The Functional Pharmacist
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I'm a Pharmacist, a mom of 2, wife, and pharmacy owner. My passion has always been helping others through my work in pharmacy. Over the last 5 years, my approach has drastically changed. Early on, my role in healthcare was to educate and counsel patients about their prescribed medication at our local pharmacy. While I loved providing education, I always felt there was more that I could do. I hated
05/14/2026
One of the strangest things researchers found about perimenopause?
A lot of women don’t actually struggle to FALL asleep.
They struggle to STAY asleep.
Meaning:
you can be exhausted, all asleep immediately, then suddenly wake up at 3:17AM completely alert like your brain clocked into another shift.
A 2024 menopause review found that the most common sleep complaint during perimenopause wasn’t sleep onset insomnia.
It was frequent nighttime awakenings and increased awake time after falling asleep.
That’s why so many women say during consultations that "I can fall asleep fine, but I can’t stay asleep anymore and once I’m awake, my brain starts spiraling."
Another interesting part?
Researchers are now looking at how cortisol patterns change during menopause transitions, especially around early morning waking hours. Some studies found altered cortisol awakening responses in peri- and postmenopausal women with sleep symptoms.
Which is wild because cortisol naturally starts rising around 3-4 AM to prepare your body to wake up.
So if your nervous system is already more sensitive from hormone fluctuations, that tiny cortisol rise can feel like somebody hit the ON switch in your brain.
Eyes open.
Heart racing.
Suddenly thinking about:
- your to-do list
- your health
- random embarrassing moments from 2009
- whether you replied to that email
Meanwhile everyone keeps telling women: try melatonin. But fragmented sleep during perimenopause is often way deeper than a basic sleep supplement problem.
One reason perimenopause gets missed is because a lot of women are still having periods, so they assume what they’re feeling must be stress, aging, or just a bad season.
But perimenopause happens before periods fully stop, and it can show up as sleep disruption, more irritability, more anxiety, and problems with memory or concentration.
The NHS says a change in your usual period pattern is often the first sign, and ACOG says about 4 in 10 women have mood symptoms during perimenopause that are similar to PMS.
That means waking at 3 AM, forgetting simple words, and feeling much less patient than usual can absolutely be part of a bigger hormone pattern. What to do: write down what’s changing and when.
Look for cycle changes, middle-of-the-night waking, night sweats, mood shifts, and brain fog. If it’s affecting daily life, that is enough reason to bring it up.
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