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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