Often, menstrual periods have a decidedly miserably way of warning you, “Hey, I’m about to arrive, better get ready.” I’m talking about PMS or premenstrual syndrome, which, in some folks, brings a barrage of uncomfortable symptoms, ranging from cramps and bloating to nausea, headaches, and mood swings in the lead-up to menstruation. Though it might seem like taking it easy and resting would be the best course of action during this time—and that certainly is a good call—that’s often easier said than done. That’s because sleep problems before a period are another sneaky symptom of PMS.
Experts in This Article
board-certified OB/GYN and clinical professor at the Yale University School of Medicine
board-certified clinical psychologist and behavioral sleep medicine specialist
Why the lead-up to menstruation can trigger sleep issues
Sleep problems before your period may stem from hormone fluctuations. In terms of the menstrual-cycle phases, the body typically sees a buildup of the hormones estrogen and progesterone during the follicular phase, or the part of the cycle that starts at menstruation and goes through the first two weeks, says clinical psychologist and sleep-medicine specialist Sara Nowakowski, PhD, whose research focuses on sleep in people who identify as women. “Then, if you don’t get pregnant, those hormones start to drop,” she says, “so, it’s really in that second half of the cycle, and especially the last five days before bleeding—or what we call the late luteal phase—that hormone levels are pretty low, and people tend to get sleep issues.”
“It’s really in the last five days before bleeding that hormone levels are pretty low, and people tend to get sleep issues.” —Sara Nowakowski, PhD, sleep physician
That’s because both hormones, in different ways, typically support good sleep; while estrogen works to keep body temperature low at night and helps regulate mood (both things that can help you drift off more easily), progesterone can have a directly calming or sedating effect. So, having lower levels of each hormone in the lead-up to a period can be a poor sleep double whammy. That effect is all the greater in folks who are in perimenopause or nearing menopause, says gynecologist Mary Jane Minkin, MD: “As we age, we tend to make less estrogen and progesterone overall so that right before a period, the levels get really low.”
Regardless of age or stage, though, people who tend to get other PMS or PMDD (premenstrual dysphoric disorder) symptoms are also more prone to experiencing sleep problems before a period. Essentially, these symptoms can worsen each other in a vicious cycle: “If you’re experiencing period-related bloating, cramping, or headaches, for instance, then you’re more likely to have disrupted sleep just as a result of those symptoms,” says Dr. Nowakowski. “But then, research shows that being sleep-deprived could also lower your pain tolerance, making the other symptoms feel even tougher to tolerate the next day.” So the cycle can continue until levels of both hormones rise again, around day two or three of menstrual bleeding.
While hormonal contraception could certainly help minimize or regulate period-related hormone fluctuations (and, in turn, bring about fewer sleep problems before a period), someone taking a hormonal birth-control pill would still experience the hormone dip in the period week, when they’re taking the sugar pills, says Dr. Minkin, and that can still lead to poor sleep. Though, in a severe case, you could opt to skip the sugar-pill week and your period altogether by continuing to take the active birth-control pills (which, according to Dr. Minkin, is medically fine to do). And for folks who aren’t on hormonal birth control or don’t wish to skip periods, all hope is not lost in the sleep department.
What to do if you struggle to sleep in the days before a period
Though hormones might be at the crux of your sleep issues, they’re far from the only thing that can affect the quality of your shut-eye. It’s important to remember that so much of good sleep is also environmental and, well, straight-up mental. With regard to the former, you can set yourself up for sleep success by maximizing your sleep hygiene in the week before your period. That means making sure to turn down the temperature in your bedroom, avoiding screens within an hour of your bedtime, and embracing a sleepiness-promoting nighttime ritual.
As for the latter? It’s about changing your perspective toward any potential sleep loss ahead of time. “If you know that during this week-long period, you’re going to get worse sleep, try to roll with it and avoid stressing out about it, if you can,” says Dr. Nowakowski, “as that can actually perpetuate the problem.” Rather than chasing sleep or trying to force it, avoid getting into bed until you’re actually sleepy, she suggests; instead, do something relaxing like reading a book or listening to a podcast, and then get into bed when your eyes start to droop.
If discomfort or cramps are behind your struggle to fall asleep, focus on alleviating that pain first, whether that’s with a heating pad or a pain reliever, rather than trying to sleep it away—as that’ll just make it harder to doze off, says Dr. Nowakowski. “If the pain wakes you up in the middle of the night, follow the 15-minute rule: If you’re up for more than 15 minutes, get out of bed, and go back to your reading, podcast listening, or a different relaxing activity in another room,” she says. “We don’t want to condition the bed as a place for arousal and pain, so it’s best to stay in the other room until you feel sleepy enough to get back into bed.”
And regardless of how much sleep you actually get on those pre-period nights, aim to still wake up at your usual time, she says. Sticking to that schedule will give your sleep the best chance at returning to its natural rhythm once your period comes to an end.
—medically reviewed by Angela Holliday-Bell, MD
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