About 40% to 60% of women experience sleep disorders, like insomnia, during the menopausal transition.(1) Restless leg syndrome (RLS) is one of the contributors to sleep problems during this transitional phase.
RLS is a neurological condition marked by an uncontrollable urge to move the legs. It’s usually triggered by uncomfortable sensations such as tingling, crawling, or aching. These symptoms tend to worsen in the evening or during rest, making it difficult to fall or stay asleep. RLS can also affect mood, increasing the risk of anxiety and depression.(2)
Treatment options include lifestyle changes, non-hormonal therapies, and hormone replacement therapy (HRT). It’s recommended to seek medical help if experiencing symptoms of RLS. A physician can help identify underlying causes and suggest a personalized treatment plan. Early support can help manage symptoms and improve sleep and quality of life during menopause.
What is restless leg syndrome?
Restless leg syndrome, or Willis-Ekbom disease, is a neurological condition marked by an uncontrollable urge to move the legs. It’s often accompanied by sensations such as crawling, tingling, or pulling. These symptoms typically worsen during rest, especially in the evening or at night, and are partially or completely relieved by movement.(3)
Although not life-threatening, RLS can significantly disrupt sleep and daily function. The repeated urge to move the legs may delay sleep onset or cause insomnia, leading to daytime fatigue, poor concentration, and reduced quality of life. The condition can also interfere with social activities, work, and emotional well-being in severe cases.(3)
How Menopause & Perimenopause Contribute to RLS
The exact cause of RLS isn’t fully clear, but it may be linked to the part of the brain that controls body movements, the basal ganglia. This area relies on a chemical called dopamine to help the body move in a steady and coordinated way. If the brain doesn’t get enough dopamine, it can’t regulate movements effectively.(3)
Iron is also essential because it helps dopamine work as it should. When the brain doesn’t get enough iron, dopamine activity may drop, increasing the risk of RLS.
During perimenopause and menopause, declining estrogen levels may contribute to this imbalance. Estrogen plays a vital role in supporting dopamine activity. This support weakens as estrogen levels drop, making the brain more vulnerable to dopamine changes. This may help explain why RLS is more commonly experienced by women, especially during phases of hormonal transition such as pregnancy and menopause.(3)(4)
Iron deficiency is also more common during menopause, which can further reduce dopamine function and increase the risk of developing RLS.(3)(4)
Common Symptoms of Restless Legs
Some common symptoms of RLS include the following:(3)
An irresistible urge to move the legs, often worse at night
Uncomfortable sensations in the legs, such as tingling, crawling, or pulling
Symptoms worsening during rest or inactivity
Temporary relief with movement, like walking or stretching
Disrupted sleep due to repeated leg movements
Difficulty falling or staying asleep, leading to daytime fatigue
Sensations occasionally extending to the arms in severe cases
“Hot legs,” leg cramping, or a need to shake the legs at night
Sleep Disruption: Night Sweats and Restless Legs
Research suggests that women experiencing vasomotor symptoms, such as night sweats, are more likely to develop RLS. While the exact mechanism linking these two conditions is not yet fully understood, hormonal changes during menopause likely play a role in both.(2)
Night sweats can cause repeated awakenings throughout the night. These interruptions may trigger or intensify leg discomfort in those with RLS, making it difficult to return to sleep. The sensations, often described as crawling, tingling, or pulling, tend to arise during periods of rest, making nighttime particularly challenging.(4)
This combination of vasomotor symptoms-related arousals and restlessness can significantly fragment sleep. Disrupted sleep patterns may lead to daytime fatigue, reduced cognitive function, and decreased quality of life.
Managing Restless Legs
RLS often requires a combination of approaches, like lifestyle adjustments, supplements, and hormonal therapy.
Lifestyle Changes
Improving daily habits can ease symptoms and reduce flare-ups, including the following:(5)
Exercising: Gentle exercise, such as walking, yoga, or stretching, may help reduce the buildup of restlessness in the legs.
Maintaining Bedtime Routine: Going to bed and waking up at the same time each day helps regulate the body’s internal clock and may reduce nighttime symptoms.
Limiting Caffeine, Alcohol, and Nicotine: These substances can worsen symptoms by interfering with sleep quality and nervous system regulation.
Managing Stress: Techniques like deep breathing, meditation, and cognitive behavioral strategies can help calm the nervous system and reduce symptom intensity.
Trying Warm Baths or Massaging Legs Before Bed: These techniques may temporarily ease discomfort and make it easier to fall asleep.
Non-Hormonal Options
The following non-hormonal treatment options can help manage symptoms of RLS:(5)
Supplements
Iron Supplementation: If blood tests show low iron levels, iron supplements may help restore them and improve dopamine activity, which plays a role in RLS.
Magnesium: It may promote muscle relaxation and help reduce leg twitching or discomfort, especially at night. However, it’s essential to consult a physician before taking any supplements.
Medications
Dopamine Agonists: These medications, such as pramipexole or ropinirole, mimic the action of dopamine in the brain and are often used for moderate to severe RLS.
Alpha-2-Delta Ligands: Medicines like gabapentin and pregabalin help calm nerve activity and reduce sensory symptoms. However, gabapentin and pregabalin are classified as controlled substances. They should be taken with caution and only after consulting a physician.
Pneumatic Compression Therapy
This involves the use of a device that inflates and deflates air-filled sleeves wrapped around the legs. It creates a gentle, rhythmic pressure that mimics the natural pumping action of muscles, improving circulation and relieving discomfort or restlessness in the legs.
Hormone Replacement Therapy (HRT)
Studies suggest that estrogen supports healthy dopamine activity in the brain. When levels of this hormone drop during menopause, this balance can be disrupted, potentially contributing to the onset or worsening of RLS.
HRT helps by replenishing estrogen, which may support dopamine regulation and improve symptoms related to nervous system function. It also reduces vasomotor symptoms like night sweats and hot flashes, which are common triggers for sleep disruption. For women experiencing both RLS and sleep disturbances during menopause, HRT may contribute to better rest and improved quality of life.
However, HRT is typically considered when an individual has other menopausal symptoms, like hot flashes, rather than as a standalone solution for RLS. Decisions around HRT should be individualized, taking into account a woman’s medical history and overall menopausal experience.
HRT typically involves estrogen alone (for women who have had a hysterectomy) or a combination of estrogen and progesterone (for those with an intact uterus). Adding progesterone helps protect the uterine lining and lowers the risk of endometrial cancer.
When to See a Doctor
Persistent symptoms of RLS that interfere with sleep, daily function, or overall health warrant medical evaluation. Early diagnosis and appropriate treatment can significantly improve symptom control and quality of life.
Clinical assessment is recommended in the following situations:
Disrupted sleep or frequent awakenings due to leg discomfort
Daytime fatigue, cognitive problems, or mood changes linked to poor sleep quality
Progressive worsening of symptoms
A thorough evaluation may include a review of medical history and current medications; sleep pattern assessment; and laboratory testing for factors such as ferritin, iron levels, or thyroid function. Identifying underlying contributors, such as iron deficiency or hormonal imbalance, is essential to developing an effective, individualized treatment plan.
Many individuals with RLS experience relief and improved sleep quality with proper diagnosis and a comprehensive treatment approach.
Final Thoughts: Seeking Solutions for RLS in Menopause
While the exact cause of restless legs syndrome isn’t fully understood, research suggests that changes in hormones, dopamine activity, and iron levels may all play a role during menopause. The encouraging news is that RLS can be managed. Individuals can find relief and improve their sleep and overall well-being with the right support and treatment. Anyone experiencing persistent symptoms should consult a physician to explore personalized treatment options.
