The question
You have started waking at 3am and cannot get back to sleep. Or you can no longer fall asleep easily after a lifetime of sleeping well. You are wondering whether this is connected to your hormones, or just something that happens with age.
Yes, insomnia is a very common perimenopause symptom
Sleep disruption is one of the most prevalent and most underrecognised symptoms of the perimenopause transition. More than half of perimenopausal women report significant sleep disturbance. It is not simply an age-related change: it has direct hormonal causes and tends to worsen during the transition.
How perimenopause disrupts sleep
Progesterone, which begins declining early in perimenopause, has a naturally sedating quality. It supports GABA, the brain’s calming neurotransmitter, and promotes the deeper stages of sleep. When progesterone falls, sleep becomes lighter, less restorative, and more easily interrupted.
Oestrogen influences melatonin and serotonin, which regulate the sleep-wake cycle. It also helps maintain the lower core body temperature that sleep requires. As oestrogen fluctuates, both the circadian rhythm and temperature regulation are disrupted.
Night sweats add a further layer. Over time, the brain can begin anticipating the waking, making it harder to achieve deep sleep even on undisturbed nights. Consistent early morning waking between 3am and 5am is linked to cortisol rhythm changes driven by hormonal fluctuation.
Is your insomnia likely linked to perimenopause?
It is more likely to be hormonal if sleep disruption has appeared or significantly worsened during your perimenopause years, if night sweats are present, if sleep does not improve despite good sleep habits, or if other perimenopause symptoms are present.
What to do next
Insomnia during perimenopause responds best when the hormonal context is part of the assessment. A nurse practitioner at My Clinic can help you understand what is most likely driving your sleep disruption.