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Emerging research on progesterone and sleep architecture in menopausal women indicates that oral micronised progesterone increases non-REM sleep, particularly slow-wave sleep, through its neuroactive metabolite allopregnanolone acting at GABA-A receptors. This is distinct from the vasomotor symptom relief provided by oestrogen. Some women with sleep maintenance insomnia who do not have significant vasomotor symptoms may benefit more from progesterone alone than from oestrogen. Polysomnography data from small trials shows increased total sleep time and improved sleep efficiency compared to placebo.

In my clinical experience, micronised progesterone taken orally at bedtime is one of the most reliably effective interventions for perimenopausal sleep disruption. It has a well-documented sedative metabolite — allopregnanolone — which acts on GABA receptors. Many of my patients report improved sleep onset and maintenance within two to three weeks. I typically start with 100mg and the morning grogginess, if present, usually resolves within a fortnight.