Experts reveal how to stop restless legs immediately - and why the 'fizzy' feeling happens at night

As hormones fluctuate in perimenopause and beyond, our sleep can go haywire. One cause can be a condition called restless legs syndrome, thought to affect millions of people in the UK and double the number of women as men.

Some women will experience restless legs for the first time in 'midlife', while others may have had it during pregnancy. Either way, you'll know you have it. Symptoms come on at night and (take it from me!) are hard to ignore, making it difficult to sleep well and to relax in the evenings.

The cause is still something of a mystery. It's categorised as a sleep and movement disorder, but the symptoms can vary from day to day and will affect people in different ways.

What is restless legs syndrome and how does it affect sleep?

NHS GP and women’s health expert Dr Deepali Misra-Sharp explains that restless legs syndrome, also known as Willis-Ekbom Disease (WED), is “where you get an urge to move your legs that you really can't ignore”.

It might feel like your legs are "fizzy" or crawling, like you have ants under the skin. The doctor tells me she once had a patient describe it as feeling like "her legs were full of lemonade".

Some people feel like their legs move involuntarily, and it can be hard to get comfortable. However, it's more of a nighttime condition than one that affects sufferers in the day because you're on the move and distracted.

Once you sit or lie down, symptoms appear, making sleep challenging for many women. Dr Louise Newson, women's health expert and menopause specialist, says: "Lots of women think they have insomnia, when actually it's their legs keeping them awake."

It can emerge alongside uncomfortable menopause symptoms for some women, making sleep impossible to come by. “When you're not sleeping properly night after night, everything feels harder. You're exhausted, foggy, irritable and low, and those are already symptoms of the changing hormones, such as during perimenopause,” adds Dr Newson.

How to stop restless legs immediately

• Leg massage or warm compress: Dr Newson says these can help muscles relax in the evening, improve circulation, and may ease uncomfortable restlessness in the legs.
• Have a bath: Warm water calms the nervous system, so this can also help, explains the doctor. Add magnesium salts or soothing scents into your bath for a boost.
• Distract yourself: When you're sat down for long periods, try engaging activities like reading, knitting, or doing a puzzle. Avoid scrolling on your phone as blue light can make it hard to fall asleep.
• Exercise: Dr Newson says regular exercise can also help ease symptoms of restless legs, but keep it light and do it a few hours before bedtime to avoid cortisol spikes that keep you awake.
• Set a regular bedtime: Keeping the same bedtime and wake-up times every day (including weekends) gives the brain a sleep schedule. It'll start to naturally wind down in the evenings.
• Avoid caffeine and alcohol: Some experts think dopamine is responsible for restless legs syndrome. Avoid messing with yours by staying away from alcohol and any caffeinated drinks at least six hours before you go to sleep.

What causes restless legs syndrome?

Scientists aren't entirely sure what causes restless legs syndrome, but low iron and dopamine levels are often cited as triggers. “People with restless legs often have low iron in the brain even when a standard blood test looks fine, and dopamine levels naturally dip in the evening and overnight, which is why symptoms tend to creep in as the day winds down," says Dr Misra-Sharp.

While we often think of dopamine as the 'feel-good' hormone, it's the chemical messenger in the brain that helps control movement.

Restless legs syndrome has been linked to other serious health conditions, such as high blood pressure, diabetes, depression, and cardiovascular disorders, according to experts at the University of Cambridge.

What is the treatment for restless legs?

1. Iron

Low iron levels are one of the "biggest triggers" for restless legs, says Dr Misra-Sharp, so the first thing she does when treating restless legs is check the patient's ferritin. This is the iron stores, not just the blood count.

“Heavy, unpredictable periods quietly drain iron stores," she explains, and "you can have a 'normal' result but still experience symptoms."

She says 75 is the ferritin level she aims for in patients. “Topping up iron can make a real difference on its own,” she says.

2. Hormone therapy

Hormone levels affect everything in our body, including our muscles and nerves. Dr Newson says that “fluctuating and low levels of oestradiol, progesterone and testosterone” in our 40s and beyond can all be a trigger for restless legs syndrome.

Many women she treats find that their restless legs symptoms improve with the “right dose and type of hormone treatment (HRT), often containing all three hormones”.

HRT will improve other perimenopausal symptoms that could also be disrupting sleep, such as night sweats or anxiety, and also have long-term health benefits.

There's no official test for menopause, so speak to your GP if you’d like more information. HRT alternatives are available if you don't want or are unable to have hormone therapy.

3. Medication review

Dr Misra-Sharp says there are some types of common medication that trigger restless legs. These include sedating antihistamines, which include sleep remedies you can buy from a pharmacist, some antidepressants and anti-sickness tablets.

The best thing to do is to talk to a pharmacist or your doctor before taking them, to find out the side effects and whether there are any alternatives you can take.

4. Magnesium

If you’ve been following the explosion in the supplement industry, you'll have noticed magnesium’s rise in popularity. Woman&home's own resident doctor calls it an "underrated" supplement for women thanks to its benefits for sleep and bone health in midlife.

From rubbing it on your feet to sprinkling it into your bath, it’s a popular mineral that may also help ease restless legs. A study in BMC Complementary Medicine and Therapies found that both magnesium and vitamin B6 eased severe symptoms.

5. Lifestyle changes

Dr Newson says lifestyle changes such as stopping smoking can help ease symptoms, and the NHS suggests that regular moderate exercise (e.g. walking or swimming workouts) during the day, warm baths, and stretching have been known to ease symptoms.

As discussed, reducing alcohol and caffeine intake may also lessen symptoms of restless leg syndrome.