What's actually happening.
Disrupted sleep is one of the most common reasons women seek help in midlife. Difficulty falling asleep, waking at 3 to 4am with anxiety, night sweats fragmenting sleep architecture, new-onset restless legs. It is rarely just one cause.
Sleep disruption is its own clinical problem. It compounds mood, cognitive function, weight regulation, immune response, and cardiovascular health. Treating it well is one of the highest-leverage interventions in midlife medicine.
Common signs
- · Difficulty falling asleep, often paired with anxiety
- · Waking at 3 to 4am unable to return to sleep
- · Night sweats fragmenting sleep
- · New-onset restless legs
- · Persistent fatigue despite reasonable hours
How I approach this.
I take a full sleep history. Some causes are hormonal, some behavioural, some medical (sleep apnoea, restless legs syndrome). The first job is identifying which apply to you, and that takes more than a ten-minute appointment.
For perimenopausal sleep disruption, micronised progesterone taken at night is one of the most underrated parts of HRT. It has mild sedative properties and is often the part of HRT that women notice first.
Where the picture suggests a different primary cause, I will arrange the appropriate investigations or onward referral. Sleep hygiene matters, but it is rarely enough on its own to fix hormonally driven insomnia.
Ready to sleep through the night again?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.