Does melatonin help with fatigue during perimenopause?

Fatigue is one of the most disruptive symptoms of perimenopause, and it tends to be multifactorial. Poor sleep, night sweats, hormonal fluctuations, low iron levels, thyroid changes, and the cumulative weight of managing everything at once can all feed into exhaustion. Melatonin addresses one specific driver of that fatigue: disrupted sleep. Whether it helps depends largely on whether your fatigue is rooted in poor sleep quality.

Melatonin is a hormone produced by the pineal gland that signals to the brain that it is time to sleep. Its production peaks in the dark and is suppressed by light. During perimenopause, melatonin levels decline alongside estrogen. Research by Toffol et al. (2014) documented measurably lower melatonin in perimenopausal women and found that lower levels correlated with poorer sleep. This creates a cycle: low melatonin leads to lighter, more fragmented sleep, which leads to daytime fatigue, which can make the hormonal transition feel even harder.

When melatonin supplementation restores a clearer sleep-onset signal, several things can improve. Sleep latency (the time it takes to fall asleep) often shortens. Sleep efficiency improves, meaning more of the time spent in bed is actual sleep. Zhdanova et al. (2001) found that low doses of melatonin (around 0.3 mg) improved sleep in middle-aged women without the next-morning grogginess associated with higher doses. Better sleep directly addresses sleep-driven fatigue. Women often report feeling more energized and mentally clearer on days following genuinely restorative nights.

Melatonin also helps regulate the body's circadian timing, which influences energy rhythms throughout the day. A disrupted circadian clock, common in perimenopause, can leave women feeling alert at the wrong times and exhausted when they need to function. Correcting that timing can restore more natural energy patterns.

Bellipanni et al. (2001) found that perimenopausal women who took 3 mg of melatonin nightly for six months reported improvements in general wellbeing, which likely included energy levels. The improvements were attributed in part to better sleep and in part to possible effects on the hormonal environment, though the exact mechanisms were not fully established.

Melatonin's anti-inflammatory properties, reviewed by Rossignol and Frye (2011), may also contribute. Chronic systemic inflammation is associated with fatigue, and melatonin's ability to reduce NF-kB-mediated inflammatory signaling could support energy in a secondary way. This is still largely theoretical for perimenopause-related fatigue, but it adds another plausible pathway.

It is important to be realistic. If your fatigue is driven primarily by iron deficiency, thyroid dysfunction, significant depression, or sleep apnea, melatonin will not adequately address those underlying issues. It is a sleep-timing tool, not a general energy booster.

Research has examined doses ranging from 0.3 mg to 3 mg taken at bedtime, with lower doses often performing as well as higher ones for sleep outcomes. Higher doses carry a greater risk of next-day drowsiness, which would worsen rather than help fatigue. Talk to your healthcare provider about the right dose for your situation.

Safety: melatonin is generally well tolerated for short-term use. It may interact with blood thinners, immunosuppressants, and some diabetes medications. People with autoimmune conditions should use it under medical guidance.

Tracking your sleep and energy together in PeriPlan can help you identify whether sleep quality and daytime energy are moving in the same direction when you try melatonin. Two to four weeks of consistent tracking gives you meaningful data to bring to your provider.

When to see a doctor: Fatigue that is persistent, severe, or does not improve with better sleep deserves medical evaluation. Blood tests for iron, ferritin, thyroid function, and vitamin B12 can identify common and treatable causes of fatigue that are distinct from hormonal changes. Sleep apnea, which becomes more common in midlife women, causes significant fatigue and requires its own treatment. Do not attribute severe or unrelenting fatigue to perimenopause without ruling out other causes.

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