I had insomnia long after menopause ended - here's what finally helped me sleep through the night

While many women experience insomnia in menopause, many also expect the problem to get better with time as hormones adjust. But for some, it's the start of a new nightlife.

“I didn’t have insomnia before perimenopause,” says Julie*, on the grey Saturday morning that I spoke to her on the phone. “The changes began over 10 years ago, when I was in my late 40s. My sleep hadn’t been great since I had children, but then it got significantly worse, and I started waking regularly in the early hours.”

Julie is one of up to 60% of women who experience insomnia or disturbed sleep during the menopause transition. Given that more than a billion women worldwide are menopausal or post-menopausal, that’s millions of women struggling. Not only at night, but during the day, when a lack of sleep can cause tiredness, sluggishness, poor concentration, mood swings and irritability.

“Chronic insomnia is a recognised condition when sleep problems last for three months or longer, and affect how you feel or function in the daytime," explains Dr Zoe Schaeldel, a GP, menopause expert and sleep specialist at Myla Health.

"Women are twice as likely to have insomnia as men for several possible reasons, including hormonal changes during the menstrual cycle, pregnancy and the menopause transition," she says. Unfortunately, these are periods in a woman’s life when restful sleep is crucial.

During perimenopause, “fluctuating hormones can influence systems that regulate sleep and body temperature. Hot flushes and night sweats can interrupt sleep, while anxiety, low mood, aches and pains, and needing to pass urine at night can also disrupt sleep", she says.

Then there’s the added pressure of midlife responsibilities. “From work to caring for children or ageing parents, these factors can combine to make sleep more vulnerable. Night-time caring responsibilities, particularly looking after babies and children, can also play a part,” says Dr Schaeldel.

This was certainly true for Julie. “After I had children, my sleep got worse, and I became more anxious and on alert,” she says. It’s a vicious cycle, as anxiety can also be detrimental to sleep. Coupled with hormonal shifts, it’s no surprise that sleep disorders become a hindrance for women in midlife, through menopause and beyond.

That heady mix of hormones and sleep deprivation can also trigger mood swings, which not only make life harder for sufferers, but for loved ones bearing the brunt. “My husband noticed them,” she says. “There was a change in my behaviour, and I realised something was going on.”

While Julie’s husband was understanding, it became obvious that she needed medical intervention. Yet, 10 years ago, we weren’t having conversations about menopause the way we are now, and information was scarce. Fortuitously, she was thrown a lifeline.

“I heard a programme about menopause on the radio, and it was a massive eye-opener,” she says. “I had no idea menopause could have such an effect! It wasn’t discussed or understood then. People mostly talked about hot flushes, so I didn’t connect my symptoms with menopause.”

Does HRT help insomnia in menopause?

In previous years (and, to some extent, now), countless women in menopause didn’t get the right medical attention. For example, Julie was offered SSRIs, often prescribed as antidepressants, before HRT.

“I went to my GP about my sleep and was prescribed an antidepressant that was meant to help with mood and sleep,” she says. “I tried it, but I don’t think it helped.” In 2019, a scandal erupted about the over-prescribing of antidepressants to treat menopausal symptoms when the What Women Want at Menopause Survey found that nearly 40% of women were prescribed antidepressants, despite 80% feeling this was ‘inappropriate’.

As she was able to do so, Julie decided to pay and go private for her menopause care. “I saw Professor Studd, who told me it was menopause and prescribed gel. It was transformative,” she says. “He gave me testosterone soon afterwards, too. HRT changed my life. I think I’d be a completely different person without it.”

HRT enabled Julie to return to work full-time. “It changed everything for me. My symptoms held me back, but once I got on top of them, I felt much more able to pursue my career.”

That's not to say HRT doesn't have side effects - or that it's a cure-all. It helps some women with symptoms, including poor sleep, but not others, and not everyone can have the therapy.

“My main issue is that I’m intolerant to progesterone, which I don’t think is discussed or taught about enough," says Julie. "I suspect this sensitivity may be more common than people realise, or more common than it’s diagnosed."

When Julie takes too much progesterone, she actually develops insomnia, anxiety, and depression. “It may help me fall asleep, but a few hours later it wakes me up,” she explains. “If I hadn’t understood what was happening, I wouldn’t have known what was going on.”

She now takes less than the official dose. “Most GPs wouldn’t be happy with that, but my specialist is willing to prescribe oestrogen with less progesterone, while carefully monitoring my levels and arranging regular scans.”

If you feel like your doctor isn't listening, get a second opinion. There are more menopause clinics than ever. Your GP can refer you, or you can go private (though this is pricey). Specialist care is more likely to provide nuanced, in-depth support. As both menopause and insomnia are multifactorial, some tweaks to your treatment are to be expected, so expect a bit of trial and error.

Insomnia in post-menopause

At 59, Julie thinks she is “well past menopause, although I’m not sure because I’m on HRT.” Her sleeplessness is largely under control, although she recently had a “funny few months with insomnia” that she can’t explain. Was HRT the answer to her menopausal nightmares?

“I may need to stay on HRT for the rest of my life,” she says. “I see someone from the London Menopause and PMS Clinic every six months, and I’m still taking testosterone. My specialist encourages me to keep my level up. It’s great for my sex drive, which is good for my relationship, and it contributes to my get-up-and-go. I plan to stay on it. A friend of my mother, who’s in her 90s, still takes it. She looks so young - she’s an advert for it!”

While only a small percentage of women on HRT also take TRT (testosterone replacement therapy), there’s an indication that TRT can improve women’s mood and cognition, as well as help both women and men with sleep. Currently, testosterone is regarded as ‘off-label’, but it’s available from GPs to treat menopausal symptoms on a specialist’s recommendation.

How to help yourself

Over-the-counter insomnia treatments didn’t work for Julie, although therapy helped her anxiety. Dr Schaeldel recommends a particular type of cognitive behavioural therapy for insomnia, called CBT-I. “It’s the first treatment for chronic insomnia, as it helps address the thoughts and behaviours that keep sleep difficulties going.”

Dr Suzanne Wylie, GP and medical adviser for IQdoctor suggests that you:

• Keep a regular time for getting up, including weekends. A consistent waking time helps reinforce the body's sleep-wake rhythm.
• Have a cool, dark, comfortable bedroom, and wear breathable nightwear.
• Avoid caffeine later in the day and limit alcohol, particularly close to bedtime.
• Take daytime exercise in natural light.
• Allow time to wind down before bed rather than moving directly from work, screens or household tasks.
• If you lie awake for a long time, get up briefly and do something quiet in dim light until you feel sleepy.
• Don’t assume that poor sleep is something you have to put up with because you’re menopausal.

If sleep has been persistently poor for several weeks or is accompanied by significant snoring, gasping or choking during sleep, restless legs, low mood or anxiety, speak to a GP, suggests Dr Wylie.

Together, you can work out whether the problem is menopausal, an insomnia disorder or sleep disorder, or a combination of these.

* Name has been changed

This year, woman&home's Menopause Awareness Month series explores women's experiences of developing health conditions during perimenopause, and the lasting impact they can have on their lives. From chronic fatigue and persistent UTIs to brain fog and struggling to recognise themselves in it all, these experiences go to show that menopause is more than a life stage. It can extend far beyond, affecting women's health, wellbeing and sense of self for years to come.