Restless Legs Syndrome (RLS): What It Is, What Causes It, and How to Get Relief

That creeping, crawling sensation in your legs just as you settle into bed, the one that forces you to kick, stretch, or get up and pace, has a name: Restless Legs Syndrome, or RLS. Also known as Willis-Ekbom disease, it is a neurological condition that creates an overwhelming urge to move the legs, usually accompanied by uncomfortable sensations that are difficult to describe and impossible to ignore.

RLS affects an estimated 5 to 10 percent of adults, but it is more common in women than in men, and its prevalence rises during perimenopause and menopause. A study examining RLS across the female life cycle found that women with vasomotor symptoms during the menopausal transition had a higher prevalence of RLS, and nearly 70 percent of those with existing RLS reported worsening symptoms after menopause.

This article explains what RLS is, what causes it, why menopause can make it worse, and what you can do to find relief.

What Is Restless Legs Syndrome?

RLS is a sensorimotor disorder, meaning it involves both abnormal sensations and an uncontrollable movement response. People with RLS describe the feelings in their legs as crawling, pulling, throbbing, itching, or an electric-like tingling. The sensations are not painful in the traditional sense, but they are deeply uncomfortable and create an irresistible urge to move.

Four features define the condition: the urge to move the legs, symptoms that begin or worsen during rest, relief with movement, and a pattern of worsening in the evening and nighttime hours. This last feature is what makes RLS particularly disruptive to sleep. Just as the body is trying to wind down, the legs demand attention.

RLS is often confused with leg cramps, but the two are distinct. Leg cramps involve sudden, painful muscle contractions. RLS involves a persistent, uncomfortable sensation paired with an urge to move. Both can disrupt sleep, but they require different approaches.

What Causes Restless Legs Syndrome?

The primary driver of RLS is a disruption in dopamine signaling in the brain. Dopamine is a neurotransmitter that helps regulate movement, and when its pathways are not functioning properly, the result is the involuntary sensations and movement urges that define RLS.

Research on dopamine and iron in RLS pathophysiology has shown that iron plays a critical role in this process. Iron is a cofactor in dopamine production, meaning the brain needs adequate iron to synthesize dopamine properly. When iron levels in the brain are low, dopamine function suffers, and RLS symptoms emerge or worsen.

Genetics also play a significant part. About half of people with RLS have a family member with the condition, and several genetic variants linked to RLS have been identified. If a parent or sibling has RLS, your risk is substantially higher.

Certain medications can trigger or worsen RLS symptoms. Antihistamines, SSRIs and other antidepressants, anti-nausea medications, and some antipsychotics are known offenders. If your symptoms started or intensified after beginning a new medication, that connection is worth raising with your provider.

How Menopause Worsens RLS

Menopause and RLS intersect in several ways, and the hormonal changes of this transition can turn mild symptoms into nightly disruptions.

Estrogen appears to modulate dopamine pathways in the brain. As estrogen declines during perimenopause, dopamine regulation becomes less stable, lowering the threshold for RLS symptoms to appear. Research exploring why women are prone to RLS points to female hormones as a key factor in the clinical expression of the condition, with hormonal changes rather than absolute hormone levels likely responsible for triggering or worsening symptoms.

Progesterone also has a protective effect on dopaminergic neurons. As progesterone drops during menopause, the nervous system loses some of its natural calming influence, which can amplify the sensorimotor symptoms of RLS.

Iron absorption can decrease with age and hormonal shifts, compounding the dopamine deficiency that underlies RLS. Many women in midlife have borderline iron levels that are considered normal by standard lab ranges but fall below the threshold where RLS symptoms tend to improve. For RLS specifically, sleep specialists often target a ferritin level above 75 mcg/L, which is higher than the general cutoff for iron deficiency.

How RLS Is Diagnosed

There is no single blood test or scan that confirms RLS. Diagnosis is clinical, based on your symptom description and whether your experience matches the four core criteria: an urge to move the legs, worsening at rest, relief with movement, and a pattern of evening or nighttime onset.

A provider will also look to rule out conditions that mimic RLS, including leg cramps, peripheral neuropathy, and venous insufficiency. Blood work typically includes a ferritin level, a complete blood count, kidney function tests, and a thyroid panel. If periodic limb movements during sleep are suspected, a sleep study may be recommended.

For women in perimenopause or menopause, a comprehensive evaluation may also include a hormonal panel alongside iron studies, since the two systems are interconnected and both can contribute to the problem.

Treatment Options That Work

RLS treatment depends on the severity of symptoms and what is driving them. For many women, a combination of lifestyle changes and targeted medical treatment provides meaningful relief.

1. Check and Correct Iron Levels

If your ferritin level is below 75 mcg/L, iron supplementation is the first-line treatment. A comprehensive review of the neurobiology and treatment of RLS confirms that restoring iron levels improves symptoms in a significant number of patients. Oral iron supplements taken with vitamin C on an empty stomach improve absorption. For severe deficiency or poor absorption, intravenous iron infusion may be recommended.

2. Make Targeted Lifestyle Adjustments

Several daily habits can reduce the intensity of RLS symptoms. Moderate exercise earlier in the day helps regulate dopamine and improve sleep quality, but intense late-night workouts can make symptoms worse. Reducing caffeine and alcohol intake, particularly in the afternoon and evening, removes substances that are known to aggravate RLS.

Before bed, gentle leg stretching, massage, or alternating warm and cool compresses can ease discomfort. A structured evening routine, like the D.R.E.A.M. Method™, can help your body transition into a calmer state before sleep, which some people find reduces the onset of RLS symptoms.

3. Understand Medication Options

For moderate to severe RLS, medication may be necessary. The 2025 American Academy of Sleep Medicine clinical practice guideline recommends alpha-2-delta ligands, such as gabapentin enacarbil and pregabalin, as first-line treatment when ferritin levels are already optimal and symptoms still affect your sleep. These medications do not carry a risk of augmentation and can improve both symptoms and sleep quality, which makes them a good fit for patients who also experience pain or anxiety alongside their RLS.

Dopamine agonists like pramipexole and ropinirole are FDA-approved for RLS and were the standard treatment for years, but they have fallen out of favor. Long-term use carries a risk of augmentation, a phenomenon where symptoms gradually worsen, sometimes spreading to the arms or starting earlier in the day.

4. Review Medications That May Be Making It Worse

If you are taking antihistamines, SSRIs, anti-nausea drugs, or other medications known to worsen RLS, a conversation with your prescribing provider about alternatives may lead to noticeable improvement. In some cases, a simple medication switch reduces or eliminates RLS symptoms without needing additional treatment.

Relief Starts With Understanding the Cause

Restless Legs Syndrome is a real neurological condition with well-understood mechanisms, not a quirk of aging or something you need to push through. The connection between iron, dopamine, and hormonal changes explains why so many women first encounter RLS during perimenopause and menopause.

If your legs will not let you rest at night, start by checking your iron levels and making lifestyle adjustments that support better sleep. If symptoms persist, a provider experienced with RLS can guide you toward the right treatment, whether that involves iron supplementation, medication, or addressing a hormonal component.

You do not have to spend another night fighting your own legs for the right to sleep.

This article is for informational purposes only and does not replace professional medical advice. Always consult a qualified healthcare provider for guidance on your individual health needs.