Hormonal Link of Menstrual Sleep Issues and Fatigue
Health LibraryMenstrual Symptoms and Causes
Hormonal Link of Menstrual Sleep Issues and Fatigue


A restful night's sleep is crucial for everyone’s overall well-being, but for many individuals, the menstrual cycle can disrupt sleep patterns and leave them feeling fatigued and drained. Menstrual sleep issues and fatigue are common complaints among women during different phases of their menstrual cycle, with reports of insomnia occurring 1.5-2 times more frequently than in men. Indeed, sleep complaints commonly occur during the postovulatory luteal phase in healthy women.

In this article, we will explore the causes of these symptoms and the intricate relationship between menstrual sleep issues, fatigue, and hormonal fluctuations.

Causes of Menstrual Sleep Issues and Fatigue

When it comes to the question of “what causes my menstrual sleep issues and fatigue”, various factors come into play: hormonal fluctuations, pain and discomfort, mood disorders, and lifestyle habits all play significant roles in contributing to the development of these issues. Let us now explore each of these causes in greater depth to gain a comprehensive understanding of their impact.

1. Hormonal Fluctuations

The hormonal changes that occur during the menstrual cycle can impact sleep patterns. Fluctuations in estrogen and progesterone levels, particularly during the premenstrual and menstrual phases, can disrupt the sleep-wake cycle and make it challenging to fall asleep or stay asleep throughout the night. This is because there has been an interaction between the melatonin system and these sex hormones (in particular, estrogen). 

Further support for such an interaction comes from the colocalization of melatonin receptors with estrogen and progesterone receptors throughout the brain and periphery, and melatonin has been found in human ovarian follicular fluid. Furthermore, various sources indicate that receptors for melatonin, progesterone, and estrogen can all be found at the different human fluids/tissues.

Along with sex hormones (such as estrogen), melatonin comes into the picture. As many people may already know, melatonin is a hormone that regulates sleep-wake cycles, can be affected by hormonal fluctuations. As we just mentioned, estrogen and progesterone may influence the production and release of melatonin, impacting sleep quality and giving rise to fatigue during the menstrual cycle.

Besides, cortisol, the primary stress hormone, can also influence sleep patterns. Hormonal imbalances during the menstrual cycle, along with increased stress levels, can lead to elevated cortisol levels, disrupting sleep and contributing to fatigue.

2. Prostaglandins and Pain

Menstruation often brings discomfort and pain due to the release of prostaglandins, hormone-like substances that cause uterine contractions. These cramps and physical discomfort can make it difficult for individuals to find a comfortable sleep position and lead to disturbed sleep. 

3. Mood Disorders

Conditions such as premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) can contribute to sleep issues and fatigue during the menstrual cycle. Mood disturbances, including anxiety, irritability, and depression, can disrupt sleep patterns and lead to feelings of exhaustion.

4. Restless Leg Syndrome (RLS)

RLS is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. Some individuals experience worsening symptoms of RLS during the premenstrual and menstrual phases, leading to sleep disruption and subsequent fatigue.

5. Lifestyle factors

Lifestyle factors play an important role in preventing many chronic diseases or discomforts. Stress, poor diet, and lack of exercise may all contribute to menstrual sleep issues and fatigue. 

It's important to note that these causes may vary from person to person. Some individuals may experience one or multiple factors that contribute to their menstrual sleep issues and fatigue. Understanding these underlying causes can help individuals identify strategies and interventions to improve sleep quality and alleviate fatigue during their menstrual cycle.

If menstrual sleep issues and fatigue significantly impact daily functioning and persist beyond the menstrual period, it is advisable to consult a healthcare professional for further evaluation and guidance. They can provide personalized recommendations and explore potential underlying conditions that may require additional treatment or management strategies.


Menstrual sleep issues and fatigue can significantly impact the quality of life for individuals during different phases of their menstrual cycle. The causes of these symptoms are multifaceted, with hormonal fluctuations, prostaglandins, mood disorders, and conditions like restless leg syndrome playing a role. Understanding the complex relationship between menstrual sleep issues, fatigue, and hormones can empower individuals to implement effective strategies for better sleep and increased energy levels. Prioritizing sleep hygiene, managing pain and discomfort, addressing mood disorders, and seeking professional guidance can all contribute to alleviating menstrual sleep issues and combating fatigue. By nurturing a balanced hormonal environment and adopting healthy sleep practices, individuals can embrace their menstrual cycles with improved sleep and restored vitality.

  • Shechter, Ari, and Diane B. Boivin. "Sleep, hormones, and circadian rhythms throughout the menstrual cycle in healthy women and women with premenstrual dysphoric disorder." International journal of endocrinology 2010 (2010).
  • Brzezinski, Amnon, et al. "Melatonin in human preovulatory follicular fluid." The Journal of Clinical Endocrinology & Metabolism 64.4 (1987): 865-867.
  • Allen, Richard P., et al. "Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology: a report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health." Sleep medicine 4.2 (2003): 101-119.
  • Youseflu S, Jahanian Sadatmahalleh S, Roshanzadeh G, Mottaghi A, Kazemnejad A, Moini A. Effects of endometriosis on sleep quality of women: does life style factor make a difference? BMC Womens Health. 2020 Aug 10;20(1):168.
2.Causes of Menstrual Sleep Issues and Fatigue