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Key takeaways Sleep disruption during perimenopause affects up to 60% of women and has clear hormonal causes — it's not just stress or ageing Declining oestrogen reduces melatonin production, while falling progesterone lowers GABA activity — both directly affect your ability to fall and stay asleep The common 3am wake-up is often caused by an early cortisol surge, compounded by night sweats and circadian rhythm changes Your gut produces 95% of your body's serotonin (a precursor to melatonin), making gut health an overlooked route to better sleep Evidence-based strategies that help include: morning light exposure, magnesium-rich nutrition, regular movement, targeted supplements, HRT and CBT-I In this article How perimenopause affects sleep Common perimenopause sleep symptoms What actually helps: evidence-based strategies When to see your GP The bottom line How perimenopause affects sleep Sleep problems during perimenopause aren't caused by one thing