Cramping during menopause: How to treat your symptoms

If you’re like many women, for the past decades, you could count on your PMS symptoms like clockwork. A few days before your period, the breast tenderness starts, then the food cravings and moodiness, and then the cramping. But then, suddenly, things got a lot less predictable. While you might have expected your periods would become more irregular during perimenopause (the transition phase between your reproductive years and menopause), it may be surprising to find out that your PMS symptoms would also take that same turn.

Take cramps. Maybe they’re feeling worse, are happening more frequently, or strike at the most random of times. Read on to learn more about cramps during menopause, the many causes, and — importantly — what you can do to find some relief.

What are perimenopause cramps?

As the name implies, these are menstrual cramps — a throbbing ache or pain in your lower abdominal area — that occur during perimenopause, which commonly occurs in your 40s. They are pretty common: Research shows about 58% of perimenopausal women reported abdominal cramping. “Perimenopause is a transitional period,” says Dr. Christine Greves, M.D., a board-certified OB/GYN at Orlando Health Women’s Institute Center for Obstetrics and Gynecology. During this time, levels of the hormones estrogen and progesterone decline — but not in a steady way. Instead, they fluctuate up and down, and these dips and surges trigger menopause symptoms, which can include cramping at surprising times. “The hormonal fluctuations make periods more irregular and the cramping less predictable,” says Greves. “You can have cramps whether you’re bleeding or not.”

What causes cramps during the menopause transition?

When it comes to perimenopause and cramps, several factors are at play, including hormonal changes, gynecological and health conditions, and lifestyle factors.

Hormonal fluctuations

As you near menopause — which is when you haven’t had a period in a full year — your estrogen and progesterone levels start decreasing in an irregular way. And this triggers changes in your menstrual cycle. “You’re in more of a constant state of hormonal fluctuation and [possibly more frequent] bleeding, which could cause some increase in cramping symptoms,” says Dr. Taraneh Shirazian, M.D., a practicing gynecologist in New York City. This is because surges in estrogen trigger the production of prostaglandins, which are hormones that cause uterine cramping.

Those fluctuations in estrogen also create less consistency in your cycle. One month it’s short, the next it’s long, some months you bleed for many days, sometimes just a couple, other months you might skip your period completely. This causes another problem: “With less cycle predictability, women feel less in control of their bodies,” Shirazian says. “So there’s a heightened sense of cramping.”

Preexisting gynecological conditions

Several gynecological conditions can cause abdominal pain or cramping during menopause, including:

• Uterine fibroids: These benign tumors grow in and/or around the uterus, contributing to heavy, painful periods. “The bleeding from fibroids tends to worsen in perimenopause because of hormonal fluctuations,” says Shirazian, noting that it then improves after menopause.

• Endometriosis: In this disease, uterine lining-like cells grow outside of the uterus, triggering severe pain during your period, during/after sex, or when using the bathroom. Shirazian points out that cramping due to endometriosis improves after menopause.

• Uterine polyps: These are uterine growths that are usually benign, though some may be precancerous. Most likely to occur during the menopause transition, they can cause irregular, heavy periods, bleeding in between periods, and bleeding after menopause. Sometimes, these can cause a dull aching in your abdomen.

• Interstitial cystitis: Also called painful bladder syndrome, interstitial cystitis is a chronic condition that can cause pelvic pain, urinary urgency and frequency, as well as pain while using the bathroom and during sex.

• Adenomyosis: This is a condition where endometrial tissue (the tissue lining the uterus) grows into the uterus, causing heavy, prolonged periods, “knife-like” cramping during your period, chronic pelvic pain, and pain during intercourse. It usually goes away after menopause.

Lifestyle and environmental factors

When it comes to perimenopause and cramps, lifestyle factors are also impactful. Having a higher BMI is a risk factor for painful periods, as is smoking and drinking alcohol during your period. In addition, being more sedentary has been associated with more frequent and severe menstrual symptoms, including painful cramps. And for women going through the menopausal transition, anxiety is associated with more severe abdominal pain, according to research.

Other underlying health conditions

Gastrointestinal conditions, notably irritable bowel syndrome (IBS), can cause abdominal pain and cramping. When you have IBS, your bowels don’t work correctly, and people have abdominal pain, bloating, and diarrhea and/or constipation. In general, IBS symptoms have been found to get worse during menstruation. Having uncontrolled Crohn's disease (one type of inflammatory bowel disease) can also cause pain during menstruation.

How to treat menopause cramps

Doctors recommend treating cramping during perimenopause the same way as you would menstrual cramps that occurred in your earlier years, says Greves. Here’s what you can do:

Dietary changes

Certain eating patterns are associated with more painful menstruation, so tweaking your diet can make a difference. Reducing how much added sugar you consume, increasing your protein intake, and consuming an overall balanced diet rich in vitamins and minerals is a good idea. What’s more, many people gain weight throughout perimenopause, which is linked to more painful periods. Reaching a healthy weight through a weight-loss program like WeightWatchers, which involves a healthy diet and exercise, may help.

Medical treatments

Using over-the-counter pain relievers like ibuprofen (Motrin, Aleve, Advil) can bring down cramp intensity and severity. Taking a combined oral contraceptive (which contains both estrogen and progestin) may also help both prevent pregnancy in perimenopause (still a risk!) and improve menstrual symptoms.

In addition, talk to your healthcare provider about hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT). These treatments are usually a combination of estrogen and progesterone. And while estrogen is what improves many classic menopause symptoms like hot flashes, the cramping benefits from the progesterone since that’s what stabilizes the uterine lining. “Progesterone helps a lot in perimenopause, especially if you have other gynecological diseases, including endometriosis and adenomyosis,” says Shirazian.

Non-medical treatments

Along with heating pads or a warm soothing bath, relaxation techniques also tend to be really effective for cramping, says Greves, as they can help release tight uterine muscles. You could try breathing exercises, gentle yoga, progressive muscle relaxation, or self-massage. And while it may be one of the last things you want to do right now, getting up and moving can help tremendously. “Exercise can help a lot of people with pain because it produces endorphins in our body, which help reduce pain,” says Greves.

When to see a doctor for menopause cramps

If there’s been a change in the frequency or severity of cramping or abdominal pain in perimenopause (or any time of life, really) or the discomfort is persistent or affecting your life or daily activities, Greves recommends talking to your doctor. In addition, if you are post-menopause and experiencing pelvic pain, it may be due to an underlying condition (such as those mentioned above), and you should contact your doctor.

“Your doctor may want to do an evaluation to make sure there’s not something else going on,” Greves says, noting that abdominal pain can stem from various organs and tissues like your ovaries, bladder, or bowel. “These may be perimenopause cramps, or it may be due to another health issue. We can do an exam and help tailor the conversation to try to figure out what’s going on. You’re not meant to process these questions alone.”

If you’re looking for professional support, clinicians at WeightWatchers Clinic for Menopause have been specially trained on treating menopause-related symptoms and can prescribe medications like MHT if appropriate.

The bottom line

Although you may be ready for period symptoms like cramping to end with menopause, cramps during perimenopause are common. Often, that’s due to the fluctuations in hormones, particularly estrogen, during the years leading up to menopause. This can cause changes and irregularity in period symptoms. Still, you don’t have to accept it. Treatment options, including medications and lifestyle changes, can make a big difference. And don’t hesitate to bring it up to your provider. “I tell women they should see their doctor if they’re not feeling like themselves during menopause,” says Shirazian. “I’m sure there is something we can do about it.”