You fall asleep without much trouble. Then, somewhere in the early hours, you are awake. Your body is exhausted, your mind is running through tomorrow, and sleep will not come back.

It is one of the most common things women describe in their late thirties and forties. It is not random, and it is rarely just stress.

You are far from alone

The Study of Women's Health Across the Nation, one of the largest long-term studies of midlife women, found insomnia symptoms in 31 to 42 per cent of perimenopausal women in any given year. Lower oestradiol and higher FSH were both linked to waking several times a night.

In other words, the early-hours wake-up has a hormonal signature.

The early hours are a sensitive window

Cortisol reaches its lowest point around midnight, then starts building towards its morning peak. By the early hours, your body is already shifting gear towards waking.

When stress is high or your rhythm is out of time, that shift can be enough to tip you out of lighter sleep.

Progesterone, your built-in sedative

Progesterone breaks down into a compound called allopregnanolone. It acts on the same calming receptor system in the brain targeted by some sleep medications. In one study, progesterone given at bedtime increased deep, non-REM sleep.

As progesterone starts to fall from your thirties, that natural calming support fades with it. Many women notice the change in their sleep long before anything else.

Oestrogen and night-time heat

Falling oestrogen brings night sweats and hot flushes for many women, and these are strongly linked to broken sleep. The same research shows the two do not always travel together, though. Sleep problems can carry on well after the flushes have settled.

The nightcap that backfires

A glass of wine can feel like it helps. A review of the research on alcohol and sleep found that at every dose, alcohol helps you fall asleep faster and deepens the first half of the night. The second half is a different story, with more disrupted sleep and more waking.

That second half is exactly where the 3am wake-up lives.

What dinner has to do with it

In my programme, dinner is the lightest meal of the day, built around protein and non-starchy vegetables with only a small amount of carbohydrate. The aim is a calmer evening for your blood sugar and a steadier night to follow.

Why guessing does not work here

Cortisol timing, progesterone, oestrogen, alcohol and evening eating all overlap, so two women can wake at 3am for completely different reasons. The Swiss Perimenopause Study, which followed 127 women for 13 months, found that oestradiol and progesterone fluctuate in highly individual ways rather than falling in a neat line.

That is why your 3am needs your data. A DUTCH test maps your cortisol rhythm across the day alongside your sex hormones, so you can see which of these is actually driving it.

Sleep and stress have a full week of their own in my six-week programme, built around your results.

Want to see which hormones the test looks at? Download The Dutch Dozen, my free guide. 

Get to know your body.

Sources:

• Kravitz HM and Joffe H, Sleep During the Perimenopause: A SWAN Story
• Journal of Obstetric, Gynecologic and Neonatal Nursing, Longitudinal Study of Insomnia Symptoms Among Women During Perimenopause, 2017
• ScienceDaily, Sleep problems associated with menopause vary among ethnic groups (SWAN, 2008)
• Kravitz HM et al., Sleep, Sleep disturbance during the menopausal transition in a multi-ethnic community sample of women, 2008
• Life, The Influence of Light Wavelength on Human HPA Axis Rhythms: A Systematic Review, 2023
• American Journal of Physiology, Progesterone-induced changes in sleep in male subjects, 1997
• Psychoneuroendocrinology, Administration of progesterone produces mild sedative-like effects in men and women, 2004
• Ebrahim IO et al., Alcoholism: Clinical and Experimental Research, Alcohol and Sleep I: Effects on Normal Sleep, 2013
• Grub J et al., Frontiers in Global Women's Health, Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study, 2021