleep during menopause.

• Cognitive Behavioral Therapy (CBT), a type of talk therapy, may be helpful not just for insomnia but also for handling other discomforts associated with menopause, such as anxiety, stress, depressive moods, and even hot flashes and night sweats, says Abbasi-Feinberg.
• CBT-I is a talk therapy specifically to treat insomnia and involves a combination of behavioral changes and changing negative thoughts associated with sleep.
• FDA-approved sleep medication may be prescribed if sleep disruptions are severe, says Abbasi-Feinberg.

Supplements for sleep

Some supplements may support sleep quality in menopause:

• Magnesium L-threonate: A small 2024 study found that magnesium supplements may significantly improve sleep quality. This form of magnesium can cross the blood-brain barrier and increase magnesium levels in neuron cells to improve sleep. ¹⁸
• Melatonin supplements act on MT1 and MT2 receptors in the brain that help regulate sleep. ¹⁹
• Valerian root, CBD, and medical cannabis may reduce anxiety and promote relaxation by enhancing GABA activity and by slowing activity in the central nervous system. ^{20 21 22 23}

Lifestyle tips for better sleep

There are also a few changes you can make to improve your sleep during menopause:

• Avoid caffeine and alcohol, especially close to bedtime. Research found that caffeine for up to 6 hours before bed stimulates your brain and disrupts sleep. ²⁴
• Try deep breathing or meditation. Research suggests mindfulness meditation can effectively treat sleep disturbance. ²⁵
• Limit snacks after dinner. Eating within 3 hours of bedtime can disrupt sleep.

Sleep hygiene tips for menopause

To get more deep rest, try these strategies, recommended by Kunsman and Abbasi-Feinberg:

• Use cooling sheets and lightweight blankets. Research has found that cooler temperatures and airy bedding and clothing can improve sleep. ²⁶
• Go to bed and wake up at the same time each day. Maintaining a consistent sleep schedule.
• Create a restful space. Keep your room cool, dark, and distraction-free.
• Avoid screens before bed. Blue light and artificial illumination keep your brain alert. Limit their use 30-60 minutes before bed.