a calendar showing someone's menstrual cycle lining up with days of not sleeping

Hormones, PMS, and Restless Legs Syndrome Severity

I have noticed that premenstrual syndrome (PMS) and my menstrual cycle impact my restless legs syndrome (RLS) severity. My symptoms increase quite a bit, and I need much more medication at that time.

I wondered if it was an estrogen thing since I get hormonally-triggered migraine attacks as well.

No anemia or iron deficiency

Since RLS can be caused by an iron deficiency, that may be a reason for some people to have a higher intensity of RLS during their cycle. That isn’t the reason for me. I have no iron deficiency prior to my cycle or during. I have 99 problems, but that isn’t one of them.

Looking to the research

I found this tiny study that suggested RLS does get more severe in approximately 30 percent of people during their menstrual cycles.1 According to how their study was set up, they found it wasn’t related to iron levels. In the RLS group, the symptoms were increased by 47 percent and to the extent that in at least 1 case, additional medication was required.1

Since mine is a lot worse and I do need more medication, this makes a lot of sense to me. However, this study was way too small to conclude anything. Or even the reason why this is even the case if it was established.

A larger study done in 2008 also showed 29 percent of people with RLS have perceived worsening of their RLS during their menstrual cycles. But it concluded, “Female hormonal changes do not account for the variation in perceived severity in women with RLS during their hormonal milestones and their role in the pathophysiology of RLS is unlikely.”2 So no real hormonal connection was established there.

PMS symptoms, sleep issues, and RLS severity

I wrote an article recently that connected migraine attacks with RLS severity and I do have menstrually-related migraine attacks. So I know my migraine attacks go nuts with my menstrual cycle, and that could be why my RLS is more severe.

I don’t have the best temperature control with PMS during my cycle. And for someone who already has a whole lot of trouble getting to sleep and staying asleep, any issue with temperature control can really mess that up. So I wake up a whole lot more because I am uncomfortable and hot. When I am uncomfortable in bed, especially due to temperature, my RLS is always aggravated.

Fact is, like many women, my cycle just makes sleep worse. It is very common for women to have temporary sleeping issues at this time. So my existing insomnia is just worse with PMS and my cycle. And anything that makes my quality or quantity of sleep worse makes my RLS worse. If I were to guess, I would say this is the most likely answer to why my RLS gets worse during this time.

Doing my best to manage PMS symptoms

The symptoms I am experiencing, like lack of temperature control, contribute to my insomnia and frequent waking. My sleep quality and quantity is worse at that time, which is common. And anything that impacts my sleep worsens my RLS.

My solution, you ask? Well, I’m cranking my air-conditioner. I turned up the fan in my room. I may be creating a polar bear habitat accidentally. It is way better to snuggle into my blankets than wake up hot several times. And I need to be cool to sleep.

I stick to my sleep routine every night as well. Finally, I just have to manage the comorbid migraine attacks the best I can at that time, or sleep really suffers.

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