Does melatonin help with night sweats during perimenopause?

Night sweats during perimenopause are a variation of the hot flash, occurring during sleep and often disrupting it severely. Women who experience them describe waking drenched, needing to change bedding, and struggling to fall back asleep, sometimes multiple times per night. Whether melatonin can help is a genuinely important question, and the answer requires separating what melatonin can and cannot do.

Night sweats are vasomotor symptoms, driven by the same hypothalamic dysregulation that causes daytime hot flashes. As estrogen levels decline during perimenopause, the hypothalamus, which regulates core body temperature, becomes more sensitive to small temperature fluctuations. The threshold at which it triggers a cooling response (vasodilation and sweating) becomes abnormally low. This is fundamentally a hormonal regulatory problem, and treating it at its root typically requires addressing estrogen levels, either through hormone therapy or phytoestrogens.

So where does melatonin fit? Melatonin receptors are present in the hypothalamus, and melatonin plays a role in the circadian rhythm of core body temperature. Core body temperature naturally drops in the evening as melatonin rises, signaling the body to prepare for sleep. When melatonin production is low, as confirmed in perimenopausal women by Toffol et al. (2014), this temperature drop may be less pronounced or less well-timed, which could make the hypothalamic thermostat less stable and potentially lower the threshold for vasomotor events during the night.

Bellipanni et al. (2001) gave perimenopausal women 3 mg of melatonin nightly for six months and observed reductions in vasomotor symptoms including sweating. This study provides some evidence that melatonin may reduce night sweat frequency or severity for some women, though the finding was secondary to the primary outcome and has not been replicated in larger trials. The evidence is encouraging but not definitive for night sweats specifically.

Perhaps melatonin's most relevant benefit for night sweats is indirect: improving sleep continuity and depth so that when a night sweat does occur, it is easier to return to sleep afterward. Zhdanova et al. (2001) showed that low-dose melatonin improved sleep quality in middle-aged women. Better baseline sleep architecture means less disruption overall from vasomotor events, even if those events are not fully eliminated.

Melatonin also has anti-inflammatory and antioxidant properties described by Rossignol and Frye (2011). Whether these properties reduce the intensity of vasomotor events is plausible but not established in clinical trials for night sweats.

Studies have used doses ranging from 0.3 mg to 3 mg. Talk to your healthcare provider about the right dose for your situation. Higher doses are not necessarily more effective and can cause morning grogginess. Melatonin is sold over the counter in the US without drug-level quality regulation, so choose a brand with third-party testing verification.

Drug interactions include warfarin (increased bleeding risk), immunosuppressants, antidiabetic medications, and CNS depressants. These should be reviewed with your provider before starting melatonin.

For women whose night sweats are severe enough to wake them multiple times per night and prevent adequate rest, melatonin alone is unlikely to be sufficient. More targeted options for vasomotor symptoms include hormone therapy, certain antidepressants (such as SNRIs prescribed off-label), and cognitive behavioral therapy for insomnia (CBT-I), all of which have stronger evidence for significant vasomotor and sleep improvement.

Practical bedroom and evening habits can work alongside melatonin to reduce night sweat disruption. Keeping the bedroom cool (between 65 and 68 degrees Fahrenheit is often recommended), using moisture-wicking bedding, and having a light layer nearby for post-sweat chill all reduce the extent to which a night sweat derails the rest of the night. Avoiding alcohol in the evening is particularly relevant, as alcohol is both a reliable trigger of vasomotor events and a suppressant of melatonin production. Reducing alcohol may amplify whatever benefit melatonin supplementation provides.

Tracking nights with sweats, sleep quality, and daytime energy in a structured log helps you understand the impact and builds useful data for your provider conversation. PeriPlan is designed for exactly this kind of daily symptom logging across multiple areas.

When to talk to your doctor: If night sweats are disrupting your sleep most nights, if you are exhausted during the day as a result, or if the sweats are accompanied by fever, unexplained weight loss, or significant lymph node swelling, talk to your provider. While most night sweats during perimenopause are hormonal, those latter symptoms warrant evaluation to rule 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.