Does HRT help with Sleep? | Menopause Care

While the symptoms of menopause can vary between individuals, sleep disturbance is one of the most commonly reported issues, experienced by 40-60% of women (1).

Sleep problems during menopause, including frequent waking, insomnia and night sweats can have a profound impact on your quality of life, limiting your ability to complete your regular activities, reducing work productivity and affecting your relationships.

It’s no wonder then, that many women look for solutions that will help them get a better night’s sleep. Hormone replacement therapy (HRT) is one such treatment which is an effective way to improve sleep quality (1). In this guide, we look at the link between HRT and sleep quality so that you can make an informed choice about managing your symptoms.

How do hormones affect sleep quality?

Hormones play a significant role in regulating sleep quality, and changes in hormone levels can have profound effects on how well we sleep. This is particularly relevant during menopause when hormones fluctuate drastically.

Oestrogen and progesterone are the prominent hormones that decline during menopause, but other hormones can be affected by the impact of menopause symptoms and age.

Oestrogen

Oestrogen helps regulate the sleep cycle by influencing various neurotransmitters and maintaining a stable body temperature during sleep (2).

During menopause, declining oestrogen levels can lead to difficulty falling asleep, fragmented sleep, and night sweats that wake you up.

Progesterone

Progesterone has a calming, sedative effect on the brain and promotes relaxation. It also helps with breathing regulation during sleep.

As progesterone levels drop in menopause, some women experience insomnia alongside night sweats and hot flushes which may be linked to an increased risk of sleep apnoea (2, 3).

Cortisol

Commonly referred to as the stress hormone, cortisol follows a daily rhythm. Its levels peak in the morning and decline at night to prepare the body for rest (4).

Stress and hormonal changes in menopause can disrupt this rhythm, leading to high cortisol levels at night, which can interfere with falling or staying asleep.

Melatonin

Melatonin plays a key role in regulating the sleep/wake cycle (5). As we age, melatonin production naturally decreases, making sleep more fragmented (6). During menopause, this can exacerbate sleep problems caused by other hormonal shifts.

How does HRT help with sleep?

Hormone replacement therapy (HRT) can significantly improve sleep quality for many individuals experiencing menopause fatigue and other related sleep issues.

By replenishing oestrogen levels, HRT can help regulate body temperature, reducing the frequency of vasomotor symptoms such as menopause sweating, which can disrupt sleep. It also decreases restlessness, reduces morning and daytime tiredness and alleviates other symptoms such as muscle pain and palpitations which can contribute to sleep difficulties (7).

Progesterone replacement provides the body with progesterone which acts as a natural sedative, promotes relaxation and makes it easier to fall and stay asleep.

In addition, HRT can ease other menopause symptoms such as mood swings, anxiety and depression, which are common causes of insomnia during menopause, as well as vaginal dryness and urinary symptoms which can result in frequent nighttime waking to go to the toilet.

How long does it take for HRT to help with sleep?

The time it takes for HRT to have a positive influence on sleep can differ between individuals, but most people start to notice improvements within just a few weeks. However, it can take up to 12 weeks to experience the full effects of treatment.

Several factors can influence the efficacy of HRT and how long it takes to help with sleep quality:

Types of hormones: The balance and delivery method of HRT may impact how long it takes to have an effect.
Dosage: Finding the right HRT dose can take some trial and error. Adjustments may be needed before experiencing optimal benefits.
Individual hormone profile and sensitivity: Your baseline hormone levels and how your body responds to HRT can affect how quickly improvements in sleep quality are noticed.
Severity of symptoms: If menopause-related sleep issues are severe, it may take longer for HRT to provide relief.
Overall health and underlying issues: Mental health issues can compound sleep problems so managing these alongside HRT treatment may be needed to experience improvements. Other health concerns, such as sleep apnoea, or joint pain won’t necessarily be resolved with HRT alone and may need separate treatment.

If you don’t notice any changes after 3 months, then speak to your doctor as they may be able to amend the type and dosage of HRT, discuss alternatives or refer you to a menopause specialist.

Other treatments to help with sleep quality during menopause

While HRT can be effective for better sleep, it’s not suitable for everyone. Factors like personal health history, age, and the severity of menopause symptoms should be considered. For those unable to, or who wish not to use HRT, non-hormonal options are available.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a form of antidepressant that can be used to treat depression, anxiety and panic disorders (9).

They work by increasing serotonin in the brain, which can have a positive influence on mood, emotion and sleep (9).

Find out more about non-hormonal medication for menopause.

Acupuncture

Acupuncture is a treatment derived from Chinese medicine where fine needles are placed at certain sites in the body to stimulate sensory nerves. A study of its effects on menopausal hot flushes and sleep quality found it to be beneficial (10).

Yoga

Practising yoga during menopause can help relieve physical menopause symptoms, help balance your emotions and improve self-esteem (11). It has also been shown to be beneficial for sleep. One study found that regular yoga exercises in the daily routine of older individuals significantly reduced sleep disturbances, decreased use of sleep medications and improved self-reported sleep quality scores (11,12).

Cognitive behavioural therapy (CBT)

CBT for menopause symptoms is worth considering if you are struggling with insomnia, low mood and/or anxiety, which can affect how much sleep you get and how difficult you find it to fall asleep.

It’s a form of talking therapy that helps you to reframe your thought patterns and how you respond to problems. It works for menopause sleep disturbances as it can help to eradicate the negative thoughts that keep you trapped in an unhealthy sleep schedule (13).

Sleep hygiene

Creating a cool, dark, and quiet sleeping environment and following a consistent sleep schedule can help improve sleep quality during menopause. To promote good sleep hygiene:

Go to bed and wake up at the same time each day, even on weekends
Create a relaxing bedtime routine with calming activities
Limit screen time before bed
Use blackout curtains in your bedroom to keep the room dark
Ensure your bedroom is cool and well-ventilated
Try playing ambient sounds or white noise if you struggle to fall asleep in silence
Don’t try to force sleep (14)

Lifestyle changes

It can also be beneficial to look at the lifestyle choices you are making to see if there are any small yet simple changes you can make to improve your sleep such as:

Avoiding large meals close to bedtime
Reducing caffeine, alcohol and other stimulants
Undertaking regular physical exercise
Eating a balanced, varied diet
Adopting stress management practices, such as mindfulness meditation or journalling

HRT can be a helpful strategy for combating sleep disturbances during menopause but a truly holistic approach that focuses on mental, physical and emotional well-being can yield even better results. At Menopause Care, we offer individualised support that can incorporate evidence-based guidance, tailored nutrition plans, CBT and a carefully considered medication regimen. If you think you could benefit from such support, start by booking a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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