How your sleep cycle affects your menstrual cycle
Have you ever sacrificed sleep for work, study, or an active social life? What If I told you that how you sleep is essential to your overall health, including your hormone health and menstrual cycle?
Whilst there is no ‘one size fits all’ when it comes to sleep, adults over 18 years are estimated to need between 7-9 hours of sleep each night. However, research has shown that between 20-33% of adults do not get enough sleep (1). In fact, as much as half the UK population struggle with their sleep in some way, according to a 2023 sleep census. Disproportionately higher levels of poor sleep are also reported among women, Asian, black and other minority ethnic groups, putting them at a higher risk of the negative consequences of poor sleep (2).
What are the health implications of poor sleep?
Sleep is crucial for the rest, recovery and regeneration of every cell and organ in your body. When this is disturbed, it can impact your body's ability to function on multiple levels. Most of us are acutely aware that lack of sleep can make us feel tired and sleepy during the day, but poor sleep also increases your body's stress response, contributing to that wired and tired feeling, a reduced attention span, slowed thinking, poor digestion, poor decision-making, irritability, and other mood changes.
Sleep deprivation can also lead to consistently raised cortisol (your main stress hormone) increasing risk of diabetes and cardiovascular disease. Some of the mechanisms involved include reduced insulin sensitivity, weight redistribution and a change in eating habits linked to increased cravings for foods high in sugar and fat (3). Sleep loss can also impact long term brain health and disturb cellular function, with research suggesting that even partial sleep deprivation can increase inflammation and reduce your overall immunity (4). So, whilst it's evident that sleep loss plays a crucial role in supporting your daily functions, what does the research say about sleep and your menstrual cycle
How does your sleep cycle affect your menstrual cycle?
In the days leading up to your period (the luteal phase), body temperature changes, premenstrual cramps and other symptoms related to hormone fluctuations can reduce the quality of your sleep. For some women in particular, the natural decline in progesterone at this time (progesterone is a ‘calming’ hormone that generally helps sleep) can occur more suddenly, causing more significant sleep issues. However, what we know about how sleep impacts your menstrual cycle is less apparent.
Increased stress hormone production derived from sleep loss can reduce the production of follicle stimulating hormone (FSH) and luteinising hormone (LH), two hormones essential to menstrual function. If sleep disturbances persist, this may lead to irregular or even missing periods, known as Functional Hypothalamic Amenorrhoea (FHA).
Research has shown that women with FHA have higher anxiety levels and sleep worse than those without FHA (5). Whether this means poor sleep directly results in FHA or vice versa is uncertain. However, FHA is a stress-based condition in which cognitive, behavioural, emotional, psychological and physiological stressors trigger a stress response that may ultimately result in hormonal and ovulatory disturbances, including loss of periods. Thus, stress induced by chronic sleep deprivation may contribute to the disruption of your cycle.
Other causes of FHA include relative energy deficiency (related to total energy intake, dietary composition and eating patterns), weight loss and suboptimal body fat percentage, higher anxiety levels and physical activity. Each of these factors cause stress within the body, highlighting that a multitude of mini stressors, such as poor sleep, the feeling of stress and anxiety (6) or physical stress, work synergistically to impact your cycle.
Another potential mechanism contributing to sleep-induced menstrual disturbance and FHA centres on the role of a hormone called leptin. Like all hormones, leptin has many roles in your body, including helping to regulate energy balance and menstruation, and promoting ovulation and a healthy uterine lining. Sleep disturbances are known to cause leptin levels to drop with the potential to influence menstrual cycle regularity, ovulation and the normal development of the uterine lining.
Reduced sleep and poor sleep quality are also associated with menstrual cycle irregularity, heavier bleeding, longer flow length and increased PMS symptoms such as mood swings, uterine cramps, fatigue, and irritability. These effects have been observed in women working night shifts (7) and adolescent girls (8), suggesting that even a modest reduction in sleep duration across various age groups may impact your menstrual cycle.
How can we support good sleep?
The profound impact of poor sleep on health and the menstrual cycle is clear. Unfortunately, women are more prone to sleep disturbances likely linked to a combination of biological influences and gender roles. Adopting healthier sleep habits and sleep hygiene is crucial to support your overall well-being and menstrual cycle.
Sleep hygiene – a few basic principles:
1. Keep to a regular sleep pattern
Going to bed and getting up at roughly the same time each day trains your brain and body to sleep better.
2. Keep it cool
When we sleep, our body temperature drops. Sleeping in a cool room helps you to fall and stay asleep. Whilst the ‘optimal’ bedroom temperature for each person may be slightly different, 18.3 degrees Celsius (~65 degrees Fahrenheit) is recommended for good sleep, with a wider range of between 15.6 – 19.4 degrees Celsius.
3. Keep it dark
Any light, but particularly blue light exposure from screens (phones, TVs, and tablets), suppresses melatonin production, a hormone responsible for helping you sleep. Using black-out blinds or an eye-mask can help block out ambient light.
4. Avoid exercise close to bedtime
Exercising increases cortisol (our day-time wake-up and stress hormone), endorphins and body temperature, making it more difficult to fall asleep.
5. Get some activity in (preferably outside) during the day
On the contrary, staying relatively active and exposing your eyes to bright natural light throughout the day is beneficial to sleep later.
6. Go to bed earlier
There is evidence to suggest that sleeping late may disturb your circadian rhythm, worsen the quality of your sleep, and may lead to adverse health outcomes (9, 10). There may be some truth to the old-wives tale that an hour before midnight is worth two after!
Can you eat your way to good sleep?
The answer?… Sort of. Whilst food and nutrition cannot substitute for a sleep-sabotaging lifestyle, poor nutrition or dietary habits can certainly sabotage sleep. Here are a few pointers:
1. Manage your blood sugar
Both high and low blood sugar can lead to sleep disturbances, including waking up to go to the bathroom (high blood sugar), frequent waking, night-time anxiety, and increased risk of parasomnias (night terrors) that worsen the quality of your sleep (low blood sugar) (11).
2. Ensure adequate energy intake (eat enough during the day)
Going to sleep hungry or having low energy availability can lead to difficulty falling asleep and reduced deep sleep patterns (12). Addressing daytime energy intake and meal composition is key, alongside eating a dinner that contains some slow-release carbohydrates.
3. Eat a well-balanced diet
Vitamins B, D, omega-3 fatty acids and zinc may improve sleep quality, but their effectiveness is mainly seen as part of a whole meal (not just a supplement) (12, 13). This reinforces the notion that we should aim for a balanced diet, including whole grains, unsaturated fats, a diverse range of vegetables, fruits, seeds, nuts, and good quality fish/meat (if you eat animal products) to promote healthy sleeping patterns.
4. Avoid eating a large meal close to bedtime
Eating large meals close to bedtime may disrupt our bodies' circadian rhythm (our natural internal body clock) and body temperature, disrupting sleep quality (14). Leaving a 2–4-hour gap between your last meal and bedtime will likely help you sleep better, but this is also very individual and context dependent.
5. Avoid caffeine for several hours before bed
Drinking caffeine, most commonly found in coffee, is linked with the inability to fall asleep and decreased sleep quality. Since caffeine can take up to 10-12 hours to fully leave your system, most researchers advise avoiding caffeine for several hours before bed. Instead, caffeine-free teas such as valerian tea or chamomile may improve your sleep; however, the evidence is minimal.
6. Avoid alcohol before bed
Although alcohol makes you feel more tired and may help you fall asleep faster, the net effect of alcohol on sleep is negative. Alcohol impairs your ability to fall into deep restorative sleep, it makes you more likely to wake up in the night and affects the overall quality of your sleep.
7. Include foods containing Tryptophan and melatonin
Tryptophan is an amino acid converted into serotonin in the brain. The byproduct of this process is melatonin, a hormone that helps to induce sleep and regulate waking. Research on tryptophan supplements has shown an increase in sleep time, sleep efficiency, less difficulty in falling asleep and less waking at night (12). However, research on foods naturally high in Tryptophan and melatonin, such as milk, turkey, salmon, kiwis, cherries, pistachios, oats, and grains, etc., has also been shown to improve sleep quality (13). Still, more research is needed to confirm these findings.
8. Consider adaptogens
Adaptogens are a class of plant and mushroom derived compounds that support the body and mind in building resilience to stress (15). Ashwagandha is the most well-known adaptogen for sleep (16). Other adaptogens such as American Ginseng, Holy Basil and Schisandra may reduce stress (cortisol) in the body, potentially acting as a mechanism to increase melatonin and improve sleep quality; however, the research is limited.
9. Magnesium Supplements
Magnesium supplementation may improve sleep time and efficiency by activating the parasympathetic nervous system, promoting the relaxation of your brain and body (17). Similarly, magnesium glycinate is reported to be more beneficial for conditions like anxiety, insomnia, chronic stress, and inflammatory conditions. There is limited research on its effectiveness, but its combination with the amino acid glycine, which alone has been shown to improve sleep, suggests it may be a good choice for those looking to trial other avenues of support.
Conclusion
Although often overlooked, sleep is an important enabler of health and has an impact on almost every biological process in your body including your metabolism, cognition, inflammation and even your menstrual cycle. Adopting healthy sleep hygiene and sound sleep habits is crucial to improving your overall health.
REFERENCES
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This article was researched and written with the help of Noor Wadi, MSc GHP & HCPC Registered Diabetes Dietitian, and wonderful intern at Holly Dunn Nutrition.
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