Does melatonin help with perimenopause symptoms?

Melatonin is one of the most commonly used supplements during perimenopause, and for good reason. While it is not a hormonal treatment and cannot replace estrogen or progesterone, it addresses something that sits at the center of many perimenopausal symptoms: circadian rhythm disruption. Understanding what melatonin actually does, and where the evidence is strongest and weakest, helps you make better decisions about whether it fits your situation.

Melatonin is produced by the pineal gland in response to darkness. It signals to the brain and body that it is time to sleep, coordinating dozens of downstream processes including core body temperature rhythm, cortisol suppression, and the organization of sleep architecture into its restorative stages. Research by Toffol et al. (2014) confirmed that perimenopausal women have significantly lower melatonin levels than premenopausal women of similar age, and that these lower levels correlate with sleep disturbances. The decline in melatonin happens alongside the decline in estrogen, and together they destabilize systems that affect sleep, mood, thermoregulation, and cognition.

For sleep, the evidence is strongest. Zhdanova et al. (2001) showed that low-dose melatonin (0.3 mg) improved sleep quality and continuity in middle-aged women. Better sleep has cascading benefits across nearly every perimenopausal symptom because so much of what makes perimenopause harder is amplified by sleep deprivation: mood reactivity increases, pain sensitivity increases, cognitive sharpness decreases, and stress resilience drops.

For mood and wellbeing, Bellipanni et al. (2001) conducted a six-month trial giving perimenopausal women 3 mg of melatonin nightly. Participants reported significant improvements in mood, psychological wellbeing, and reductions in vasomotor symptoms including hot flashes and sweating. This is an important study, though it was small and the vasomotor findings were secondary endpoints. It provides meaningful support for melatonin's broader impact on perimenopausal experience beyond sleep alone.

For bone health, research by Srinivasan et al. (2009) pointed to melatonin's ability to inhibit osteoclast activity, the cells that break down bone tissue. Estrogen also protects bone, and its decline during perimenopause accelerates bone loss. Melatonin's bone-protective properties, while not a replacement for estrogen's effects, suggest a complementary benefit.

For migraine, which is more common during perimenopause, Peres et al. (2004) found that 3 mg of melatonin nightly reduced migraine frequency in a clinical trial. Hormonal migraines, which often worsen during perimenopause, may be one area where melatonin's evidence is actually quite relevant.

Melatonin also has antioxidant and anti-inflammatory properties described by Rossignol and Frye (2011). Chronic low-grade inflammation is elevated during the perimenopausal transition, and oxidative stress increases as estrogen declines. Melatonin's activity in these pathways may offer systemic benefits that extend beyond any single symptom, though the clinical evidence translating these properties into specific symptom relief in perimenopausal women remains limited.

Studies have used doses ranging from 0.3 mg to 3 mg. Talk to your healthcare provider about the right dose for your situation. Many women find that lower doses work well for sleep without causing morning grogginess, while higher doses have been used in studies targeting mood and vasomotor symptoms. Melatonin is sold over the counter in the US without drug-level regulatory oversight, so quality varies meaningfully between brands. Choose a product with third-party testing verification.

Drug interactions to be aware of include warfarin (where melatonin may increase bleeding risk), immunosuppressant medications, antidiabetic drugs, and CNS depressants. Women with autoimmune conditions should discuss melatonin with their provider before use. Most research has studied melatonin for periods of up to three months, so long-term use beyond that should be discussed with your provider.

Tracking your symptoms before starting melatonin and logging them consistently during a trial period gives you real data on whether it is helping. PeriPlan is designed for exactly this kind of multi-symptom daily tracking, helping you connect sleep quality, mood, energy, and other symptoms over time.

When to talk to your doctor: If your perimenopausal symptoms are severe, affecting your ability to work, sleep, or maintain relationships, a supplement trial is not a substitute for a full clinical conversation. Hormone therapy, CBT-I, and other evidence-based options exist. Bring your symptom logs to your appointment so your provider has the full picture.

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