Does melatonin help with hot flashes during perimenopause?

Hot flashes are one of the most talked-about perimenopause symptoms, and many women wonder whether melatonin might offer some relief. The honest answer is that the evidence is limited but there are plausible biological reasons why melatonin could help for some women.

Melatonin is a hormone produced by the pineal gland that primarily regulates your circadian rhythm, the internal clock that controls when you feel sleepy and when you feel awake. Research published by Toffol et al. in 2014 found that perimenopausal women tend to have lower melatonin levels compared to premenopausal women, and this decline correlates with increased sleep complaints and other symptoms. The drop in melatonin does not happen in isolation. It occurs alongside falling estrogen levels, and together these shifts can destabilize systems across the body, including thermoregulation.

The most relevant clinical evidence comes from a study by Bellipanni et al. (2001), which gave perimenopausal women 3 mg of melatonin nightly for six months. The researchers observed improvements in mood and overall wellbeing, and participants also reported reductions in vasomotor symptoms, which include hot flashes and flushing. This is an encouraging finding, but it is worth noting the study was small and the vasomotor changes were not the primary endpoint. The evidence for melatonin as a direct hot flash treatment remains preliminary.

The biological mechanism being proposed is indirect but reasonable. Hot flashes are thought to originate in the hypothalamus, where the thermostat controlling your core body temperature becomes dysregulated as estrogen declines. Melatonin receptors are present in the hypothalamus, and melatonin plays a role in coordinating circadian temperature rhythms, the natural dip in core body temperature that accompanies sleep onset. When melatonin signaling is disrupted, the hypothalamic thermostat may become less stable, potentially lowering the threshold at which a hot flash is triggered. Restoring melatonin levels, particularly the evening rise, may help stabilize that thermostat for some women.

Melatonin also has antioxidant and anti-inflammatory properties documented by Rossignol and Frye (2011), which may have downstream benefits on the inflammatory signaling that contributes to vasomotor instability, though this connection is speculative in the context of hot flashes.

Practical lifestyle factors can either support or undermine whatever melatonin does for hot flash regulation. Dimming lights in the evening, avoiding screens that emit blue light close to bedtime, and keeping your bedroom cool all encourage the pineal gland's natural melatonin release and reinforce the supplemental dose. These habits do not cure hot flashes on their own, but they create conditions in which melatonin is most likely to work. Some women also find that alcohol and caffeine, both of which suppress melatonin production, are significant hot flash triggers. Reducing them may amplify any benefit from supplementation.

Studies have used doses ranging from 0.3 mg to 3 mg. Low doses around 0.3 mg, as examined by Zhdanova et al. (2001), can be effective for sleep without causing morning grogginess. Talk to your healthcare provider about the right dose for your situation.

Melatonin is sold as an over-the-counter supplement in the US and is not regulated as a drug, meaning potency and purity vary significantly between brands. Choosing a product with third-party testing (such as NSF or USP verification) gives you more confidence in what you are actually taking.

Known drug interactions include warfarin (melatonin may increase bleeding risk), immunosuppressant medications, antidiabetic drugs, and CNS depressants including sedatives and some antihistamines. If you have an autoimmune condition, discuss melatonin with your provider before starting, as it can influence immune function. Most research has studied melatonin for periods of up to three months.

Tracking your symptoms before and during a melatonin trial is genuinely useful. PeriPlan lets you log hot flash frequency and intensity alongside sleep quality so you can see whether patterns shift after starting a new supplement.

When to talk to your doctor: If your hot flashes are severe, occur more than seven times per day, are significantly disrupting sleep or daily functioning, or are accompanied by heavy irregular bleeding, heart palpitations, or other new symptoms, speak with your healthcare provider before experimenting with supplements. Hormone therapy and other evidence-based treatments may be more appropriate options for severe vasomotor symptoms.

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