In Detail
Sleep is often the first casualty of perimenopause. Women fall asleep without difficulty but wake at 2 or 3 a.m., often with a racing heart or a low-grade hot flash, and cannot return to sleep. Over time this fragmentation degrades mood, cognition, metabolism, and immune function.
Micronized progesterone, taken orally at bedtime, is sedating for most women through its metabolite allopregnanolone. For women whose sleep disruption is driven by night sweats, transdermal estradiol reduces the underlying vasomotor trigger. Low-dose testosterone can improve sleep quality indirectly by supporting muscle, mood, and energy.
We also evaluate for sleep apnea — which is markedly underdiagnosed in women — and for other contributors such as alcohol load, late caffeine, and untreated anxiety. Hormone therapy works best as part of a broader sleep plan.