There are some period symptoms that are common but fixable in most cases (like PMS,  cramping, and moodiness), and others that, for the most part, are physiologic (like bowel changes)–but it’s possible to mitigate them with a few habit changes. Sleep disruption around menses falls into the latter category, too, as there are good physiological reasons why it happens.

The Fixable Causes of Insomnia with Menses

Let’s start with the obvious: if you’re anxious or in pain, you’re not going to be sleeping very well. In these cases, insomnia is a secondary rather than a primary effect of your period.

As mentioned above, while cramping and moodiness are both quite common leading up to and during menses, in most cases they are fixable. These both go back to estrogen dominance more often than not, and it is usually quite possible to balance levels of estrogen to progesterone with a healthy diet, exercise, balancing your gut flora, and/or liver detoxification. There are supplements available that can speed this process along, and in some cases these are necessary depending on the actual diagnosis if there is one, and the level of severity. But these are the basic principles.

Physiologic Causes of Insomnia with Menses

The main cause of insomnia during menses is the same as the most obvious cause of looser bowels with menses: the sudden drop in progesterone. Progesterone has a sedative effect (in fact whenever I prescribe bioidentical progesterone, I always recommend that patients take it at night so that this doesn’t become a problem. The sedative effect of progesterone is also one of the major causes of fatigue in pregnancy, as the levels rise so steeply.) This is because progesterone increases GABA receptor activity—one of the calming neurotransmitters, and the target of benzodiazepines (the anti-anxiety class of medications, which many people take for sleep as well). It also increases MAO activity (that enzyme responsible for breaking down catecholamines, like adrenaline—and obviously that can keep you awake.)

Because the body is used to a higher level of progesterone, the precipitous decline can cause a rebound of insomnia during menses.

The other potential cause is the drop-off of estrogen. Estrogen increases production of serotonin, which is the precursor for melatonin (the sleep hormone). Low estrogen can therefore lead to low melatonin.

What to Do About It

For many women whose hormones are otherwise in balance (through healthy eating, exercise, liver detoxification and healthy gut flora), the drop in progesterone isn’t enough to disrupt sleep.

For those who do have an issue, progesterone *might* be an option—progesterone will lighten the period, and too much of it may suppress it altogether. A better choice would be tryptophan or 5HTP, the precursors for serotonin… or perhaps just melatonin during menses. Doses for the former two vary, but I’d start with 1000 mg nightly of tryptophan, or (assuming you’re not on an SSRI or SNRI medication) 50 mg 5HTP. For melatonin, a standard dose is around 3 mg.

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