What Happens to Your Hormones During Perimenopause

Perimenopause is one of the most significant hormonal transitions in a woman’s life. It can start in the late 30s to early 40s and last anywhere from two to ten years. During this time, your body undergoes complex hormonal shifts that can affect mood, energy, temperature regulation, cognitive clarity and sleep.

Many women describe perimenopause as a “rollercoaster.” Biologically, that’s not far off. Fluctuating estrogen and progesterone levels, and shifts in other key hormones, can impact everything from circadian rhythms to how the brain manages stress and temperature.

Understanding these changes isn’t just about science. It’s about empowerment.

Knowing what’s happening inside your body helps you make smarter, evidence-based decisions about sleep support, nutrition, movement, and targeted interventions that actually work.

What Hormones Change the Most During Perimenopause?

The primary hormones affected during perimenopause are estrogen (particularly estradiol) and progesterone.

• Estrogen begins to fluctuate unpredictably. Some days, levels spike; other days, they drop sharply. These swings drive many hallmark symptoms of perimenopause — including hot flashes, night sweats, and mood shifts.
• Progesterone tends to decline more steadily over time. Because progesterone has a calming, sleep-promoting effect, this decline can lead to trouble falling asleep or staying asleep.

But these aren’t the only hormones involved. FSH (follicle-stimulating hormone) and LH (luteinizing hormone) start to rise as the ovaries respond less consistently to hormonal feedback. This increase is often used to identify perimenopause in lab testing — though because levels fluctuate from day to day, hormone testing alone isn’t always definitive.

Melatonin, your body’s sleep hormone, can be suppressed by night sweats and hormonal changes, like spikes in cortisol, your stress hormone. In some women, thyroid hormone regulation may also shift during this time, compounding fatigue and mood symptoms.

A 2015 study in Menopause found that perimenopausal women are significantly more likely to report difficulty maintaining sleep compared to premenopausal women. In fact, the Sleep Foundation reports that 40-60% of perimenopausal women experience sleep disturbances.

 

How Hormonal Fluctuations Affect Sleep

Estrogen plays an important role in regulating body temperature and neurotransmitters like serotonin and melatonin. When estrogen dips, your body becomes more sensitive to small changes in temperature, which can trigger hot flashes or night sweats. The hypothalamus, your brain's "thermostat," is influenced by estrogen and becomes oversensitive to small temperature fluctuations, mistaking them for overheating. These events can jolt you out of deep sleep and make it harder to fall back asleep.

Progesterone is known for its mild sedative effect. As levels drop, many women notice feeling “tired but wired” at night — exhausted yet unable to fully relax. This is also when anxiety tends to spike.

Melatonin production can be disrupted by both hormonal fluctuations and external factors, such as light exposure. Lower nighttime melatonin levels can increase sleep onset latency (the time it takes to fall asleep) and reduce deep sleep duration.

The Role of FSH, LH, and Circadian Rhythm

As estrogen and progesterone fluctuate, the hypothalamus — the brain’s hormone control center — tries to maintain balance by increasing FSH and LH. These signals encourage the ovaries to produce more estrogen, but as ovarian function naturally declines, the response becomes inconsistent. This hormonal “push and pull” can cause cycles to become irregular and unpredictable.

Importantly, these hormonal swings affect circadian rhythms. Cortisol peaks may shift, melatonin may be blunted, and the body’s temperature rhythm may flatten. This is why many perimenopausal women describe feeling wide awake at 3 am or struggling with early-morning awakenings.

 

Emotional & Cognitive Effects of Hormone Shifts

Hormonal fluctuations affect far more than physical symptoms. They can shape how you feel, think, and cope. Estrogen interacts closely with serotonin, dopamine, and GABA, neurotransmitters tied to mood and calmness.

When estrogen dips, it can lead to heightened anxiety, irritability, and difficulty concentrating. These mood changes are often amplified by poor sleep, creating a feedback loop where anxiety interferes with sleep and poor sleep worsens anxiety.

A study in The Lancet reported that sleep disturbance is one of the strongest predictors of mood symptoms in the menopause transition.

"Sleep isn’t optional. It’s foundational," says Dr Mary-Claire Haver. "In perimenopause and menopause, disrupted sleep is one of the most common (and most disruptive) symptoms I see. Without restorative sleep, your body can’t reset, rebuild, or restore, and everything from cortisol to insulin resistance can spiral."

This is why many people in perimenopause benefit from multimodal approaches — combining lifestyle, clinical, and sometimes supplemental strategies rather than relying on one quick fix.

 

How the Endocannabinoid System (ECS) Fits In

The endocannabinoid system helps regulate sleep, mood, pain, and endocrine signaling. Estrogen influences ECS receptor sensitivity. When estrogen fluctuates, ECS signaling weakens, which may lead to increased anxiety, fragmented sleep, and heightened sensitivity to temperature.

Research shows estrogen increases levels of anandamide, a key endocannabinoid that supports relaxation and sleep. As estrogen levels drop, anandamide levels may also decrease, making it harder to sustain restful sleep (Frontiers).

“Our body’s natural endocannabinoids help regulate sleep, mood, and body temperature," says Dr. Daniele Piomelli, Director, Center for the Study of Cannabis, UC Irvine. "When estrogen fluctuates, that regulatory balance can get thrown off.”

CBD doesn’t replace estrogen or progesterone, but it may support the ECS signaling by slowing the breakdown of anandamide, which can enhance relaxation and potentially improve sleep onset. It’s not a hormone therapy, but it can be part of a holistic support toolkit.

 

A Step-by-Step Hormone-Smart Sleep Support Plan

Create a stable sleep routine. Go to bed and wake up at the same time daily. A consistent rhythm supports melatonin production.

Cool your sleep environment. Maintain a room temperature of 16–19 °C (60–67 °F). Use breathable bedding and layers for flexibility.

Support the ECS and hormone balance. Consider evidence-based natural supplements, such as CBD, to help improve sleep.

Regulate light exposure. Get bright light in the morning to reset your circadian rhythm, and reduce blue light at night.

Add gentle movement. Activities such as walking, yoga, or Pilates help regulate cortisol levels and improve sleep architecture.

Try the Opal & Joy Restorative Sleep System. This system is designed to support deep relaxation and temperature regulation — two key factors that are often disrupted during perimenopause.

Discuss HRT with your clinician if it is appropriate. Hormone therapy can significantly reduce vasomotor symptoms and improve sleep in many women, though it’s not right for everyone.

“Your body needs to drop its core temperature by about two to three degrees Fahrenheit to initiate sleep.” — Dr. Matthew Walker, neuroscientist (DailyGood).

Learn More

• Perimenopause and Sleep
• How to Support Your Endocrine System During Perimenopause
• The Ultimate Guide to CBD and Perimenopause
• Restorative Sleep System

 

FAQs: What Happens to Your Hormones During Perimenopause?

What hormones change the most during perimenopause?

Estrogen and progesterone fluctuate significantly, and FSH/LH levels rise, affecting temperature regulation, mood, and sleep.

How do hormone changes affect sleep?

Fluctuations can make your temperature set point more sensitive, reduce calming progesterone, and disrupt melatonin rhythms.

Does CBD help balance hormones?

No, but it may support the ECS, which interacts with hormone signaling and sleep pathways.

Can hormone therapy help?

Yes, for some people. It can reduce hot flashes and night sweats and improve sleep quality.

What lifestyle changes help hormonal sleep disruption?

A cool sleeping environment, consistent schedule, calming rituals, morning light exposure, and gentle movement.