During the climacterium, which covers the menopausal transition through to postmenopause, women experience vasomotor symptoms (hot flashes and sweating) and sleep disturbances. Hormone therapy is generally acknowledged as the most effective therapy for reducing climacteric vasomotor symptoms and related secondary insomnia. This review describes the effects on sleep of the gradual cessation of hormonal secretion, specifically estrogen and progesterone, by the ovaries and evaluates different treatment options. Aging is briefly discussed with a focus on menopausal transition and related changes in biological functions.