Restless Legs Syndrome and Perimenopause: What You Need to Know
Restless legs syndrome often worsens during perimenopause. This guide explains why it happens and what practical steps can bring relief.
What Is Restless Legs Syndrome?
Restless legs syndrome (RLS) is a neurological condition that creates an overwhelming urge to move the legs, usually when you are resting or trying to fall asleep. It often comes with uncomfortable sensations described as crawling, tingling, aching, or pulling deep inside the legs. The urge is temporarily relieved by movement, which means many women end up pacing, stretching, or kicking their legs for hours before sleep finally comes. RLS ranges from mildly annoying to severely disruptive, and it tends to be worst in the evenings.
Why Perimenopause Makes It Worse
Estrogen and progesterone influence dopamine pathways in the brain, and dopamine regulation is central to RLS. As hormone levels become erratic and eventually decline through perimenopause, some women experience RLS for the first time while others find existing symptoms intensify significantly. Iron deficiency is another important factor. Falling estrogen levels can alter iron metabolism and absorption, and low iron stores are one of the strongest known triggers for RLS regardless of age. Thyroid changes, which are also more common during perimenopause, can compound the picture further. If your legs feel restless mainly on nights when your sleep is already disrupted by hot flashes or anxiety, the two problems often fuel each other.
Practical Steps That Can Help
Start with the basics that can make a real difference without medication. A regular moderate exercise routine, particularly walking, cycling, or stretching in the afternoon, helps regulate dopamine and reduces RLS severity for many women. Avoid intense exercise close to bedtime as this can temporarily worsen symptoms. Leg massages, warm baths, or alternating heat and cold packs before bed provide relief for some people. Cutting back on caffeine and alcohol, especially after midday, is worth trying for a few weeks to gauge the effect. Check whether any medications you take, including some antihistamines, antidepressants, or anti-nausea drugs, list RLS as a side effect. If they do, raise this with your prescriber.
Nutritional Factors Worth Checking
Iron, folate, magnesium, and vitamin D deficiencies are all linked to RLS. Ask your GP to run blood tests for ferritin (stored iron) rather than just haemoglobin, because ferritin can be low even when standard anaemia tests appear normal. If your ferritin is below 50 micrograms per litre, supplementing iron under medical guidance often reduces RLS noticeably. Magnesium glycinate taken in the evening is considered safe to try and may ease the leg sensations for some women. A perimenopause-aware GP can help you identify which nutritional gaps apply to you.
Medical Treatment Options
If lifestyle changes and addressing nutritional deficiencies do not bring adequate relief, your GP can refer you to a neurologist or sleep specialist. Several medications are approved for moderate to severe RLS, including low-dose dopamine agonists and certain anticonvulsants used off-label. HRT is not a direct treatment for RLS, but some women report improvement when their overall hormonal environment stabilises, possibly because progesterone has a calming effect on dopamine pathways. This is worth discussing with a menopause specialist as part of a broader conversation about your symptoms.
Keeping Track to Get Better Care
RLS tends to be variable, and documenting when it is worst gives useful clinical information. Note the time of day, whether it correlates with your cycle, what you ate or drank, and how it responded to movement or remedies you tried. PeriPlan lets you log symptoms and track how they change over time, giving you a clear record to share at medical appointments. Consistent tracking makes it much easier to identify triggers and demonstrate the impact on your sleep.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.