In the years leading up to menopause, sleep disturbances are common. Hot flashes, night sweats and mood changes can lead to both interrupted sleep and early mornings. Thankfully, patients don’t have to suffer in silence.
“There are many options available,” said Yale Medicine ObGyn Sangini Sheth, MD, MPH, associate professor of obstetrics, gynecology and reproductive sciences at Yale School of Medicine. “It may take some trial and error for each person to figure out what’s the right treatment for them. But most people can get there.”
What is perimenopause?
Dr. Sheth says a common misconception is that menopause happens like a light switch, where suddenly someone stops having their period. Instead, perimenopause captures the transition leading up to menopause. It typically starts in the mid-40s and can last between four and eight years on average.
“How people experience perimenopause is very individual and variable in the same ways that how people experience puberty are not the same from one person to the next,” said Dr. Sheth.
Perimenopause symptoms
Common symptoms associated with perimenopause can include:
- Irregularity in the menstrual cycle
- Hot flashes
- Night sweats
- Mood changes
- Vaginal dryness leading to pain or discomfort during sex
- Brain fog
- Weight changes
- Sleep disturbances
At least half of people will have trouble sleeping during perimenopause. Sometimes sleep disturbances are related to other symptoms such as night sweats. Hormonal changes can also impact sleep.
Natural remedies for better sleep
There are some things people can do on their own to try to improve sleep. The first is to establish healthy sleep behaviors. This can include:
- Regular bedtimes and wake times
- Avoiding caffeine late in the day
- Being mindful of screens, especially at night and in the bedroom
To address night sweats and hot flashes, patients should opt for a cooler room, use cooling sheets and sleep with a fan. For patients experiencing mood disturbances, it’s important to establish care with a mental health provider. Cognitive behavioral therapy has been shown to be effective in treating perimenopausal symptoms.
Treatments for perimenopause
In addition to making changes at home, it’s important for patients to work with their clinician to find treatment options that address their individual symptoms. Dr. Sheth says menopausal treatment falls into two categories: hormonal treatments and non-hormonal treatments.
Hormonal treatments typically include estrogen and progesterone therapies. These can come in a variety of forms including pills, patches or topical gels. Hormonal therapies are safe, but some patients cannot tolerate them for other medical reasons. Other medications, such as selective serotonin reuptake inhibitors (SSRIs), which are often taken for depression, have also been shown to help with menopausal symptoms.
Sleep aids should not be taken unless under the guidance of a clinician, especially since they can interact with other medications.
When to get help for perimenopause
Any time a patient is experiencing uncomfortable symptoms, they should speak with their healthcare provider for guidance. This can happen even before symptoms appear.
“It should be a routine conversation as part of their annual visit starting in their 40s, so that they know what to be looking out for,” said Dr. Sheth. “These anticipatory conversations can be helpful even before someone develops symptoms. They will then know what to look out for and once symptoms start, they can be seen by a clinician. You don’t have to deal with the discomfort or wait until symptoms get worse.”
