I am 31, female. Are my hormones causing severe insomnia?

Question

Hello doctor,

I am a 31-year-old woman and I have been experiencing severe insomnia that began about six months after I gave birth to my daughter, who is now approximately 18 months old. Initially, I thought it was just a typical new mother's sleep disruption, but even though she is now sleeping through the night, I still cannot fall asleep or stay asleep. I lie awake for hours with racing thoughts, often worrying about whether I am a good enough mother. I also wake up multiple times during the night drenched in sweat.

My menstrual periods returned about six months ago, but they are much heavier and more painful than they were before pregnancy. I am still breastfeeding once or twice a day, and I am wondering if that is affecting my hormones and sleep. I am also experiencing postpartum hair loss and mood swings that appear to be related to my menstrual cycle.

My partner and I are planning to try for another baby soon, but I feel exhausted and I am worried about how this ongoing sleep deprivation might affect another pregnancy.

My concerns are:

Could my continued breastfeeding be affecting my sleep patterns and hormones?
Is this insomnia related to postpartum depression or anxiety that I should be concerned about?
How do the hormonal changes during my menstrual cycle affect my sleep quality?
Are there safe sleep aids I can take while occasionally breastfeeding?
Could my heavy and painful periods be contributing to my sleep problems?
What sleep strategies are safe if I become pregnant again soon?
Is the night sweating related to hormonal imbalances from breastfeeding or something else?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

From what you have described, your insomnia seems to have a mix of possible contributors: postpartum hormonal shifts, ongoing breastfeeding, cycle-related changes, mood fluctuations, and the stress load of parenting.

Breastfeeding, even once or twice a day, can still influence prolactin and estrogen balance, which may affect sleep patterns and mood. Night sweats and heavy, painful periods could point towards hormonal fluctuations, possibly low estrogen or perimenopausal-like changes that some women experience postpartum. Racing thoughts about parenting adequacy can also be linked to mild postpartum anxiety or depression, which often goes underdiagnosed several months after delivery.

Probable causes:

Postpartum hormonal changes (prolactin, estrogen, progesterone imbalance).
Possible mild postpartum anxiety or depression.
Heavy menstrual bleeding causes fatigue and possible iron deficiency.
Sleep cycle disruption due to stress and mood swings.

I suggest the following investigations:

Complete blood count (CBC) and serum ferritin (to check for anemia).
Thyroid profile.
Serum prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol.
Vitamin D (nutritional supplement) and vitamin B12 (nutritional supplement) levels.
Screening for postpartum depression or anxiety (Edinburgh Postnatal Depression Scale).

I would suggest the following treatment plan:

Correct any anemia or vitamin deficiencies if present (for example, iron supplements [hematopoietic agent], Vitamin D [nutritional supplement], Vitamin B12 [nutritional supplement]).
Minimize breastfeeding sessions if you wish to allow your hormones to reset more quickly.
Maintain consistent sleep hygiene, fixed bedtime, dim lighting, and avoidance of screens before bed.
Use relaxation techniques such as deep breathing, progressive muscle relaxation, or guided meditation.
If anxiety or mood symptoms persist, consult a mental health professional for counseling, which is safe even during breastfeeding.
Safe over-the-counter options for sleep during occasional breastfeeding are limited; avoid sedatives unless prescribed after an in-person evaluation.
Short-term use of certain Antihistamines (sedating antihistamines) may be considered under supervision, but only after confirming safety in your stage of breastfeeding.
If you are planning a pregnancy soon, avoid strong sleep medications, focus primarily on non-drug strategies

The following preventive measures can be taken:

Consume a balanced diet rich in iron and protein.
Maintain adequate hydration.
Engage in light exercise or yoga.
Avoid caffeine in the afternoon and evening.
Incorporate stress management activities daily.

I hope this helps.

Thank you.