Sleep Disturbance and the Menopause

Key points

  • Disturbed sleep is a common complaint during the peri-menopausal period.
  • Various factors are implicated in the sleep disturbance associated with menopause.
  • Management may include medications as well as lifestyle and behaviour modification.

pdfAMS Sleep Disturbance and the Menopause352.96 KB

Many women complain of disturbed sleep during the peri-menopause and after menopause. Complaints about poor sleep include difficulty falling and staying asleep, coupled with early morning and nocturnal awakenings (1).

Sleep duration of less than seven hours a night has been associated with increased mortality (2), as well as linked to cardiovascular disease, obesity, mood disorders and diabetes (3, 4).

Contributing factors




  1. Ameratunga D, Goldin J, Hickey M. Sleep disturbance in menopause. Internal Medicine Journal. 2012;2(7):742-7.
  2. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Archives of general psychiatry. 2002;59(2):131-6.
  3. Matteson-Rusby SE, Pigeon WR, Gehrman P, Perlis ML. Why treat insomnia? Primary care companion to the Journal of clinical psychiatry. 2010;12(1):PCC.08r00743.
  4. Polo-Kantola P. Sleep problems in midlife and beyond. Maturitas. 2011;68(3):224-32.
  5. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
  6. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.
  7. Chung, F, Yegneswaran, B, Liao, P, Chung, SA, Vairavanathan , S, Islam, S, Khajehdehi , A, Shapiro, CM. STOP Questionnaire. A Tool to Screen Patients for Obstructive Sleep Apnea. Anesthesiology 2008; 108:812–21.
  8. Hale GE, Burger HG. Hormonal changes and biomarkers in late reproductive age, menopausal transition and menopause. Best practice & research Clinical obstetrics & gynaecology. 2009;23(1):7-23.
  9. Erkkola R, Holma P, Jarvi T, Nummi S, Punnonen R, Raudaskoski T, et al. Transdermal oestrogen replacement therapy in a Finnish population. Maturitas. 1991;13(4):275-81.
  10. Polo-Kantola P, Erkkola R, Helenius H, Irjala K, Polo O. When does estrogen replacement therapy improve sleep quality? American journal of obstetrics and gynecology. 1998;178(5):1002-9.
  11. Hays J, Ockene JK, Brunner RL, Kotchen JM, Manson JE, Patterson RE, et al. Effects of estrogen plus progestin on health-related quality of life. The New England Journal of Medicine. 2003;348(19):1839-54.
  12. Eichling PS, Sahni J. Menopause related sleep disorders. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine. 2005;1(3):291-300.
  13. Wafford KA, Ebert B. Emerging anti-insomnia drugs: tackling sleeplessness and the quality of wake time. Nature reviews Drug discovery. 2008;7(6):530-40.
  14. Winokur A, Demartinis N. The Effects of Antidepressants on Sleep: Sleep Disorders, Depression, Psychopharmacology 2012 [updated 13 JUne 2012].
  15. Mayers AG, Baldwin DS. Antidepressants and their effect on sleep. Hum Psychopharmacol. 2005;20(8):533-59.
  16. Vakkuri O, Kivela A, Leppaluoto J, Valtonen M, Kauppila A. Decrease in melatonin precedes follicle-stimulating hormone increase during perimenopause. European journal of endocrinology / European Federation of Endocrine Societies. 1996;135(2):188-92.
  17. Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. Journal of sleep research. 2007;16(4):372-80.
  18. Dodson ER, Zee PC. Therapeutics for Circadian Rhythm Sleep Disorders. Sleep medicine clinics. 2010;5(4):701-15.
  19. Cunnington D, Junge MF, Fernando AT. Sleep disorders: a practical guide for Australian health care practitioners. Med J Aust 2013; 199 (8 Suppl): S36-S40. doi: 10.5694/mja13.10718. Published online: 2013-10-21
  20. Epstein DR, Sidani S, Bootzin RR, Belyea MJ. Dismantling multicomponent behavioral treatment for insomnia in older adults: a randomized controlled trial. Sleep. 2012;35(6):797-805.

AMS Empowering Menopausal Women

Note: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider.

This Information Sheet may contain copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. Any other use of this information (hardcopy and electronic versions) must be agreed to and approved by the Australasian Menopause Society.  

Content updated September 2018