The short answer
Many women do take melatonin with HRT, but check with your doctor or pharmacist first. Estrogen may raise the amount of melatonin in your blood, which can mean more drowsiness, headache, or dizziness.1 That is one more reason to start with a low dose.
HRT and melatonin also do different jobs. HRT treats hot flashes and night sweats. Melatonin is a timing signal for sleep. It does not treat hot flashes.2,3
What I see in women on HRT
"What I have seen in women who use HRT is that many still have sleep problems. HRT can help with hot flashes, but it does not always fix sleep. There are many factors, so it is hard to say what the direct cause is. Some of them ask me if it is safe to add melatonin."
Tyler Smith, RN
That matches the research. In a four year study of recently menopausal women, low dose hormone therapy improved sleep quality about twice as much as a placebo.4 But sleep improved along with fewer hot flashes and night sweats, and many things can still keep you awake. For a full look, read perimenopause sleep problems.
Does estrogen affect melatonin?
It can. Your liver breaks down melatonin. Estrogen may slow that down, so more melatonin stays in your blood for longer.
- Estrogen therapy. A major drug interaction checker lists estrogen with melatonin as a moderate interaction. Estrogen may raise melatonin levels in the blood.1
- Birth control pills. They can raise melatonin levels and its effects, including drowsiness.5
- What you may notice. Extra drowsiness, headache, dizziness, or feeling groggy the next morning.1
This does not mean you cannot take both. It means the dose matters more. A high dose of melatonin plus estrogen is more likely to linger into your morning. Read how much melatonin is too much.
HRT and melatonin do different jobs
| HRT | Melatonin | |
|---|---|---|
| What it is | A prescription hormone | A timing signal that tells your body night has started |
| Hot flashes | Treats them2 | Does not treat them3 |
| Sleep | Improved sleep quality in recently menopausal women4 | Helped people fall asleep about 7 minutes faster on average6 |
| Who decides | Your doctor | You, with your doctor or pharmacist if you take HRT |
The Menopause Society does not recommend supplements or herbal remedies for hot flashes.3 If night sweats are what wake you up, talk to your doctor about treatment for them. Melatonin is a better fit for a body clock that has drifted, such as falling asleep later and later, or a bedtime that changes every night.
What about progesterone at bedtime?
Many women on HRT also take progesterone. Oral progesterone can cause drowsiness and dizziness, which is why it is usually taken at bedtime.7
If you add melatonin on top, the drowsiness can add up. That is not always a problem at bedtime, but ask your doctor whether to take them at the same time, and do not drive if you feel drowsy.7
What I tell women on HRT
"I tell them it is very important to speak to their family doctor, gynecologist, or a menopause specialist before adding anything to their HRT. Their pharmacist can check too. If their doctor says melatonin is fine, I suggest starting low, like 1 mg, at the same time every night, instead of the 5 mg or 10 mg most people grab off the shelf."
Tyler Smith, RN
Questions to ask your doctor or pharmacist
Bring your HRT and your melatonin to the appointment, or take a photo of both labels. Then ask:
- Is melatonin safe with my HRT? Say which kind you use: a pill, a patch, a gel, or a spray.
- What dose should I start with? Ask if a low dose, like 1 mg, makes sense for you.
- Can I take it with my progesterone? Ask if they should be taken at the same time.
- What about my other medicines? Mention blood thinners, blood pressure or diabetes medicine, and sleeping pills.5
- What if my sleep does not improve? Ask what to look at next, such as night sweats or sleep apnea.
A routine matters as much as the dose
"HRT and melatonin do different jobs. Melatonin is not a sedative. It is a timing signal that tells your body night has started. I tell women to keep a regular routine and a regular bedtime. No electronics at night. Put the phone away, with no blue light and no TV. Try to relax, and remember that everyone is different."
Tyler Smith, RN
If you wake in the middle of the night, a second dose is not the answer. Read why you keep waking up at 3am. If you are also on a GLP-1, read GLP-1s in perimenopause and menopause.
Where Driffly fits
A low dose, if your doctor says yes
I chose 1 mg of melatonin for Driffly because it is a low dose, much closer to what your body makes than the 5 mg and 10 mg on most shelves. For women on HRT, that matters even more, since estrogen may raise melatonin levels.1
Each strip also has valerian root 50 mg, lavender 20 mg, chamomile 10 mg, and hibiscus 10 mg. Valerian can add to drowsiness with other sleep aids, so show your doctor the full label.8 Read more about valerian root.*
- 1 mg of melatonin in each strip.
- Melts on your tongue. No water and no sugar.
- Take it 30 minutes before bed, at the same time every night.
Every order comes with a 30 night money back guarantee.
Common questions about melatonin and HRT
Can you take melatonin with HRT?
Many women do, but ask your doctor or pharmacist first. Estrogen may raise melatonin levels, so a low dose is a safer place to start.1
Does estrogen increase melatonin?
It may. Estrogen can raise the amount of melatonin in your blood, which can mean more drowsiness, headache, or dizziness.1
Can I take melatonin with progesterone?
Ask your doctor. Oral progesterone can make you drowsy and is usually taken at bedtime, so the effects may add up.7
Does melatonin help with hot flashes?
No. Melatonin is a timing signal for sleep. The Menopause Society does not recommend supplements for hot flashes.3 Talk to your doctor about treatment for hot flashes and night sweats.
Can I take melatonin with birth control?
Birth control pills can raise melatonin levels and drowsiness.5 Ask your doctor or pharmacist before you combine them.
Does HRT help you sleep?
It can. In recently menopausal women, low dose hormone therapy improved sleep quality more than a placebo, along with fewer hot flashes and night sweats.4 Whether HRT is right for you is a decision for you and your doctor.
What dose of melatonin is best with HRT?
There is no official dose. Many women start low, around 1 mg, taken 30 minutes before bed. Your doctor can tell you what is right for you. Read is 1 mg of melatonin enough.
Sources
- Drugs.com. Drug interactions between conjugated estrogens and melatonin. Interaction checker, moderate interaction.
- The North American Menopause Society. The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29(7):767-794.
- The North American Menopause Society. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590.
- Mayo Clinic News Network. Study finds hormone therapy improves sleep quality for recently menopausal women (Kronos Early Estrogen Prevention Study, published in Menopause). 2017.
- U.S. Pharmacist. Although safe for most, melatonin causes unexpected interactions in others. October 2019.
- Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013;8(5):e63773.
- Drugs.com. Prometrium (progesterone): uses, dosage, side effects.
- MedlinePlus. Valerian. US National Library of Medicine.
Tyler Smith, RN, BSN, BA is a registered nurse and the founder of Driffly. He writes and reviews the articles in the sleep education hub. About Tyler
The author is the founder of Driffly, which sells the product mentioned in this article. This article is for education and is not medical advice. *These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.