Perimenopause Cramps: OB/GYN Explains Causes of Abdominal Pain and Best Practices for Relief

Cramps are irritating enough, and they can get even worse depending on your life stage. For example, many women report cramping during perimenopause, both during menstruation for those still getting periods and at other times. We reached out to our experts to find out why perimenopause cramps can be so severe and how to find relief. 

Why do perimenopause cramps occur?

To understand the cause of perimenopause cramps, it’s important to have a grasp on the transition itself. The National Institute on Aging describes perimenopause as the years leading up to menopause, which generally occurs 12 months after a woman's last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes or a variety of other potential symptoms, are called the menopausal transition or perimenopause.

“People who have never experienced cramping may now experience cramping during [perimenopause],” explains Rajita G. Patil, MD, Obstetrician-gynecologist, Director - Comprehensive Menopause Care Program at UCLA Health. “Others just have it worse. This is all because of fluctuating hormone levels that occur during the transition to menopause. The periods during perimenopause become unpredictable in timing and they may come earlier or later and eventually, period cycles can be skipped.” 

The normal fluctuation of estrogen and progesterone does not occur anymore once the body is in perimenopause, she says, so the estrogen levels in the body are at times higher than what would be normally present during a natural cycle during reproductive years. This causes the body to release more prostaglandins which cause more contractions of the uterus, which lead to more cramping. 

How to treat perimenopause cramps

There are a few different options for relieving cramp pains including over-the-counter products, birth control and natural remedies. 

Pharmaceuticals 

“Some of the best treatment options are nonsteroidal anti-inflammatory medications (NSAIDS) like ibuprofen which can really help with cramping pain,” offers Dr. Patil. “You want to use them right when you start having the cramps and not when they are already very severe to help stay in front of the pain and not behind it.”

Hormonal birth control can also help regulate the cycle and keep the estrogen levels in check to minimize cramping, she adds. Hormonal birth control also limits the amount of uterine lining that is built up each month that needs to be shed with the period, which in turn helps to minimize the number of uterine contractions that are needed to shed the lining which decreases cramps. 

“A hormonal intrauterine device (IUD) can especially help control the pain by limiting the local estrogen effect in the uterus,” offers Dr. Patil. “It is less systemic in nature than most of the other hormonal birth control methods like the patch, pills and vaginal ring.”

Diet and exercise 

Another non-pharmacologic treatment that helps reduce pain is moderate intensity exercise as it helps to divert blood flow to the brain and help release endorphins, she notes. This can help decrease the perception of pain from the cramping.

Additionally, applying heating pads to your lower abdomen may help soothe some of the pain, and mind-body relaxation techniques can be an effective coping strategy. These practices can help manage stress levels, and one study published in the journal Occupational & Environmental Medicine found that period pain was twice as common in women who were stressed out than in women with low stress. 

Avoiding caffeine and spicy or greasy foods can help prevent additional lower abdominal discomfort during uterine cramps as well, Dr. Patil says, as these foods may irritate the bowels.

Should you see a doctor for perimenopause cramps?

Cramping during perimenopause is not always exclusively caused by hormone levels, so at a certain point, you’ll want to see your doctor to rule out more serious medical conditions. 

“You should see a doctor if the pain is not well controlled with lifestyle measures described above or use of NSAIDS and/or if you feel the pain is not controlled enough for you to go about with your normal day,” says Dr. Patil. “It would be important to further discuss what treatment may better relieve your symptoms. Also, because cramps are not always because of perimenopause and changes in the hormone levels, it is also important to seek help if pain is worsening and/or associated with any abnormal bleeding outside of your period cycles.”

More tips for managing menopause:

What Is Menopause Flooding? Doctors Share Symptoms and Ways to Prevent It

These 8 Natural Remedies for Hot Flashes Help You Beat the Heat

What Is Natural Hormone Replacement Therapy? Doctors Weigh in on Treatment

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.