Does melatonin help menopause sleep?

What did the studies find?

The 2021 meta-analysis combined 8 groups of women in menopause from randomized trials that lasted 3 to 12 months¹. Compared with the control groups, melatonin brought no clear improvement in sleep quality, overall menopause symptoms, hot flashes, anxiety or depression¹. One score, for physical symptoms, did improve when 4 trials were pooled¹. The authors said larger trials are needed to confirm their findings¹.

Outside menopause, NCCIH reports that a 2022 review of 12 studies (2,666 people with insomnia) found melatonin helped people fall asleep faster and feel less sleepy in the day. It didn't improve sleep quality or time awake during the night².

What do the experts say?

The American Academy of Sleep Medicine (2017) suggests that clinicians not use melatonin for trouble falling or staying asleep. It's a weak recommendation, based on limited evidence³.
NIH's complementary health center (NCCIH) notes that guidelines from 2017 and 2019 recommended against melatonin for chronic insomnia².
The Menopause Society (2023) lists supplements and herbal remedies under "not recommended" for hot flashes. It recommends cognitive behavioral therapy (Level I)⁵.
ACOG's October 2026 guideline summary doesn't mention melatonin. It lists CBT among its non-drug options for hot flashes, sleep and mood symptoms⁶.

What has worked better in midlife women?

In a 2016 trial, 106 women aged 40 to 65 with insomnia and hot flashes had six phone sessions of CBT for insomnia (CBT-I) or menopause education. CBT-I eased insomnia more than menopause education did. At 8 weeks, 70% of the CBT-I group were in the no-insomnia range, compared with 24% of the education group⁴. Hot flashes didn't become less frequent, but they bothered women less⁴.

Is melatonin safe?

NCCIH says melatonin looks safe for most people in the short term, but long-term safety hasn't been established⁷. Reported side effects are mild, such as headache, dizziness, nausea and sleepiness. Melatonin can stay active longer in older people and cause daytime drowsiness⁷. Anyone taking medicine should check with a provider first, especially people with epilepsy or those taking blood thinners⁷.

In the US, melatonin is sold as a dietary supplement. The FDA regulates supplements less strictly than drugs and doesn't approve them for safety before they're sold^{7, 8}. Labels can be off: NCCIH reports that in a 2023 test, 22 of 25 melatonin gummy products didn't contain the amount listed².

The limitation

The menopause review included only 8 study groups that differed in design. Only 3 or 4 trials fed each result, and the authors called for larger trials¹. The CBT-I trial was small and compared CBT-I with education, not with melatonin⁴.

One thing to try, one thing to ask

If you take melatonin, write it on your sleep record and the medicine list you bring to appointments. Our sleep path has a 2-week record. Then ask: "Could CBT for insomnia fit me, and is there a phone or online option?"