Does melatonin help with anxiety during perimenopause?

Melatonin is best known as a sleep hormone, but the question of whether it can ease anxiety during perimenopause is a reasonable one. The relationship between melatonin and anxiety is indirect rather than direct, and understanding that distinction can help you set realistic expectations.

Melatonin is produced by the pineal gland and its primary role is regulating the circadian rhythm, the internal clock that governs your sleep-wake cycle. During perimenopause, melatonin production declines alongside estrogen. Research by Toffol et al. (2014) found that perimenopausal women had measurably lower melatonin levels, and that these lower levels correlated with sleep complaints. This is significant because disrupted sleep is one of the most powerful amplifiers of anxiety. When your sleep architecture is fragmented, your amygdala (the brain's threat-detection center) becomes more reactive, and your prefrontal cortex, which helps regulate emotional responses, becomes less effective. In other words, poor sleep makes anxiety worse.

This is the main mechanism through which melatonin may help with anxiety: by improving the quality and timing of sleep, it can reduce the neurological conditions that make anxiety symptoms more intense. This is an indirect pathway, but it is a real one.

Beyond sleep, Bellipanni et al. (2001) conducted a small study in which perimenopausal and postmenopausal women took melatonin (3 mg nightly) for six months. The researchers reported improvements in mood and general wellbeing alongside improved sleep. The study was small and the mechanisms were not fully explained, but the findings suggest melatonin may have broader effects in this population than simply sedation.

Melatonin also has antioxidant and anti-inflammatory properties. Rossignol and Frye (2011) reviewed evidence that melatonin reduces activation of NF-kB, a key driver of inflammatory signaling. Systemic inflammation has been associated with anxiety and depression, so melatonin's anti-inflammatory role may contribute to mood stabilization, though this connection remains an area of ongoing research rather than established clinical guidance.

It is important to be clear: there is no strong clinical trial evidence showing that melatonin is a direct anxiolytic, meaning it does not work the way anti-anxiety medications do. It does not bind to GABA receptors or otherwise directly dampen the stress response in the short term. Women looking for immediate relief from acute anxiety symptoms are unlikely to find that melatonin fills that role.

In terms of dosing, research by Zhdanova et al. (2001) found that low doses of melatonin (around 0.3 mg) improved sleep in middle-aged women as effectively as, or more effectively than, higher doses. Higher doses can cause next-day grogginess and may disrupt the natural feedback loop that regulates melatonin production. Studies examining mood and wellbeing effects have often used doses in the 0.5 to 3 mg range. Talk to your healthcare provider about the right dose for your situation.

Safety is generally favorable for short-term use. Melatonin can interact with blood thinners such as warfarin, immunosuppressant medications, and some diabetes drugs. It is generally not recommended in people with autoimmune conditions without medical guidance. It is not intended as a long-term substitute for addressing the root causes of anxiety.

If you are tracking your sleep and mood patterns, tools like PeriPlan can help you notice whether better sleep is translating into calmer days, giving you real data on whether melatonin is making a meaningful difference for you.

When to see a doctor: If your anxiety is frequent, severe, or interfering with daily functioning, please speak with a healthcare provider. Anxiety during perimenopause can be driven by hormonal fluctuations that may respond to hormone therapy, or it may have other treatable causes. Persistent anxiety alongside heart palpitations, weight changes, or tremor warrants evaluation to rule out thyroid dysfunction. Melatonin is not a replacement for professional assessment of significant anxiety symptoms.

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