Abstract:

Sleep disturbances are one of the most common and debilitating symptoms reported by perimenopausal and menopausal women. While lifestyle interventions are often recommended, many women continue to experience fragmented, poor-quality sleep. This study examines the effectiveness of hormone replacement therapy (HRT) in improving sleep quality, sleep duration, and next-day functioning in a cohort of women aged 40–55 undergoing hormonal transition.

Introduction:

Perimenopause is associated with declining levels of estrogen and progesterone, which directly impact circadian rhythms, thermoregulation, and neurotransmitter function — all key factors in healthy sleep. Many women report difficulty falling asleep, frequent night wakings, early morning waking, and non-restorative sleep. These disruptions can severely affect mental health, work performance, and quality of life.

This study explores how individualized HRT can support sleep improvement by addressing hormonal imbalances at the root of these disturbances.

Methods:

A total of 276 women aged 40–55 were recruited from Newson Health clinics. All participants reported moderate to severe sleep disturbances and had not responded adequately to non-hormonal interventions (e.g., CBT-I, sleep hygiene practices).

Participants received tailored HRT regimens including:

• Transdermal estrogen (gel or patch)
• Micronised progesterone (orally at night)
• Testosterone in select cases

Sleep quality was measured using:

• The Pittsburgh Sleep Quality Index (PSQI)
• Daily sleep diaries
• Actigraphy (wearable sleep tracking devices) over 3, 6, and 12 months

Results:

• Significant PSQI improvement:
  Average PSQI scores improved by 44% after 6 months of HRT.
• Reduced night wakings:
  71% of participants reported fewer awakenings per night, with many noting uninterrupted sleep for the first time in years.
• Progesterone's calming effect:
  Oral micronised progesterone taken at bedtime was associated with improved sleep onset and reduced night-time anxiety.
• Enhanced next-day function:
  Participants reported better concentration, mood, and reduced irritability during the day.
• Minimal side effects:
  Reported side effects were low and manageable (e.g., transient breast tenderness, mild bloating).

Discussion:

HRT — particularly when it includes both estrogen and night-time progesterone — appears to have a significant positive effect on sleep quality in perimenopausal women. These findings reinforce the importance of treating hormone-related insomnia at its root, rather than relying solely on sleep aids or lifestyle changes.

The results also suggest a potential role for testosterone in enhancing energy and reducing early morning fatigue, especially in women with persistently disrupted sleep.

Conclusion:

Sleep disruption in perimenopause is often hormonally driven and can be effectively managed with individualized HRT. Clinicians should proactively inquire about sleep in midlife women and consider body-identical hormone therapy as a first-line treatment when indicated.

Authors:

Dr. Joanna Russell, Dr. Louise Newson, Dr. Martin Dean

Published by:

Newson Health Research & Education

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