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Dr. Laura Pipher

How your period can cause sleep issues

Do you experience sleep issues leading up to your period?
Turns out they may be more common than you think.

When you evaluate the menstrual cycle, you can easily break it up into two phases. In the first part of your period,  estradiol (estrogen) is your dominant reproductive hormone. In the second part of your period (after ovulation), progesterone is your dominant reproductive hormone (1) Up to 70% of women say that their sleep changes just before their period. The most common time for this is 3 to 6 days before menses begins (5). Lack of sleep can lower your pain threshold, leaving many women tired and uncomfortable in the days before and in the days during their monthly periods (5).

Your reproductive hormones not only play major roles in the menstrual cycle, but  can also influence sleep and circadian rhythms (3).

During the luteal phase (second half of the cycle before your period starts), sleep efficiency has been shown to decrease by 3.3 percent and the number of awakenings per night increased by three (1).

Reasons Why

Premenstrual Syndrome  

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) are characterized by emotional, behavioural, and physical symptoms that occur in the premenstrual phase of the menstrual cycle, and resolve after your period starts.

Women with severe premenstrual syndrome also report more disturbing dreams, fatigue, decreased alertness and concentration during the premenstrual phase (3). Physical and emotional symptoms can impact your ability to sleep for obvious reasons, and women with premenstrual syndrome often have an imbalance between their estrogen & progesterone, which can lead to significant sleep concerns.

Progesterone and Sleep

Progesterone is meant to balance out the actions of estrogen and is known to exert a sleep induction or hypnotic effect allowing us to get a good quality sleep (6). In post menopausal women (where progesterone levels are naturally low), supplementation with progesterone has been shown to improve quality and duration of sleep (9).

Higher levels of progesterone tend to promote a sense of calm, boosting relaxation and facilitating sleep. High levels of progesterone–especially during pregnancy, when a woman’s progesterone levels surge–can also make you feel sleepy during the day(8). Progesterone increases production of GABA, a neurotransmitter that helps sleep. Low progesterone can bring about anxiety and restlessness, and trouble sleeping, including a tendency to wake frequently during the night.

During your menstrual cycle, progesterone falls 9-10 days after you ovulate, getting you ready to start your next period. If you have trouble sleeping, it may be possible that your progesterone levels are falling too soon or they aren’t high enough to begin with.

What causes low progesterone levels?
  1. Anovulation – After you ovulate, your body starts making progesterone, if this does not happen then you may be left in a deficient state
  2. Stress- our body prefers to make stress hormone over sex hormone. If you are suffering from chronic stress your reproductive hormones may end up suffering
  3. Poor detoxification – When our body is not properly getting rid of our excess estrogens, we can be left in a state of relative progesterone deficiency .
  4. Poor digestion – our digestive system is responsible for getting rid of our excess estrogens. poor digestion can allow our body to reuse estrogen that was supposed to be on it’s way out, leading to a relative deficiency of progesterone

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  1. https://www.sciencedaily.com/releases/2019/03/190323145156.htm
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524984/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327930/
  4. https://www.sleep.org/articles/how-to-sleep-better-during-period/
  5. https://www.sleephealthfoundation.org.au/pdfs/Menstrual-Cycle-and-Sleep.pdf
  6. https://pubmed.ncbi.nlm.nih.gov/17168724/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864880/
  8. https://thesleepdoctor.com/2018/01/05/menopause-affects-sleep/
  9. https://academic.oup.com/jcem/article/96/4/E614/2720877

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