Does iron help with sleep disruption during perimenopause?

Iron deficiency has a direct and well-researched connection to one of the most disruptive sleep disorders: restless legs syndrome. If your iron stores are low and you experience uncomfortable leg sensations at night, correcting the deficiency may significantly improve your sleep. For other types of sleep disruption, the relationship to iron is more indirect but still biologically plausible. Testing first is essential before considering iron supplementation for any reason.

The strongest evidence connects low ferritin specifically to restless legs syndrome. A landmark study by Earley and colleagues published in 2004, along with a substantial body of subsequent research, established that ferritin below 50 ng/mL is strongly associated with restless legs symptoms, independent of whether hemoglobin meets the clinical threshold for anemia. Restless legs syndrome involves uncomfortable crawling, aching, or tingling sensations in the legs that arise at rest and are most intense during the evening and overnight. The urge to move the legs for relief causes repeated awakenings and severely fragments sleep architecture. Multiple controlled studies have shown that correcting iron deficiency reduces restless legs severity, sometimes substantially, particularly in women with ferritin below 50 ng/mL.

Beyond restless legs, iron deficiency impairs dopamine production. Dopamine is not just a mood chemical. It plays a critical role in the brain circuitry that regulates the sleep-wake cycle, supports smooth transitions between sleep stages, and maintains the timing of sleep onset. When dopamine is compromised by low iron, sleep can become lighter, more fragmented, and less restorative even without the discomfort of restless legs. Iron deficiency anemia also activates the sympathetic nervous system as the body compensates for reduced oxygen delivery. This elevated autonomic arousal raises baseline alertness and works against the physiological processes needed to initiate and maintain deep sleep.

Perimenopause adds its own layers of sleep disruption that operate independently of iron. Declining progesterone removes one of the body's natural sleep promoters, as progesterone has a sedating effect through GABA receptors. Declining estrogen increases nighttime awakenings and reduces sleep efficiency. Hot flashes and night sweats are among the most common causes of sleep disruption in this phase. If iron deficiency is also present, the cumulative impact on sleep quality can be significant. Standard hemoglobin testing alone will miss early iron depletion. Never supplement with iron without a confirmed deficiency from a blood test (ferritin, serum iron, complete blood count). Ask your provider specifically for ferritin, which is the most sensitive marker for stored iron.

If deficiency is confirmed, your provider will advise on appropriate form and duration. Heme iron from red meat and fish absorbs significantly more efficiently than non-heme iron from plant sources or standalone supplements. Pairing non-heme iron with vitamin C at the same meal, such as lentils with lemon-dressed greens or beans with tomatoes, improves absorption meaningfully. Iron supplements commonly cause GI side effects including constipation and nausea. Take with vitamin C. Avoid taking with calcium, dairy, green tea, or coffee. Iron interacts with thyroid medications, antibiotics (quinolones, tetracyclines), and bisphosphonates. Separate iron from these by at least two to four hours. Excess iron accumulates in tissues, so supplementation requires medical supervision and periodic retesting.

Improvement in sleep from iron correction takes time. Ferritin rebuilds gradually over eight to twelve weeks. Restless legs symptoms often begin to ease meaningfully within that window once ferritin climbs above 50 ng/mL. Overall sleep quality improvements tied to better dopamine function tend to follow on a similar timeline. Some women notice energy improving first, with sleep quality catching up a few weeks later.

If iron levels are normal and sleep disruption continues, the most likely causes in perimenopause are hormonal or behavioral. Hormone therapy has well-established evidence for improving sleep by reducing hot flashes and restoring some progesterone effect. Cognitive behavioral therapy for insomnia, known as CBT-I, is considered the most effective non-drug treatment for chronic insomnia and can be as effective as sleep medication with longer-lasting results. Both are worth discussing with your provider if iron correction is not applicable or not sufficient.

See a doctor if restless legs symptoms are nightly and severe, if sleep disruption is causing significant daytime impairment including cognitive problems or mood changes, or if you are already relying on sleep medication regularly. These situations warrant clinical evaluation rather than self-management.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log sleep disruption daily so you can spot whether patterns shift over time, including after any changes to your iron status or other health interventions.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.