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Restless legs syndrome is more common in women and can worsen around menopause. Learn the causes, why iron matters, and which treatments and self-help work.
Restless legs syndrome causes an uncomfortable urge to move your legs, usually in the evening or at night, that eases when you move. It’s almost twice as common in women as in men, and menopause may make it more frequent and severe. Low iron is a treatable contributor, and checking iron, avoiding triggers and medicines can help.
Many people also have jerking leg movements during sleep, which a bed partner may notice.
A 2020 review asking why women are prone to restless legs made several points:
Iron deficiency in specific parts of the brain has been shown in restless legs. Before menopause, women’s iron stores are lower than men’s because of monthly blood loss. Heavy periods in perimenopause can make this worse.
You can have low iron stores (ferritin) without being anemic. The American Academy of Sleep Medicine’s 2024 guideline suggests iron supplementation in adults with restless legs if ferritin is 75 ng/mL or below, or transferrin saturation is below 20%. That’s a higher threshold than for the general population. Iron should only be taken on medical advice, as too much can be harmful.
| Factor | Notes |
|---|---|
| Caffeine, alcohol, nicotine | Common triggers; cutting back often helps |
| Some medicines | Some antidepressants (especially serotonergic ones), sedating antihistamines, some anti-sickness and antipsychotic medicines |
| Untreated sleep apnea | Can worsen symptoms |
| Kidney disease | Restless legs is very common in people on dialysis |
| Diabetes and nerve damage | Can cause similar sensations |
| Pregnancy | A high-risk time |
| Family history | Restless legs often runs in families |
Leg cramps, nerve problems, arthritis and circulation problems can feel similar. See muscle aches and perimenopause or something else.
Restless legs is diagnosed from your symptoms. A clinician will ask about the sensations, timing and relief with movement, and about sleep, medicines, alcohol and caffeine, periods and family history. The AASM guideline advises that people with significant restless legs have iron studies, including ferritin and transferrin saturation, ideally in the morning. Other tests, such as kidney function and blood sugar, may be suggested.
The AASM guideline says the first step is addressing aggravating factors:
If iron stores are low, oral or intravenous iron can reduce symptoms. Your clinician will decide which is appropriate based on your blood tests.
Night sweats and restless legs can both disrupt sleep, and poor sleep can make restless legs worse. Treating hot flashes and night sweats may help sleep overall. Low mood is also common with restless legs. See low mood.
| Restless legs | Night-time leg cramps | |
|---|---|---|
| Sensation | Urge to move, with crawling, tingling or aching | Sudden, painful tightening of a muscle |
| Relief | Moving or walking | Stretching the muscle |
| Timing | Evening and night, when resting | Often at night, suddenly |
| Duration | Persists while resting | Seconds to minutes |
Book an appointment if restless legs disturb your sleep, cause daytime tiredness, or affect your quality of life.
See a clinician promptly if you have:
- Symptoms that started after a new medicine
- Leg weakness, numbness or pain that doesn’t ease with movement
- A swollen, red, painful calf. Seek urgent care, as this can signal a blood clot.
- Heavy periods, tiredness and breathlessness, which may suggest iron deficiency anemia
See your first menopause appointment.
Sleep problems · Fatigue · Heavy bleeding · Night sweats · Muscle aches
Research suggests menopause can increase how often and how severely restless legs happens, possibly because of changing estrogen levels.
Only after a blood test. Guidelines suggest iron treatment if ferritin is 75 ng/mL or below, which is higher than the usual threshold for iron deficiency. Too much iron can be harmful.
There isn’t good evidence that HRT treats restless legs. Checking iron and addressing triggers are the first steps.
Restless legs follows a daily rhythm and is typically worse in the evening and at night, especially when you’re resting.
Usually not, but it can be linked to iron deficiency, kidney disease, nerve problems or medicines, so it’s worth checking.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
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