Last updated: October 15, 2025

I had restless leg syndrome with both of my pregnancies before there was even a name for it. Back then, nobody talked about it. Now it's all over TV ads, and I'm experiencing it again during menopause. It's a creepy, jittery feeling and I just can't sit still. If you're dealing with this too, you're not alone—and there are things you can do about it.

Restless legs syndrome (RLS) is more than just an occasional urge to stretch your legs. For many women, it becomes a nightly battle with sleep. This neurological condition creates uncomfortable sensations in the legs—often described as tingling, crawling, pulling, or aching—that improve only when you move them. Unfortunately, menopause can increase the likelihood of experiencing RLS, making it yet another unwelcome midlife companion.

What is Restless Leg Syndrome?

According to the Mayo Clinic, restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a condition that causes a very strong urge to move the legs. The urge to move usually is caused by an uncomfortable feeling in the legs that typically happens in the evening or at night when sitting or lying down.

The chief symptom is an overwhelming urge to move your legs, accompanied by uncomfortable sensations that:

• Begin while resting or sitting for extended periods
• Improve with movement like stretching, walking, or pacing
• Worsen in the evening and at night
• May include nighttime leg twitching or periodic limb movements during sleep

People describe RLS sensations as crawling, creeping, pulling, throbbing, aching, itching, or electric feelings deep within the leg rather than on the skin. These aren't muscle cramps or numbness—they're a compelling, irresistible urge to move.

What Women Are Saying About Restless Legs During Menopause

"I couldn't sit through a movie without my legs going crazy. I'd have to get up and pace in the back of the theater. My husband didn't understand what I was dealing with." — Rachel, age 51

"The creepy-crawly feeling kept me up until 3am. I'd walk around the house, do stretches, anything to make it stop. Then I'd finally fall asleep and my alarm would go off." — Linda, age 49

"I thought I just needed to exercise more. But no amount of yoga or walking during the day helped the nighttime sensations. It wasn't until my doctor explained the hormone connection that it all made sense." — Patricia, age 53

"It started in perimenopause and got worse after my periods stopped. Some nights are better than others, but when it's bad, it's impossible to relax or fall asleep." — Karen, age 50

These experiences highlight how disruptive RLS can be and how many women struggle to understand what's happening to their bodies during the menopausal transition.

What's the Connection Between Restless Legs and Menopause?

Research suggests that hormonal shifts play a key role in the development or worsening of RLS during menopause. According to the RLS Foundation, while we don't fully understand why RLS worsens with menopause, several factors are at play.

Estrogen's Role in Dopamine Regulation

Estrogen and progesterone levels drop during perimenopause and menopause, and these changes may influence dopamine, a brain chemical that helps control muscle movement. The Mayo Clinic notes that researchers suspect RLS may be caused by an imbalance of dopamine in the brain.

Lower dopamine function has been linked to restless legs, and since estrogen helps regulate dopamine production and receptor sensitivity, the decline in estrogen during menopause can disrupt this delicate balance. This connection between estrogen deficiency and neurological function affects multiple systems throughout the body, from sensory perception to movement control.

The Sleep Disruption Cascade

The RLS Foundation points out an important question: does worsening sleep itself lead to worsening RLS symptoms? During menopause, estrogen plays an important role in helping regulate the body's temperature during sleep. When estrogen levels are insufficient, frequent awakening due to hot flashes and night sweats can occur, leading to insomnia symptoms.

This creates a vicious cycle where:

1. Hot flashes and night sweats disrupt sleep
2. Poor sleep quality may worsen RLS symptoms
3. RLS makes it even harder to fall asleep or stay asleep
4. Chronic sleep deprivation worsens overall inflammation in the body
5. Increased inflammation can further affect neurological function

Women experiencing heart palpitations during menopause may also find these symptoms contribute to nighttime awakening and difficulty staying asleep, compounding the RLS experience.

Other Menopausal Risk Factors

In addition, menopause often overlaps with other risk factors for RLS:

Iron Deficiency: Lower iron or ferritin levels, sometimes seen in midlife women, are strongly associated with RLS symptoms. The RLS Foundation emphasizes that ferritin levels should be over 75-100 mcg/L, as lower numbers correlate with worse RLS symptoms.

During perimenopause, irregular menstrual cycles can range from skipped periods to excessive and prolonged bleeding. The latter can lead to anemia and low iron stores in the body, which worsens RLS symptoms. Additionally, inflammation during menopause can affect iron absorption and utilization.

Medications: Some antidepressants, antihistamines, or anti-nausea drugs can trigger or worsen RLS. According to the RLS Foundation, drugs that worsen RLS include sedating antihistamines, most antidepressants, and anti-dizziness drugs.

Other Health Conditions: Menopause is also a time when women may be diagnosed with conditions like diabetes, thyroid disorders, kidney dysfunction, or hypertension—all linked to RLS according to the Mayo Clinic.

Aging and Circadian Rhythm Changes: The RLS Foundation notes that aging can change sleep patterns. Loss of brain cells that helped regulate sleep now causes us to fall asleep earlier and wake up earlier. These physiologic changes in sleep patterns may affect RLS symptoms in aging and menopausal women.

Restless Legs vs Hot Feet: Understanding the Difference

Many women searching for information about nighttime leg discomfort wonder if they're experiencing restless legs or another common menopause symptom: hot feet.

Hot Feet During Perimenopause

Hot feet (also called burning feet syndrome) is a sensation of heat, burning, or tingling in the feet, particularly at night. Unlike RLS, hot feet:

• Cause a burning or overheated sensation rather than a crawling feeling
• Don't necessarily create an irresistible urge to move
• May be relieved by cooling measures like removing blankets or using a fan
• Are often related to peripheral neuropathy or circulation issues

Some women experience both hot feet and restless legs simultaneously, as both can be related to hormonal changes affecting the nervous system. Learn more about the specific causes and treatments for burning feet in menopause.

Key Differences

Restless Leg Syndrome:

• Crawling, creeping, pulling sensations deep in the legs
• Overwhelming urge to move
• Relief with movement
• Worse when sitting or lying still
• Primarily affects the legs (occasionally arms)

Hot Feet:

• Burning, tingling sensation on the surface of the feet
• May not improve with movement
• Relief with cooling measures
• Can occur at any time but often worse at night
• Specifically affects the feet

If you're unsure which condition you're experiencing, keeping a symptom diary can help you track patterns and discuss them with your healthcare provider.

Restless Legs and Other Neurological Symptoms of Menopause

RLS doesn't occur in isolation—it's often part of a broader pattern of neurological symptoms during menopause. Understanding these connections can help you see the bigger picture of how hormonal changes affect your nervous system.

Common Neurological Symptom Clusters

Women with RLS during menopause may also experience:

• Facial twitching or muscle spasms
• Tingling or numbness in extremities
• Phantom smells or heightened smell sensitivity
• Migraines or changes in headache patterns
• Brain fog and memory issues
• Dizziness or vertigo

All of these symptoms share a common thread: they're influenced by declining estrogen levels and the resulting changes in neurotransmitter function, including dopamine, serotonin, and GABA.

The Dopamine Connection

Just as dopamine imbalance contributes to RLS, it also affects other aspects of neurological function. The same hormonal changes that trigger restless legs can contribute to mood changes, movement disorders, and sensory disturbances. This is why addressing the underlying estrogen deficiency through hormone therapy or other interventions can sometimes improve multiple neurological symptoms simultaneously.

How Restless Legs Syndrome Affects Midlife Health

For women in perimenopause and menopause, RLS can have far-reaching effects beyond just nighttime discomfort.

Sleep and Fatigue

RLS makes it harder to fall asleep or stay asleep, leading to chronic fatigue. According to the Mayo Clinic, serious symptoms of RLS can affect quality of life and result in depression. Not being able to sleep may lead to excessive daytime drowsiness, and RLS may even interfere with daytime napping.

Mental Health Impact

The Mayo Clinic notes that many people with RLS find it hard to fall or stay asleep, and serious symptoms can result in depression. Poor sleep worsens mood issues like anxiety, irritability, and depression—symptoms that are already common during menopause.

Quality of Life

RLS can:

• Reduce quality of life by interfering with intimacy, travel, or even just relaxing in the evening
• Make social situations difficult (movies, concerts, long dinners)
• Contribute to the "snowball effect" where poor sleep worsens hot flashes, brain fog, and overall resilience
• Affect work performance due to daytime fatigue and difficulty concentrating

The Inflammation Connection

Chronic sleep disruption from RLS contributes to increased systemic inflammation throughout the body. This inflammation can worsen other menopause symptoms including joint pain, frozen shoulder, and cardiovascular risk factors.

Managing Restless Legs During Menopause

The good news: RLS can often be managed with a combination of lifestyle adjustments, medical evaluation, and (when needed) targeted treatment.

Check Your Iron Levels

According to the RLS Foundation, when ordering tests to check for anemia, be certain to ask for a ferritin level to check iron stores in your body. We want the ferritin value to be over 75-100 mcg/L, as lower numbers correlate with worse RLS symptoms for some individuals.

Iron supplementation: Iron tablets can help build iron stores; IV iron is considered if a rapid response is required or if oral iron therapy is not helpful. Work with your healthcare provider to determine if supplementation is appropriate for you.

Iron-rich foods: Include foods high in iron in your diet, such as:

• Red meat, poultry, and fish
• Dark leafy greens like spinach and kale
• Legumes and beans
• Fortified cereals
• Pumpkin seeds and quinoa

Explore our recipes for menopause support for meal ideas that include iron-rich ingredients and other nutrients that support hormonal balance.

Important note: Inflammation can affect iron absorption and utilization. Understanding the role of estrogen in inflammation can help you take a comprehensive approach to improving iron status.

Sleep Hygiene

The RLS Foundation recommends:

• Go to bed and get out of bed at the same time every 24 hours
• Go outside after awakening so the sun can set your internal clock
• Keep a regular bedtime and limit screens at night
• Avoid caffeine or alcohol in the evening
• Eliminate caffeine entirely if possible
• Consider if other sleep disorders like sleep apnea are adversely impacting sleep

Hydration

Proper hydration is essential for overall health and may help with RLS symptoms. Dehydration can worsen muscle cramping and discomfort. Try our 30-day hydration challenge designed specifically for women in menopause to build consistent hydration habits.

Movement and Exercise

The RLS Foundation recommends exercising a minimum of 150 minutes a week (6,000 steps five times a week). Additionally:

• Light stretching, yoga, or a short walk before bed can reduce symptoms
• Moving during the day may help reduce nighttime symptoms
• Avoid intense exercise close to bedtime

Temperature Therapy

Some women find relief with:

• A warm bath before bed
• Heating pad applied to the legs
• Cold pack applied to the legs
• Alternating warm and cold therapy

Experiment to see what works best for your body.

Track Your Symptoms

Keeping a menopause symptom diary can help you:

• Identify patterns and triggers
• Track which interventions help
• Provide detailed information to your healthcare provider
• Notice connections between RLS and other symptoms like hot flashes or diet

Medical Treatments for Restless Legs During Menopause

Hormone Therapy

While not prescribed specifically for RLS, some women report improvement in sleep and neurological symptoms when using hormone therapy (HT) for menopause. The RLS Foundation notes that for women whose sleep is interrupted by vasomotor symptoms (hot flashes and night sweats):

• Women under 52 may consider estrogen in the form of a low-dose contraceptive pill to stabilize estrogen levels and improve thermoregulation
• Women over 52 experiencing vasomotor symptoms may consider estrogen-progestin or estrogen replacement therapy
• Birth control pills can help regulate irregular menses and prolonged bleeding during perimenopause, thereby maintaining iron stores (ferritin)

By getting a better night's sleep not interrupted by night sweats, RLS symptoms may lessen significantly. Learn more about your options in our HRT 101 Guide.

Important: Any woman who still has her uterus must take a progestin with estrogen to prevent endometrial cancer.

Medications Specifically for RLS

According to the RLS Foundation and Mayo Clinic:

Gabapentin class drugs: Should be considered as first-line treatment before dopamine agonists. Gabapentin is also used by gynecologic providers for vasomotor symptoms, so it may address both hot flashes and RLS.

Dopamine agonists: Medications like Requip or Mirapex may help, but gabapentin class drugs should be tried first.

Low-dose opioids: Sometimes used for moderate-to-severe RLS when other treatments haven't worked.

For vasomotor symptoms: Low-dose antidepressants (paroxetine or venlafaxine) have been shown to reduce hot flashes and night sweats. However, the RLS Foundation notes that antidepressants, even low doses, may worsen RLS for some people.

Clonidine: An older antihypertensive medication known to decrease night sweats, may be used with estrogen or instead of it.

Addressing Underlying Conditions

The RLS Foundation recommends having yearly physical exams and lab work to check function of the kidneys, liver, pancreas, thyroid, and iron stores (ferritin) in the body. Treating conditions like diabetes, thyroid issues, kidney dysfunction, or sleep apnea can reduce RLS symptoms.

Medication Review

Review all your medications with your healthcare provider and pharmacist. According to the RLS Foundation, drugs that can worsen RLS include:

• Sedating antihistamines
• Most antidepressants
• Dopamine antagonists
• Anti-dizziness drugs

New medications may cause sleep disruption and interact with medications prescribed for RLS (either making the effect stronger or weaker).

When Restless Legs Signal Other Health Issues

While RLS during menopause is often related to hormonal changes, it's important to rule out other conditions. According to the Mayo Clinic, RLS sometimes occurs with other conditions such as:

• Peripheral neuropathy: Nerve damage in the hands and feet, sometimes due to diabetes or alcohol use disorder
• Iron deficiency: From bleeding, heavy menstrual periods, or frequent blood donation
• Kidney failure: Can cause iron deficiency and changes in body chemistry
• Spinal cord conditions: Damage or injury to the spinal cord
• Parkinson's disease: People with Parkinson's may have increased risk of RLS

When to Seek Help

Talk with your healthcare provider if:

• RLS is disrupting your sleep or quality of life
• Symptoms are progressively worsening
• You have symptoms of other neurological conditions
• Self-care measures aren't helping
• You suspect medication side effects
• You have risk factors for the conditions listed above

Because symptoms often overlap with other menopause-related issues, many women dismiss or normalize RLS, but effective help is available. Consider working with a menopause specialist who understands the full spectrum of hormonal and neurological symptoms.

What This Means for Your Midlife Health

Restless legs syndrome may not be as widely discussed as hot flashes or mood swings, but it's part of the larger picture of how menopause affects sleep, brain health, and overall wellbeing. By recognizing RLS as a legitimate and treatable condition, women can take proactive steps to reclaim their rest—and their nights.

The connection between RLS and other symptoms like inflammation, neurological changes, and sleep disruption highlights the interconnected nature of menopausal symptoms. Addressing RLS often requires a comprehensive approach that considers hormonal balance, iron status, sleep quality, and overall health.

Remember, you don't have to suffer through restless legs. Whether you experienced it during pregnancy (like I did) or it's a new symptom during menopause, there are evidence-based strategies that can help. Start by tracking your symptoms, checking your iron levels, optimizing your sleep hygiene, and working with a healthcare provider who takes your concerns seriously.

Frequently Asked Questions

Can perimenopause cause restless legs?

Yes, perimenopause can definitely cause or worsen restless legs syndrome. During perimenopause, fluctuating estrogen and progesterone levels affect dopamine production and receptor function in the brain. Since dopamine helps control muscle movement, hormonal imbalances can trigger the uncomfortable sensations and urge to move characteristic of RLS. Additionally, perimenopause-related sleep disruption from hot flashes and night sweats can worsen RLS symptoms.

Does menopause make restless leg syndrome worse?

Menopause can worsen existing RLS or trigger it for the first time. The decline in estrogen affects dopamine regulation, iron absorption, sleep quality, and overall nervous system function—all factors that influence RLS severity. Women who had RLS during pregnancy often find it returns or intensifies during the menopausal transition due to similar hormonal mechanisms.

What helps restless legs during menopause?

Several strategies can help manage RLS during menopause: checking and correcting iron/ferritin levels (aim for 75-100 mcg/L or higher), improving sleep hygiene, staying hydrated, regular exercise, temperature therapy (warm baths or cold packs), avoiding caffeine and alcohol, and considering hormone therapy to address underlying estrogen deficiency. For persistent symptoms, medications like gabapentin or dopamine agonists may be prescribed.

Is restless leg syndrome related to estrogen?

Yes, RLS is related to estrogen. Estrogen influences dopamine production and receptor sensitivity in the brain, and dopamine imbalances are strongly linked to RLS. When estrogen levels decline during perimenopause and menopause, it can disrupt dopamine function and trigger or worsen RLS symptoms. This is why RLS commonly occurs during times of hormonal change like pregnancy and menopause.

Can low iron cause restless legs in menopause?

Yes, low iron is one of the strongest risk factors for RLS, and it's particularly common during menopause. Irregular or heavy menstrual bleeding during perimenopause can deplete iron stores. Ferritin levels (which measure iron stores) should be above 75-100 mcg/L for optimal RLS management. Many women experience significant improvement in RLS symptoms once iron deficiency is corrected through supplementation or dietary changes.

Why am I experiencing restless legs during menopause?

Restless legs during menopause occur due to multiple interconnected factors: declining estrogen affects dopamine regulation in the brain; hormonal changes can lead to iron deficiency (especially if you have heavy periods); sleep disruption from hot flashes and night sweats worsens RLS; aging naturally changes sleep patterns and increases RLS risk; and menopause coincides with other health conditions (diabetes, thyroid disorders) that can trigger RLS. For more detailed answers about this and other menopause symptoms, visit our Q&A about menopause.

How long does restless leg syndrome last during menopause?

The duration of RLS during menopause varies among women. For some, symptoms improve once hormone levels stabilize after menopause. For others, RLS may persist or worsen with age. The good news is that with proper management—including iron supplementation, hormone therapy when appropriate, medication, and lifestyle modifications—symptoms can be significantly reduced or eliminated regardless of how long you've been experiencing them.

Symptom Relief

Managing menopause symptoms can feel overwhelming, especially when effective solutions seem hard to find. From unexpected skin changes to frustrating hot flashes, these shifts can impact daily life and overall well-being. Explore our Symptom Relief page to discover products that other women have found helpful in managing their symptoms of perimenopause and menopause.

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Explore More

Want to dive deeper into menopause and its symptoms? Visit our Resources page, where you’ll find a collection of studies, articles, and books from trusted experts. Whether you're looking for the latest research or practical insights, these resources can help you better understand your body and make informed decisions about your menopause journey.

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