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Having Sleep Problems During Menopause? You’re Not Alone

Not only can menopause be a challenging period for women, but it can sometimes come with sleep problems. Learn why this happens and how to get restful sleep again.

Older woman sits in bed holding a flask in one hand and pills in the other hand.

Sleep problems are a lesser-known symptom of menopause, compared to hot flushes and joint pain. Yet, it affects 35% to 60% of post-menopausal women and 39% to 47% of perimenopausal women. Could menopause be the cause of your poor sleep?  

We speak to two Malaysian women about their menopausal sleep issues and how they achieved restful sleep.

Poor Sleep: The Lesser-Known Symptom of Menopause and Perimenopause 

For women who have menopause and perimenopause, sleep problems are often an overlooked symptom. Sheila was 47 when her sleeping difficulties began. “I thought my husband’s snoring was disturbing my sleep. It never bothered me before,” she recalls. 

Three years later, when she officially entered menopause, she realised the true culprit.

While sleeping issues are common during menopause, they can start in perimenopause. You may notice these symptoms:  

  • Hot flushes 
  • Mood swings 
  • Difficulty having intercourse due to vaginal dryness  
  • Sleep disorders, including insomnia, sleep-disturbed breathing, and restless leg syndrome 
  • Joint pain 

Suriya, on the other hand, never imagined that she would be perimenopausal at the much younger age of 42. “I realised I was one of the ‘lucky’ few who started this process much earlier,” she laments. “I spent nearly a year after turning 40 trying to figure out why I had the worst sleep of my life.” 

Why Menopause Causes Sleep Problems

Woman lying awake in bed with a clock showing 3am.
Fluctuating and decreasing oestrogen and progesterone levels as a woman approaches menopause can cause sleep problems.

The two key female reproductive hormones, oestrogen and progesterone, affect sleep quality. Oestrogen influences your sleep-wake cycle, helps keep your body temperature low at night for comfortable sleep and is naturally anti-depressive. Progesterone affects proper breathing, which enables you to sleep more soundly. 

The production of these two hormones in the ovaries fluctuates in the lead-up to menopause. However, during menopause and after, their levels are permanently lower because the ovaries stop producing them altogether. 

The two stages of menopause share similar symptoms, including disturbed sleep.

TCM’s View on Sleeping Problems and Menopause 

“In Traditional Chinese Medicine (TCM), women experience a depletion of Kidney jing (essence) and reproductive essence around the age of 49. This is when they’re nearing menopause.”

TCM Physician Lim Sock Ling

This depletion in Kidney jing leads to sleeping problems due to: 

  • A disruption in the balance between yin (cool, passive energy) and yang (warm, active energy) caused by Liver and Kidney Yin Deficiency. Yang energy remains high at night, causing insomnia. 
  • Disharmony of the Heart and Kidneys leads to Heart Fire and Kidney Yin Deficiency. This causes a “monkey mind” and a racing Heart, leading to dream-disturbed sleep. 
  • Liver Qi (vital life force) Stagnation leads to emotional disturbance as the Liver governs your emotions. This contributes to poor sleep quality. Women who experience this complain of anxiety that robs them of rest.  

Western and TCM Treatment for Menopause and Sleep Problems  

Doctors would usually recommend hormone replacement therapy (HRT) to replenish a decline in oestrogen levels. It can help relieve symptoms caused by the drop. 

Meanwhile in TCM, treatments to ease symptoms of menopause and perimenopause involve herbal remedies and acupuncture. 

Suriya recalls trying different ways to improve her sleep before turning to TCM. “I tried a lot of things. I ate healthily, exercised regularly, and did breathing exercises before bed.” 

“I lived in a city with a large population of people of East Asian ancestry, and I learned about TCM from one of my friends. I read up on the research and decided to try it too,” she shares. 

Her TCM physician put her on a combination of herbal therapy, moxibustion, and acupuncture. After a few months, she noticed improved sleep and overall health. This gradual positive change has remained. 

Hormone Replacement Therapy (HRT) 

HRT replaces either oestrogen alone or oestrogen and progesterone together. The treatment is associated with health risks such as blood clots, stroke, and dementia, among other issues. If you choose this route, your doctor will likely recommend the lowest possible dose.

For Sheila, her sleep problems were affecting her daily life and causing her to feel tired, which is when she turned to HRT. “It was so difficult for me to fall asleep and stay asleep. I would be so fatigued and be in a horrible angry mood the next day. I had to do something,” she says.

Now her sleep has improved, and she feels herself again.

Doctor speaking to an older woman who is a patient.
Don’t be afraid to talk to your doctor about your perimenopause or menopause symptoms.

Herbal therapy 

Looking for natural ways to curb menopausal sleep problems? Physician Lim shares a few TCM herbs and formulas that help: 

  • Sour jujube seed soup (suan zao ren tang, 酸枣仁汤) 
  • Pearl powder (zhen zhu fen, 珍珠粉) 
  • Jiao tai pills (交泰丸) 
  • Albizia bark (he huan pi, 合欢皮) 

To improve symptoms of menopause, pills such as Menoease modulate the endocrine and immune systems of post-menopausal women.

For best results, it’s advisable to speak to a qualified TCM physician before trying these remedies. 


Acupuncture, including auricular therapy (ear acupuncture), is another proven treatment for menopause-related sleep disturbances. “The emphasis is to nourish yin and suppress hyperactive yang, nourish the Heart and calm the spirit,” Physician Lim explains. 

Acupuncture requires sessions with a professionally trained and licensed acupuncturist. In the meantime, you can improve sleep by performing acupressure on yourself.

Try massaging these three acupoints: 

  • San yin jiao (SP6, 三阴交): Tonifies Kidneys, nourishes blood and yin, promotes Liver qi, and calms the mind. 
  • Tai chong (LR3, 太沖): Targets the Liver to encourage balance and calmness.  
  • Tai xi (KI3, 太溪): Revitalises the Kidneys, which strengthens the lower back and knees, making sleep more comfortable. It also regulates the uterus.

Sleep problems in menopause can negatively impact this later chapter of your life, but it doesn’t have to be permanent. “We can’t escape ageing and menopause – it’s a part of life. It comes down to managing it,” reminds Sheila. “Speak to your gynaecologist about your symptoms.” 

Know a woman who’s dealing with sleep problems and menopause? Show you care and share this article with her.


  1. Malaysian Ministry of Health. 2022. Clinical Practice Guidelines: Management of Menopause in Malaysia. [online] [Accessed 2 February 2023] 
  2. SleepFoundation.org. 2022. Menopause and Sleep. [online] [Accessed 2 February 2023]  
  3. Evidence-Based Complementary and Alternative Medicine. 2011. Suan Zao Ren Tang as an Original Treatment for Sleep Difficulty in Climacteric Women: A Prospective Clinical Observation. [online] [Accessed 2 February 2023] 
  4. Frontiers in Pharmacology. 2019. In Silico Study of Anti-Insomnia Mechanism for Suanzaoren Prescription. [online] [Accessed 2 February 2023] 
  5. Journal of Cellular and Molecular Medicine. 2020. Pearl powder reduces sleep disturbance stress response through regulating proteomics in a rat model of sleep deprivation [online] [[Accessed 2 February 2023] 
  6. Obstetrics and Gynecology. 2017. Acupuncture to Reduce Sleep Disturbances in Perimenopausal and Postmenopausal Women: A Systematic Review and Meta-analysis. [online] [Accessed 2 February 2023] 
  7. Journal of Education and Health Promotion. 2022. The effect of auriculotherapy on improving sleep quality in postmenopausal women aged 45-60 years: A clinical trial study. [online] [Accessed 2 February 2023] 
  8. Medical Science Monitor. 2018. Effectiveness of Mild Moxibustion for Sub-Health Conditions in Pre- and Post-Menopausal Women: A Randomized Controlled Clinical Trial. [online] [Accessed 2 February 2023] 
  9. BMC Complementary Medicine and Therapies. 2017. The effects of Jiao-Tai-Wan on sleep, inflammation and insulin resistance in obesity-resistant rats with chronic partial sleep deprivation. [online] [Accessed 2 February 2023] 
  10. Evidence-Based Complementary and Alternative Medicine. 2019. Albizia julibrissin Ameliorates Memory Loss Induced by Insomnia in Drosophila. [online] [Accessed 2 February 2023] 

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