While sleep issues are relatively common among Americans in general, once we reach perimenopause, that number skyrockets to 40%! With almost 1 in 2 perimenopausal women having sleep issues including difficulty falling asleep, waking up throughout the night, or waking up too early (hello 4am!), it feels like you can’t catch a break.
We inherently know sleep is beneficial but sometimes it can feel so elusive, especially it seems when we need it most. Out of desperation, we may turn to “Doctor Google” to see what we can do and invariably the answer that we get most often is melatonin. But what is melatonin?
Melatonin is a hormone released from the pineal gland in our brain that causes us to sleep. It follows a circadian rhythm with its production occurring due to exposure to darkness. Melatonin production ceases in the presence of light, hence the growing concern about increased levels of screen use, especially at night.
In addition to helping us sleep, melatonin is one of the strongest antioxidants in the body and is frequently used as an adjunctive cancer treatment.
In fact, there are more and more studies showing how shift workers (people who work overnight and have a disrupted circadian rhythm) have increased rates of cancer. It appears this may be due to their lack of normal production of melatonin since they have to stay awake during times of peak melatonin production.
So what about melatonin for perimenopause? Is it worth trying or another fad supplement?
The research thus far is pretty convincing. One study of perimenopausal women taking 3mg of melatonin a night had a marked improvement in mood and reduction in depressive symptoms.
And don’t forget about thyroid health. We know that our thyroid function can decrease around perimenopause which can lead to a long list of symptoms. Research has found that taking melatonin led to increased thyroid hormone production within 3-6 months.
Another study evaluated the relationship between bone health and melatonin. Peak bone density occurs around age 30 and gradually declines as we get older. There is thought to be a sharper decline in bone density after menopause so maintaining bone health as we age is important. Other studies have shown a correlation between poor sleep and decreased bone density so would melatonin have any impact?
It appears it may. A 2019 meta-analysis (a study that analyzes many studies asking the same question) found that melatonin seems to increase bone density as well as increases the production of chemicals that promote new bone growth. We still don’t know the exact mechanism behind this, but the results are promising.
With all these great benefits, why isn’t everyone taking melatonin? Like every supplement and medication, there can be some side effects and contraindications.
Since melatonin helps to induce sleep and makes you groggy, I would not recommend it for someone already on a CNS depressant like benzodiazepines or a prescribed sleep medication without talking to your healthcare provider.
Another side effect that can sometimes be unpleasant for people is increased dreaming. For some individuals this can be quite disruptive and may prohibit them from taking melatonin.
It is also important to find the right type of melatonin and the dose that works for you. There are two main forms of melatonin: immediate-release and sustained-release. Immediate-release is what’s most often studied and works well for people that have difficulty falling asleep. The other option is sustained-release, which is gradually released throughout the night and works better for those that have difficulty staying asleep through the night.
And don’t forget about dose. The most frequent dose that is studied and used is 3 mg. That being said, they offer melatonin as low as 0.5 mg or as high as 20 mg, which would be the maximum dosage. I always start at 3mg and adjust to find the right dose. If sleep hasn’t improved, we gradually increase the dose. However, if someone wakes up feeling groggy the next day, we reduce the dose. Always talk to your healthcare provider about finding the right dose for you.
Melatonin has benefits outside of perimenopause but with proven improvements in sleep, mood, thyroid production, and bone health, melatonin is an important supplement to consider in perimenopause.