Does melatonin help with sleep disruption during perimenopause?

Yes, melatonin can help with sleep disruption during perimenopause, and there is a genuine biological reason it deserves consideration. Understanding why sleep falls apart during perimenopause makes it easier to see where melatonin fits into the picture.

Melatonin is produced by the pineal gland and signals to the brain that it is time to sleep. Research has shown that melatonin levels naturally decline with age, and this decline appears to accelerate during the perimenopausal transition. A study by Toffol et al. (2014) found that lower melatonin levels correlated with sleep complaints in perimenopausal women, suggesting that the hormonal upheaval of perimenopause may compound an already-declining melatonin supply. At the same time, estrogen fluctuations disrupt the thermoregulatory system, leading to hot flashes and night sweats that fragment sleep further. Melatonin does not directly address estrogen-driven vasomotor symptoms, but it can help reinforce the sleep-onset signal that gets weakened during this transition.

The clinical research on melatonin and sleep is encouraging. A study by Zhdanova et al. (2001) found that low-dose melatonin (0.3 mg) improved sleep onset and sleep quality in middle-aged adults. Importantly, this lower dose was as effective as higher doses while minimizing next-day grogginess. A separate study by Bellipanni et al. (2001) looked at melatonin use in perimenopausal and menopausal women and found improvements not only in sleep but also in mood and overall wellbeing. While the body of evidence is not as large as the research behind some pharmaceutical sleep aids, the safety profile of low-dose melatonin is generally favorable for short-term use.

Studies have used doses ranging from 0.3 mg to 5 mg, with lower doses often performing just as well as higher ones and with fewer side effects. Talk to your healthcare provider about the right dose and timing for your situation. Taking melatonin at the wrong time of day can shift your circadian rhythm in the wrong direction, so timing and consistency matter as much as dose.

Melatonin works best when paired with consistent sleep hygiene practices. Keeping a regular sleep and wake schedule, even on weekends, dimming lights in the evening, avoiding bright screens close to bedtime, and keeping the bedroom cool all amplify melatonin's effectiveness. If night sweats are the main factor waking you up, cooling tools like a fan, moisture-wicking bedding, or a cooling mattress pad address that layer of the problem in ways melatonin alone cannot.

It is also worth understanding that melatonin primarily helps with sleep onset and circadian rhythm alignment. If your main issue is staying asleep rather than falling asleep, cognitive behavioral therapy for insomnia (CBTi) has stronger evidence for sleep maintenance and is considered the first-line treatment for chronic insomnia regardless of cause. Melatonin and CBTi can be used together.

For women whose sleep disruption is heavily driven by hot flashes and night sweats, hormone therapy addresses the root mechanism and consistently shows improvements in sleep quality in clinical trials. This may be a more targeted approach than melatonin supplementation for vasomotor-driven sleep disruption.

Another consideration is the form and timing of melatonin. Immediate-release melatonin taken 30 to 60 minutes before your target sleep time is most effective for helping you fall asleep. Extended-release formulas are sometimes used for sleep maintenance issues. The over-the-counter doses available in many countries are often far higher than the doses studied in research, so starting at the lowest available dose and adjusting based on response is a reasonable approach. Melatonin should not be thought of as a sedative in the way that prescription sleep aids work. Its mechanism is about circadian signaling, not sedation, which is why timing is so important.

Tracking your sleep reveals patterns you would otherwise miss. PeriPlan lets you log sleep quality, wake events, and daytime fatigue alongside your cycle and symptom data, so you can see whether melatonin is actually helping over time, rather than guessing based on a single night.

When to see a doctor. If sleep disruption is severe and persistent, meaning fewer than five hours most nights, multiple wake events with inability to return to sleep, or dangerous daytime fatigue, see your healthcare provider. These patterns can signal conditions beyond perimenopause including sleep apnea, thyroid dysfunction, or clinical insomnia that require targeted evaluation. Speak with your provider before using melatonin if you take blood thinners, diabetes medications, immunosuppressants, or any sedative medications, as interactions are possible. Melatonin is generally considered safe for short-term use, but long-term use should be discussed with a provider.

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