You wake up at 3 a.m. Sometimes it is a hot flash that wakes you. Other times, it is hard to know exactly why. You toss and turn, trying to fall back asleep, but instead of sleep, the thoughts begin: How will I function tomorrow? Why is this happening now? And maybe this is simply one more thing you have to learn to live with during menopause.
Sleep disturbances are among the most common and frustrating symptoms of menopause. Some women have trouble falling asleep, others wake repeatedly during the night and many say their sleep simply ‘doesn’t feel the way it used to.’ For years, research focused mainly on declining estrogen levels and hot flashes. But as awareness of menopause grows, researchers are broadening their perspective as well.
Exercise improves sleep
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In recent years, two fields drawing considerable scientific attention — muscle research and the study of the gut microbiome — have also begun entering the scientific discussion surrounding menopause. They offer a new way of looking at how different systems in the body change during this period and perhaps at how those changes are connected to sleep quality.
The gut microbiome and its effect on sleep quality
The important role of the gut and the population of microorganisms living in it, known as the microbiome, in maintaining health has become one of the most fascinating and heavily researched areas of medicine in recent years. A growing body of research suggests that the microbiome does far more than help digest food. It influences a wide range of systems in the body, including the immune system, metabolism, heart health and brain function. Now, it appears it may also be part of the menopause story.
A review published in May 2026 in the journal Menopause by researchers in Spain examined the relationship between declining estrogen levels, the microbiome and menopausal symptoms. The researchers propose viewing menopause as a systemic process in which hormones, the gut, the immune system and the brain affect one another rather than simply as the result of a decline in a single hormone.
One of the key concepts in this field is the estrobolome, the collection of gut bacteria capable of influencing estrogen metabolism in the body. These bacteria produce enzymes that may affect how the body breaks down, recycles and uses estrogen. This means the relationship between the gut and hormones may work in both directions: declining estrogen levels affect the intestinal environment, while the composition of the microbiome may also influence pathways related to estrogen.
Researchers suggest that the microbiome may help explain why women experience menopause so differently, from hot flashes and metabolic changes to symptoms such as sleep disturbances. One possible explanation involves the gut-brain axis. In other words, gut bacteria may influence processes linked to mood, inflammation and sleep regulation. Preliminary studies have found an association between microbiome composition and sleep quality in menopausal women, although it is still unclear whether the relationship is direct or stems from other factors.
The practical takeaway: Although research does not yet support recommending a specific ‘microbiome treatment’ for menopausal symptoms, some steps may help support greater diversity among gut bacteria. These include eating a fiber-rich diet based on a wide variety of plant foods, legumes, whole grains, vegetables and fruit. Research has also shown growing interest in fermented foods and probiotics, but as of now, no specific probiotic strain has been proven to provide a solution for sleep disturbances during menopause.
Bottom line: Sleep problems during menopause may be only the tip of the iceberg when it comes to broader changes taking place in the body. As research advances, it is becoming increasingly clear that improving quality of life during this stage may depend not only on one hormone, but on a deeper understanding of the connections among the body’s different systems, from muscle to the gut and brain.
Muscle mass and its effect on sleep quality
The importance of strengthening muscles during menopause has taken an increasingly prominent place in health discussions in recent years. One indication is that strength training for women has evolved from a niche form of exercise into a major health trend.
As estrogen levels decline, alongside other age-related changes, the body gradually becomes less able to maintain muscle mass and strength. This process, known as sarcopenia — the loss of muscle mass and function — is not merely a matter of physical strength or appearance.
Muscle is a metabolically active organ. It affects energy use, insulin sensitivity, inflammation and the body’s ability to cope with physical demands. It is also now known that during physical activity, muscles release small proteins called myokines, which act as signaling molecules between muscles and other organs, including the brain.
Recent studies are examining whether strengthening muscles can also contribute to better sleep. Researchers hypothesize that resistance training affects several systems associated with sleep, from reducing inflammation and improving metabolism to regulating the stress response and improving mood.
One notable study conducted in Brazil among 160 women with an average age of 69 found that a 12-week resistance-training program significantly improved sleep quality. Participants also showed improvements in mental health, daily functioning and cognitive abilities, including memory and executive function.
A recent meta-analysis published in 2025, combining 31 studies of perimenopausal and postmenopausal women, reinforces the message that physical activity is an effective non-drug intervention for improving sleep quality. The researchers found particularly strong evidence for improving sleep through approaches including combined exercise and mind-body exercise.
The practical takeaway: Regular strength training during menopause may contribute not only to strength and stability, but also to overall health and better sleep. The commonly accepted recommendation is to include at least two strength-training sessions a week, gradually increasing the load and adapting the exercises to individual ability. It is also important to allow adequate recovery time between workouts.