Just as you settle into bed, an uncomfortable, hard-to-describe urge to move your legs sets in — a crawling, tingling, or restless sensation that eases only when you shift or stretch, then returns the moment you go still. For a meaningful number of women, this experience, known as restless legs syndrome (RLS), emerges or worsens during pregnancy, and it has a particular knack for interfering with the transition into sleep.
For women navigating pregnancy after 35, sleep is often already a topic of interest, and restless legs can add another layer to nighttime rest. Understanding why RLS occurs in pregnancy, its connection to factors like iron, and the approaches that may help can make the experience feel more manageable and less isolating.
This article covers what research shows about restless legs in pregnancy, how it affects sleep, and when the symptoms are worth discussing with a healthcare provider.
What Research Shows About Restless Legs in Pregnancy
Restless legs syndrome is a neurological condition characterized by an uncomfortable urge to move the legs, typically worse in the evening and at rest. According to the National Institute of Neurological Disorders and Stroke, RLS is more common in women and is frequently reported during pregnancy, with many studies estimating that a substantial share of pregnant women experience symptoms, often peaking in the third trimester and easing after delivery.
The reasons pregnancy raises RLS risk are not fully understood, but researchers point to several contributing factors: hormonal changes, particularly rising estrogen; shifts in iron and folate status; and possibly changes in dopamine signaling, the brain chemical involved in RLS. The tendency for symptoms to resolve after birth supports the idea that pregnancy-specific physiology is central.
The Iron Connection
One of the more consistent threads in RLS research is a link with iron status. Low iron stores, even without full anemia, have been associated with RLS in both pregnant and non-pregnant people, likely because iron is involved in dopamine production in the brain.
Why this matters in pregnancy after 35
Iron demands rise substantially during pregnancy, and iron deficiency is common. Because of the iron-RLS connection, providers sometimes check iron levels — including ferritin, a marker of iron stores — when RLS symptoms appear. This is a conversation to have with your provider rather than a prompt to self-supplement, since taking iron without knowing your levels is not advisable. Our article on iron deficiency in pregnancy after 35 explores ferritin, fatigue, and related prenatal questions in more depth.
Folate and other factors
Some research has also examined folate status in relation to RLS during pregnancy, which is one of many reasons prenatal nutrition receives attention in these years. As always, individual circumstances vary, and testing provides clarity that guesswork cannot.
How Restless Legs Disrupts Sleep
Because RLS symptoms intensify in the evening and at rest, they strike precisely when the body is trying to wind down. This can make falling asleep frustratingly difficult and can also cause awakenings if symptoms return during the night. Over time, the resulting sleep loss can contribute to daytime fatigue — already common in pregnancy — and affect mood and concentration.
The relationship between pregnancy, hormones, and sleep is layered, and RLS is one piece of a larger picture. For broader context on how rest shifts during these years, our guide to how stress hormones affect sleep after 35 offers additional perspective on why nights can feel more fragmented in this stage of life. Recognizing that several factors — hormonal, nutritional, and neurological — can overlap often helps women approach the problem with patience rather than frustration.
Approaches Many Women Find Helpful
Management of RLS in pregnancy tends to emphasize non-medication approaches first, given the importance of caution with medications during pregnancy. Several strategies are commonly discussed.
Movement and comfort measures
Gentle activity earlier in the day, stretching, walking, warm or cool compresses, and massage are frequently mentioned as measures some women find soothing. Establishing a calming pre-sleep routine may also help, since stress and fatigue can worsen symptoms.
Some women also experiment with the timing of activity and rest, noticing that certain patterns ease symptoms more than others. Because RLS is so individual, keeping a brief nightly note of what preceded better or worse nights can reveal personal patterns over a couple of weeks. This kind of gentle self-observation, shared with a provider, often makes appointments more productive and helps tailor suggestions to your particular experience rather than relying on general advice alone.
Addressing underlying factors
When iron deficiency is identified through testing, treating it under a provider’s guidance may improve symptoms for some women. Reducing evening triggers that some people find aggravate RLS — such as caffeine late in the day — is another low-risk step. Importantly, some medications used for RLS outside of pregnancy are not recommended during pregnancy, which is why provider guidance is essential rather than optional.
When to Talk With a Healthcare Provider
It is worth raising restless legs symptoms at a prenatal visit, especially if they are disrupting your sleep or quality of life. A provider can check iron and other relevant markers, discuss safe approaches, and rule out other causes. Symptoms that are severe, that involve significant pain rather than the classic urge-to-move sensation, or that are accompanied by swelling or other concerning signs should be reported promptly, as they may point to something other than typical RLS. As with all aspects of pregnancy after 35, ongoing collaboration with your care team is the safest foundation.
Frequently Asked Questions
Why do restless legs get worse in pregnancy?
Researchers point to hormonal changes, shifts in iron and folate status, and possible changes in dopamine signaling. Symptoms often peak in the third trimester and commonly ease after delivery, which suggests pregnancy-specific physiology is involved.
Is restless legs related to iron deficiency?
Low iron stores have been associated with RLS, likely because iron is involved in dopamine production. Providers sometimes check iron levels, including ferritin, when symptoms appear, but testing should guide any supplementation rather than self-treatment.
Will restless legs go away after birth?
For many women, pregnancy-related RLS improves or resolves after delivery. If symptoms persist beyond pregnancy, it is worth discussing with a healthcare provider, as ongoing RLS may warrant further evaluation.
What can I do about restless legs at night?
Non-medication approaches such as gentle daytime activity, stretching, warm or cool compresses, and reducing evening triggers are commonly suggested. Because some RLS medications are not recommended in pregnancy, any treatment should be guided by your provider.
Key Takeaways
- Restless legs syndrome is common in pregnancy, often peaking in the third trimester and easing after birth.
- Hormonal changes, iron and folate status, and dopamine signaling are among the suspected contributors.
- Low iron stores are linked with RLS, so providers may check ferritin — but testing should guide supplementation.
- Non-medication approaches are generally emphasized first, since some RLS medications are not advised in pregnancy.
- Report severe, painful, or unusual symptoms to your provider, who can evaluate and recommend safe options.
Medical Disclaimer
This content is for informational purposes only and does not constitute medical advice. Individual health situations vary significantly. Always consult a qualified healthcare provider before making decisions related to your health, fertility, or pregnancy.
About the Author
Emily Carter is a women’s health writer focused on fertility, pregnancy after 35, and sleep changes in midlife. She writes research-informed, non-alarmist content to help women navigate reproductive and hormonal transitions with clarity and confidence.