The Ultimate Guide to the Menstrual Cycle and Sleep
If you’ve ever wondered if your menstrual cycle and sleep habits are affecting each other, you’re onto something. The two are definitely interconnected — as if cravings, bloating, and cramping weren’t enough!
Cameron Rokhsar, MD, FAAD, FAACS, tells Sleepopolis the fluctuating hormones that control your menstrual cycle can also be responsible for disruptions in sleep patterns. These changes can be exacerbated if someone has an abnormal menstrual cycle caused by other issues, such as polycystic ovary syndrome (PCOS) or other hormone-associated disorders.
Here’s more on what to expect with your menstrual cycle and sleep, along with how sleep quality can change during your period.
The Menstrual Cycle
Though some believe the entirety of the menstrual cycle takes place within a 3-7 day period, it’s actually the cycle of time from day one of a woman’s period to the first day of the next period. It’s controlled by a complex series of hormonal changes throughout the entire body.
While menstrual cycles are often referred to as 28 days long, everyone has a different cycle. The National Health Society explains that the average menstrual cycle can range from 23-35 days, but anything more or less than that usually signals a problem. The exception is teenagers since it can take a while for their cycles to regulate.
Many factors can determine the length of someone’s cycle. For instance, the American College of Obstetricians and Gynecologists (ACOG) explains that some people who have reproductive disorders — such as PCOS — are obese, or have thyroid problems often have irregular cycles.
Outside of disorders and medical conditions, everyday factors like interrupted sleep, travel, stress, and diet can all impact someone’s menstrual cycle.
What Is PMS?
PMS, which stands for Premenstrual Syndrome, is a collection of symptoms leading up to a woman’s period, according to the Office on Women’s Health. Not all women get PMS, but those who do often experience symptoms such as:
- Mood swings
- Depression
- Anxiety
- Irritability
- Breast tenderness
- Weight gain
- Headache
- Abdominal bloating
PMS symptoms occur during the luteal phase of the menstrual cycle after ovulation has occurred, so they can appear up to two weeks before someone’s period begins. The reason for these symptoms is still a mystery — doctors aren’t completely sure why PMS occurs.
It’s possible that some people are more sensitive to increased progesterone levels that occur during the luteal phase. It may also be related to changes in neurotransmitters in the brain such as serotonin, which is affected by hormone levels.
Some people are also more at risk for developing PMS if they:
- Have high stress levels
- Have a personal history of depression or other mental health disorders
- Have a family history of depression or other mental health disorders
PMS also tends to worsen in someone’s late 30s and 40s or as they approach menopause, which may be due to even more intensely fluctuating hormones.
How Common Is PMS?
PMS is extremely common. The Office on Women’s Health says that three out of every four women report experiencing PMS symptoms at least once in their lifetime.
What Is PMDD?
Premenstrual Dysphoric Disorder (PMDD), has many symptoms that are similar to PMS, but it’s classified as a severe disorder that can impair someone’s life. Like PMS, PMDD symptoms may begin 1-2 weeks before someone’s period begins, but unlike PMS, the symptoms can be completely debilitating.
People with PMDD may experience:
- Intense irritability and anger
- Feelings of sadness or despair, or even thoughts of suicide
- High stress and anxiety
- Panic attacks
- Mood swings or crying often
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
- Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain
When someone has PMDD, these symptoms impair daily life. For example, you may find yourself calling out of school or work due to symptoms.
How Common Is PMDD?
Luckily, PMDD is much more rare than PMS. Only 5 percent of women of childbearing age experience PMDD, but the condition can be debilitating for those who do experience it.
How Hormones Change During the Menstrual Cycle
The entire menstrual cycle is controlled by hormone levels going up and down. The rise and fall of different hormones cause different parts of the cycle to start and begin.
The four main hormones involved in the menstrual cycle are:
- Estrogen
- Progesterone
- Follicle stimulating hormone (FSH)
- Luteinizing hormone (LH)
Each phase of the menstrual cycle has different levels of each of those hormones and on average, it looks like something this:
- Menstrual phase: Low levels of estrogen and progesterone
- Follicular phase: FSH increases, then decreases to trigger one follicle to ripen and release an egg. Estrogen also rises
- Ovulation Phase: LH and FSH increase sharply to release an egg
- Luteal Phase: FSH and LH decrease, and initial progesterone and estrogen levels increase to prepare for a potential pregnancy. Without a pregnancy, all hormone levels drop
Does Quality Of Sleep Change During The Menstrual Cycle?
According to the Journal of Sleep Medicine Disorders, women tend to experience less quality sleep than their male counterparts — and that may be in part due to sleep disturbances during the menstrual cycle.
Many people might associate sleep changes with the time that someone is actively bleeding, but it’s also important to be aware that changes can happen anytime during the menstrual cycle, as hormone levels change throughout the whole cycle.
Nisarg Patel, MBBS, MS, a specialist in obstetrics and gynecology, explains that hormonal fluctuations during the menstrual cycle can have a noticeable impact on one’s ability to fall asleep and stay asleep. “Research has shown that certain hormone levels — such as progesterone, prolactin, and cortisol — change throughout the monthly fertility cycle and these can lead to disrupted sleep in some people,” Patel adds.
Additionally, anyone with a hormonal disorder or someone experiencing changes to their menstrual cycle — such as during perimenopause or menopause — will most likely have sleep changes as well.
“Perimenopause is a time when estrogen levels start to fluctuate and decline, and this can cause changes in sleep patterns, such as difficulty falling asleep, frequent awakenings during the night, or waking up too early in the morning,” explains Rokhsar. “Similarly, PCOS, a condition that affects the balance of hormones in the body, can also cause sleep disruptions. [Females] with PCOS often have higher levels of androgens (male hormones) than normal, which can interfere with sleep by causing symptoms such as snoring or sleep apnea.”
PMS and Sleep
The sleep-PMS connection may stem from the fact that stable levels of progesterone are needed to control body temperature and sleep patterns, so when they’re low, sleep may be disrupted — and you may experience increased body temperature, which can also make it hard to fall asleep comfortably.
PMS sufferers may also experience physical symptoms in the days or weeks leading up to their periods that may interfere with their sleep. For instance, cramping, breast tenderness, bloating, and pain can all lead to difficulty falling asleep and staying asleep.
Common PMS Sleep Symptoms
A study in the Journal of Sleep Medicine Disorders looked at both PMS and PMDD and how they affect sleep. The findings indicated that while both conditions can negatively affect sleep, people with PMDD report more severe sleep interruptions.
Another study in 2019 found that poor sleep quality and insomnia were common in people who had PMS. The worse they reported their PMS and menstrual symptoms — including pain — the worse their sleep quality was as well. The study’s results suggest that it could be a circular connection with PMS and sleep: People who have poorer sleep could feel PMS’s symptoms more intensely, or the more intense PMS symptoms could disrupt their sleep.
PMS could also lead someone to feel excessively tired during the day, which could lead to napping, a well-known nighttime sleep disruption — at least, if you’re napping too long or too close to bedtime.
PMS and Insomnia
Insomnia is particularly common in women, and unfortunately, hormones can play a significant role. PMDD especially, even more than PMS, can have a significant impact on someone’s sleep, says Rokhsar. He explains that insomnia is a common symptom of PMDD and can cause someone to have trouble falling asleep, staying asleep, or lead them to wake up early.
People with PMS and PMDD also report significant sleep disruptions during the late luteal phase of their cycles, which may be associated with a rise in progesterone levels. The luteal phase is the second half of someone’s menstrual cycle, when all reported negative symptoms, such as cravings, bloating, breast tenderness, and irritability tend to increase.
There isn’t a lot of research on if PMS and PMDD can lead to long-term insomnia, but there is research that suggests that people with severe PMS and/or PMDD will also experience more intense menopausal and perimenopausal symptoms — which includes insomnia. That means if you struggle with insomnia as a PMS symptom now, it may continue to be a challenge through menopause too.
The Menstrual Cycle And Sleep
Some of the most common sleep-related complaints for women tend to occur during the week leading up to menses and the first few days of menses. These symptoms tend to include:
- Insomnia
- Waking up at night a lot
- Unpleasant dreams or nightmares
- Poor quality sleep
- Daytime sleepiness
Patel explains that while everyone’s experience is different, generally speaking, changes in hormone levels may cause sleep patterns to vary through each phase of the menstrual cycle. He says it might look something like the following:
Hormone Changes and How They Impact Sleep
- During the follicular phase (days 1–14), progesterone and estrogen levels begin increasing, which can lead to increased energy and alertness during this time — this heightened alertness may make it harder for you to fall asleep as you normally do. Physical discomfort as you approach menstruation can also disrupt sleep.
- During ovulation (days 14–16), progesterone and estrogen levels peak again and can potentially cause an increase in body temperature, which could disturb someone’s ability to fall asleep.
- During the luteal phase (days 17–28), progesterone and estrogen levels decrease, which may lead to fatigue, lethargy, and difficulty sleeping in some people.
Kohskar also explains that menses can lead to decreases in serotonin, which can affect mood and how someone feels physically — all of which will impact sleep. Additionally, he notes that women who do not have enough progesterone relative to estrogen may be more likely to experience PMS symptoms, including sleep disturbances.
Is It Normal To Need More Sleep On Your Period?
It is absolutely normal to feel like you need more sleep while you’re on your period or experiencing PMS.
“Many women experience fatigue and a need for more sleep during their menstrual cycle. This can be caused by a variety of factors, including hormonal fluctuations, poor sleep, and disrupted circadian rhythms.”
– Cameron Rokhsar, MD, FAAD, FAACS
While many people experience insomnia as a result of cycle changes, extreme lethargy and sleepiness are other possible side effects. You may also need more sleep if you have PMS or PMDD.
“Many women experience fatigue and a need for more sleep during their menstrual cycle,” Rokhsar says. “This can be caused by a variety of factors, including hormonal fluctuations, poor sleep, and disrupted circadian rhythms. It is also suggested that women experiencing PMS may be at higher risk for insomnia and sleep disturbances, which can contribute to feelings of excessive daytime sleepiness and fatigue.”
And on another level, it also makes sense that your body might need a little more downtime when it’s going through something as physically demanding as shedding its own uterine lining and bleeding for up seven days — Rokhsar says that some people may even experience low iron or anemia as a result of heavy bleeding, which can also lead to increased sleep needs. Dehydration from menses could also impact sleep, Rokhsar adds.
Tips For Better Sleep During Your Period
All this information might make getting a good night’s sleep feel impossible, but luckily, there are ways to improve sleep quality during the premenstrual period and menstruation. Here are some tips for better sleep during your period and beyond.
Lower The Thermostat
Since hormones can warm your body temperature, it may be helpful to sleep with the thermostat at a lower temperature than you normally would. Even a one- or two-degree difference can be beneficial.
Exercise — But Not Right Before Bed
In one 2019 study, 60 minutes of yoga done three times per week for 10 weeks demonstrated statistically significant improvements in sleep quality, the amount of time it takes to fall asleep, and the amount of time actually spent asleep while in bed for women with PMS.
And while yoga can be a calming form of exercise, in general, sleep experts recommend no vigorous exercise before bed so your body can prepare to fall asleep.
Take Pain Medication if Needed
If abdominal cramps, muscle aches, or joint pains from your period are affecting your sleep, it can be helpful to proactively take a pain reliever such as acetaminophen or ibuprofen before bed. Taking medicine with a simple starch, like toast, or a light protein, like Greek yogurt, may also be helpful to ward off any further stomach irritation.
Have a Sleep Routine
Patel explains that it’s very important for anyone with PMS to try and maintain consistent sleeping patterns during the month to give their bodies time to adjust. Just like parents use sleep routines to “cue” babies that it’s time for bed, a consistent sleep routine for adults that includes going to bed at the same time each night and getting up at the same time each morning can help your body know when it is time to go to sleep and when it is time to be awake.
Quit Smoking
Smoking has been associated with insomnia even without the presence of PMS or menstrual cycle changes. Quitting smoking will have multiple health benefits, and improved sleep is just the beginning.
That being said, be aware that if you’re new to quitting, you may experience short-term insomnia at first, so talk to your doctor for support in your smoking cessation journey.
Limit Caffeine
It’s probably okay to have your morning coffee, but try to limit drinking caffeine after the morning hours. And if your PMS symptoms tend to increase your anxiety, it may be beneficial to slow down your consumption during those premenstrual days too, a tip echoed by the ACOG.
Don’t Force It
If someone has trouble falling asleep within 20 minutes of going to bed, they should leave their bedroom and do something relaxing, such as reading or listening to soothing music, says Rokhsar. Only return back to bed when you are tired — that way your brain is “trained” to associate your bed with sleeping.
Use Sleep Aids
Nope, not those sleep aids. Instead of turning to sleep medications, Rokhsar suggests trying guided meditation and relaxation techniques, which he says can help calm the mind and promote deeper sleep cycles. “Sleep tracking devices can also provide useful data on sleep patterns and identify any potential disruptions that need to be addressed,” he adds.
The Last Word from Sleepopolis
For women, it can often feel like our bodies are at the mercy of ever-shifting hormones. While that is the case to an extent, it can be helpful to be aware of exactly what’s going on during the menstrual cycle — and what you could do to make the process just a little less painful.
Understanding what’s happening at a hormonal level during the menstrual cycle — and how those hormone changes can impact your sleep — can help you be proactive and make a plan for getting the best night of rest possible. Listen to your body, and if it needs more sleep or extra rest during the day because of disrupted nighttime sleep, don’t feel any guilt about catching some extra Zzz’s.
If you’re having consistent sleep disruptions or difficulties falling asleep that affect your daily life and ability to function, be sure to speak with a doctor right away — they can help you determine if anything else may be going on.
