Is Melatonin Mighty for Menopause?

Tossing and turning. Can’t get to sleep. Can’t stay asleep. These are among the most common symptoms of menopause, the transition that occurs in women when estrogen and other reproductive hormones are on the decline and menses stops, usually in their 40s or 50s. In fact, studies show that 100% of women in menopause or perimenopause have some kind of trouble sleeping, ranging from occasional disruptions to chronic insomnia. That’s double the number of premenopausal women who complain of similar sleep problems.

It makes sense when you consider how your body’s production of melatonin—a hormone we all produce naturally that helps regulate sleep—drops as you age and particularly in menopause. Melatonin’s crucial role in sleep is why many people, men and women alike, reach for supplements containing the stuff when they have trouble getting enough shuteye.

Still, this hormone may be helpful for other frustrating symptoms of menopause and growing older, too. Turns out it can affect mood, hot flashes, even ongoing bone health. “We think of melatonin as this simple supplement that controls sleep, but it’s also involved in so much more in the body,” says Cydney McQueen, Pharm.D., a clinical associate professor at University of Missouri-Kansas City School of Pharmacy, who has special expertise in herbals, vitamins, and supplements.

Interestingly, melatonin’s efficacy has a chicken-or-the-egg element to it: Does improved sleep alone explain how this hormone makes other symptoms of menopause more tolerable? Or, could melatonin’s other, lesser-known properties help smooth the transition? The science suggests both—read on.

Melatonin has a not-completely-understood connection with reproductive function in women, which is why some researchers see a significant drop in melatonin, just like the corresponding drop in estrogen, as a marker of the end of the reproductive years. It’s also why replacing it could have far-reaching effects on many challenges of menopause.

“We replace hormones when we lose them in menopause. We also replace calcium and vitamin D, so why aren’t we replacing melatonin?” asks Heather Hirsch, M.D., a doctor in the Menopause & Midline Clinic at Brigham and Women’s Hospital in Boston, MA.

Researchers are trying to answer that question. And, some small studies have shown that melatonin can bring thyroid and pituitary gland function back to more youthful levels. In one Italian study, 80 women ages 42 to 62 took either 3mg of melatonin every night before bed or a placebo. At regular three-month intervals, researchers measured the women’s melatonin levels, as well as levels of several fertility-related hormones that are regulated by the pituitary or thyroid gland. After the first three months, women who were given supplemental melatonin (who also started out with the lowest melatonin levels) showed hormone levels and gland function similar to those of a much younger woman. In additon, six women from this group who had not had a menstrual period for at least a year reported that their menstrual cycles returned after melatonin treatment.

If researchers can replicate the results of this study in a larger experiment, the findings could have big implications for women in menopause. The thyroid controls metabolism, and weight gain is often a part of menopause. The pituitary gland has a role in skin, energy, mood, reproductive organs, and vision among other things. You may see changes in all of these at menopause. It also tells other glands to release hormones.

But it’s important to note that these studies were done on very small groups of women. They weren’t large enough to reach concrete conclusions. They were only large enough to raise interesting questions.

Still, it seems that melatonin may do a lot more than just lull you to sleep.

While the classic menopause symptoms of hot flashes and night sweats can lead to disturbed sleep, it’s worth noting that poor sleep quality itself is not always a direct symptom of menopause alone (though certainly hot flashes don’t help) but of simply getting older. In fact, production of melatonin—the body’s sleep chemical—decreases throughout the lifespan of both men and women.

Your body produces melatonin naturally when it is exposed to darkness. The hormone helps the body wind down and get good quality sleep. Morning light shuts down melatonin secretion. Researchers don’t agree completely as to whether a melatonin shortage is the cause of common age-related sleep troubles. But they do know that people who tend to wake up during the night have better luck sleeping through till morning when they take a melatonin supplement. According to the Journal of Clinical Endocrinology & Metabolism, scientists at MIT found that just 0.3mg of melatonin every night before bedtime can restore sleep in adults over 50 who have insomnia.

Improving sleep, even if that’s the only thing melatonin does, is no small thing. You can’t be healthy—in body or mind—without enough sleep. So, what is “enough sleep,” you ask? “Women live the longest if they sleep a good seven to eight hours a night,” Dr. Hirsch says.

Mood swings are another hallmark of the menopausal transition. These may happen in perimenopause as soon as you hit your early 40s. Some research suggests that melatonin may even play a role in alleviating those highs and lows that lead to irritability, teary outbursts, and even depression.

In the Italian study of women ages 42 to 62, for example, those who received daily melatonin reported major improvements in their mood and elimination of morning depression–a complaint many had at the start of the study.

But, it’s unclear—and would be near impossible to figure out—whether melatonin itself boosts mood directly or whether getting a good night’s sleep after taking melatonin improves mood.

“Improved sleep leads to improved mood and decreased depression,” McQueen says, “But, is there a separate impact that melatonin itself has on mood? Probably, but there’s not enough data yet to tease out exactly how that would work.”

Research is mixed as to whether melatonin supplements may have any effect on hot flashes and night sweats. Improvement in these areas is difficult to scientifically gauge. Researchers measure hot flashes by asking women to rate theirs on a scale. Some research shows melatonin can lower these ratings.

A small study that included 250 menopausal women found that after three months of melatonin treatment (3mg each night at bedtime), women rated their hot flashes as less intense.

What makes the impact of melatonin on hot flashes difficult to quantify with precision is how subjective these ratings are. “There’s a difference between number and severity of hot flashes,” McQueen explains. “Severity is about how bothered a woman is by them. Some women tolerate them better than others.” In other words, what one woman would call a “3” another might consider an “11.”

That brings us back to the idea of sleep and mood. Does melatonin improve sleep, which improves mood, which in turn makes hot flashes seem like they’re not so bad anymore? Or does melatonin have a direct effect on hot flashes and night sweats? If you are a woman who suffers from intense hot flashes, it probably doesn’t matter to you how melatonin works, just whether or not it does.

Like melatonin, estrogen drops in menopause. This important hormone protects your bones throughout life, so when your supply gets depleted, your bones can suffer. Doctors already use hormone replacement therapy in some women to help prevent bone loss. But dozens of studies have explained the positive effects that melatonin can have on bone health, too.

Here’s how it works: Your body constantly breaks down bone and builds it back up. Bone cells called osteoclasts do the breaking down work, while osteoblasts build it back up again. In menopause, when estrogen and melatonin drop, the ratio of clasts to blasts gets thrown off. You end up with more bone-breaking cells (clasts) and fewer bone-building ones (blasts). But, studies show that in menopausal women who take melatonin, the clast-to-blast ratio shifts back towards 1:1. Another reason to ask your doctor if melatonin is a supplement you should consider taking.

Most studies on the effects of melatonin are small, so its effects aren’t proven like those of prescription drugs or even over-the-counter medications. But the research certainly points to the possible benefits of embracing a regular, low-dose melatonin regimen. Even better news? There’s virtually no harm in trying.

If you’d like to see if melatonin might make menopause a little easier on you, here’s some tips:

• Start with the lowest dose possible, per the Cleveland Clinic. The recommended dose for jet lag or occasional trouble falling sleep is from 0.5mg to 3mg. The higher the dose, the greater your risk of daytime drowsiness.

• If possible, find a brand with a U.S.P. seal on the label, which means the manufacturing process meets the quality standards of the U.S. Pharmacopeia.

• If you can’t find the U.S.P. seal, opt for a major brand or a brand that also makes over-the-counter drugs. This is not the time to try to save a buck.

• If you take any medications, including other supplements or herbals, ask your doctor or a pharmacist if melatonin is safe for you. It can cause risky or unpleasant interactions with certain drugs, such as other herbal supplements, blood thinners, anticonvulsants, blood pressure meds, CNS depressants, diabetes medications, birth control pills, cytochrome substrates, fluvoxamine, immunosuppressants, and seizure-threshold lowering drugs.

“I would almost never say, ‘No, don’t try melatonin,’” Dr. Hirsch says. “I have no problem with patients taking it. It’s safe. And many women get lots of benefit from it.”