What Actually Works Best for Menopausal Insomnia?

Chronic insomnia is highly prevalent through the menopause transition and carries real consequences for thinking, mood and heart health, yet it has been unclear which treatment approach genuinely works best. This 2026 review pooled randomised trials comparing pharmacological treatments against non-pharmacological ones, including cognitive behavioural therapy for insomnia, acupuncture, yoga and massage, specifically in peri- and postmenopausal women. Across the evidence, the non-pharmacological approaches, particularly those that calm an overactive stress response, emerged as the more robust first-line options compared with medication. The authors are candid that the number of qualifying trials was small and the studies varied considerably in design, which is exactly why they call for larger trials using objective sleep measurement rather than relying only on what people report. For a woman lying awake through night sweats and racing thoughts, it offers a reasonable, evidence-informed starting point: therapy and calming, body-based approaches before reaching for a pill, while acknowledging the research behind that advice is still thinner than it should be.