Melatonin fails to improve sleep in menopause, pooled trials find

Sleep disturbance and other bothersome symptoms are a defining feature of the menopausal transition, and hormone therapy — while effective for many — carries side effects that lead some women to look for alternatives. Melatonin, a supplement widely associated with sleep, is an obvious candidate, and observational interest in it has grown. Whether it actually delivers on sleep quality, general menopausal symptoms and mood in this population is a question only pooled randomised evidence can settle, which is precisely what this systematic review set out to do.

The researchers systematically searched multiple databases, including PubMed, Web of Science, Embase, the Cochrane Library and China National Knowledge Infrastructure, for randomised controlled trials of melatonin in peri- or post-menopausal women published up to October 2020. Eight cohorts totalling 812 women met the inclusion criteria. Melatonin doses ranged from 1 mg to 5 mg and treatment durations from 3 to 12 months. Outcomes included sleep quality, general menopausal symptoms, physical, psychological, sexual and vasomotor symptom domains, anxiety, depression, body mass index and estradiol levels, with risk of bias assessed using the Cochrane tool.

Melatonin improved physical symptoms across four trials (standardised mean difference -0.376). However, it produced no significant benefit for sleep quality (SMD -0.659, P = 0.141) or general menopausal symptoms (SMD -0.625, P = 0.093). Psychological, sexual and vasomotor symptom domains did not improve significantly either. Anxiety and depression scores were essentially unchanged, and neither body mass index nor estradiol levels shifted under melatonin treatment. In short, the one clear positive was physical symptoms; everything else, including the outcome melatonin is best known for — sleep — came back null.

This result complicates melatonin's reputation as a sleep aid, at least for menopausal women: the pooled trial data simply do not show a sleep-quality benefit in this group. It also shows melatonin left estradiol levels untouched, arguing against a hormonal mechanism for the physical-symptom improvement observed. The evidence base remains thin — eight trial cohorts with varying doses and durations and notable heterogeneity — so the authors explicitly call for multiple large-scale randomised trials before firm conclusions are drawn. Whether specific doses, durations or subgroups respond differently remains open.

If you are navigating menopause and considering melatonin mainly in the hope of better sleep, this pooled evidence is a reason to temper expectations: across the available randomised trials, sleep quality did not measurably improve. The modest easing of physical symptoms is the one signal that did emerge, though it needs confirmation in larger trials. This is information rather than guidance — decisions about managing menopausal symptoms are best made with a clinician who knows your history.