The changes can cause 2am to 4am wake-ups that can make falling back asleep feel impossible
Across the world, millions of women in their 40s and 50s are regularly waking up between 2am and 4am for the same reason. The cause is related to hormonal changes triggered by the menopause and perimenopause that are common for many females around these age groups.
Menopause can be considered a natural biological phenomenon; it marks the phase in a woman’s life when her menstrual cycles cease because of decreased hormone levels, particularly estrogen. It usually happens naturally between the ages of 45 and 55, but it can occur earlier or later for different reasons.
Perimenopause is the transition period before menopause, which can cause unbalanced hormone levels and irregular menstrual cycles. The main symptoms of menopause and perimenopause include hot flashes, night sweats, sleep disturbances, mood swings, vaginal dryness, and changes in sexual desire.
According to research from December 2024, about 75% women experience problematic symptoms of menopause, like hot flashes and night sweats and 77% experience sex drive problems. The research also found that two out of three women experience brain fog and sleep disturbances. For perimenopausal women, the data reveal that more than 40% report sleep problems.
Despite the fact that almost all women experience menopause, research shows a lack of medical knowledge about it. In a 2024 survey of 157 British Menopause Society members, 72% said newly qualified healthcare professionals “have not been given enough education about menopause.” The same survey found that 55% believe there is “insufficient evidence‑based education training for qualified healthcare professionals.”
Several health experts have voiced their opinions on menopause and urge people to come forward. Dr Lanny Wilson, MD, chair of the Physician Well-Being Program at UChicago AdventHealth Hospitals, said: “It is important for women going through perimenopause or menopause not to be ashamed. We, as physicians, have to take the time to listen to patients and see what symptoms they’re experiencing because every transition is unique to every patient.”
Dr Butler, an OB-GYN and member of the AMA board of trustees, said that perimenopause and menopause vary for each woman by 85%. Dr Faubion, MD, Director of Mayo Clinic Women’s Health, revealed that in 2023, her own research found that some women have been negatively impacted by menopause regarding their careers.
“A full 13% of the women we surveyed experienced an adverse work outcome related to menopause symptoms”, she said. “And about 11% were missing days of work because of these symptoms.”
Why are these women waking up around 3am specifically?
Studies of circadian rhythm, which is your 24-hour body clock, have shown that cortisol levels naturally begin to increase between 2am and 3am. If you’re already stressed or anxious, and your cortisol levels are naturally rising, it’s not surprising that you’d wake up at that hour.
Many women also experience elevated nighttime cortisol, especially if they’re under chronic stress. This can cause 2am to 4am wake-ups that feel impossible to fall back asleep.
Plunging estrogen and progesterone levels in perimenopause disrupt thermal regulation and lower serotonin and melatonin. This drop ultimately lowers the activity of GABA receptors. GABA receptors are proteins that respond to the neurotransmitter gamma-aminobutyric acid, the main inhibitory neurotransmitter in the central nervous system. As a result, nighttime blood‑sugar dips trigger cortisol spikes, leading to a 29% higher likelihood of sleep disturbance and 41.7% prevalence of insomnia.
What can women do to avoid 3am wake-ups?
Have a balanced dinner that includes protein, healthy fats, and fibre to keep your blood sugar steady overnight. Try not to eat too close to bedtime so your digestion can do its thing before you go to bed. Studies suggest that kiwis might enhance sleep quality and duration thanks to their serotonin content. Serotonin helps regulate the sleep-wake cycle and is a precursor to melatonin, the sleep hormone.
Magnesium is great for relaxation and soothing the nervous system. Make sure to add magnesium-rich foods like leafy greens, seeds, and nuts to your meals. If you need a little extra help, after speaking to your doctor and getting their advice first, a magnesium supplement could be a good option.
Tryptophan is an amino acid that helps your body make serotonin and melatonin, which are crucial for a good night’s sleep. Foods like turkey, chicken, nuts, and seeds can help you get better rest. Certain foods can naturally increase melatonin levels. Consider adding goji berries, tart cherries, pistachios, and milk to your diet to boost your body’s melatonin production.
What is menopause?
Herbal teas such as chamomile, lavender, and peppermint can be a calming addition to your evening routine. Chamomile has apigenin, which promotes sleepiness, while lavender is known for its relaxing properties. Peppermint tea is a great choice if you’re dealing with digestive issues that keep you awake.
If you find yourself awake at 3am, don’t fight it. Recognise that it might be a hormonal or stress-related response. Deep breathing or mindfulness can help you relax and drift back to sleep. Keeping a sleep journal or using a sleep-tracking app can help you spot patterns. This can provide you with useful insights into what might be affecting your sleep.
Caffeine and alcohol are both known to disrupt sleep. Limit your caffeine intake after noon, and try to steer clear of alcohol in the evenings to improve your chances of a full night’s sleep.
Regular exercise is beneficial for balancing your sleep-wake cycle, but timing is key. Working out too close to bedtime can increase cortisol levels and interfere with sleep. Try to wrap up intense workouts a few hours before you go to bed.
A spokesperson for Vanswe Fitness said: “As perimenopause quietly unsettles millions of women’s nights, the medical community’s blind spot has left many struggling alone. Yet understanding these hormonal shifts and demanding better menopause education for clinicians can transform care.
“By combining awareness with targeted strategies like timed light exposure, CBT‑I, balanced nutrition, and stress management, women can finally reclaim restful sleep. It’s time for patients and providers to recognise perimenopausal sleep disruption as a core symptom, not an afterthought, and work together to end this silent epidemic once and for all.”
