Cramps during menopause: Symptoms, why they happen & treatment options

Cramping in menopausal women

If you have stopped getting your period but are still experiencing menstrual-like cramps, this can be confusing or worrying. While most women experience a dramatic decrease in cramping pain after going through menopause [1], cramping is still very typical during perimenopause. This is the time in the lead up to menopause, which is confirmed after you’ve not had your period for 12 months.

Is it common to experience cramps during menopause?

While cramping is not considered a common symptom post-menopause, it is frequently reported during perimenopause (the transition to menopause) [2]. Even if you are getting your period less and less frequently, it is still normal to experience perimenopausal cramps, with or without menstrual bleeding [3]. Post menopause, cramps are more likely related to other gastrointestinal or gynecological conditions. 

What causes cramps in menopausal women?

Perimenopausal cramps are linked to the hormone prostaglandin, which encourages the uterus to contract during menstruation and childbirth [4]. On the other hand, after reaching menopause, cramps are more likely symptomatic of another health issue. 

Why do menopausal women have cramps?

Cramps during perimenopause are likely menstrual cramps caused by the fluctuating hormones of your cycle. However, they can also be linked to other gynecological issues and impacted by things in your day-to-day routine, like diet, exercise, and stress. It’s important to remember that the pain you experience with abdominal cramps is not something to be ignored or minimized. Make sure to talk to your doctor if you are in pain, and especially if you experience changes or worsening to your cramps.

Hormonal fluctuations

Menstrual cramps, or dysmenorrhea, are understood to be caused predominantly by increased levels of prostaglandins. During your period, levels of estrogen and progesterone decrease while prostaglandin increases, causing the contractions that help the uterus to shed its endometrial lining (period bleeding) [4].

This same process occurs during perimenopause, even though you might be getting your period less frequently. If you are going through perimenopause and think your menstrual cramps might even be getting worse, it can be due to your estrogen levels decreasing during perimenopause [1, 3]. 

Gynecological conditions

Certain gynecological conditions can change how you experience cramps during perimenopause and after menopause. Here are some of the most common: 

• Endometriosis is an inflammatory condition where uterine-like tissue grows outside of the womb [5]. Painful cramps, or abdominal pain, are the most common symptoms. Endometriosis is most commonly a premenopausal condition that improves during perimenopause because of decreasing estrogen levels [6]. Though rarer, it’s possible to develop endometriosis during perimenopause or post menopause. 

• Polycystic Ovarian Syndrome (PCOS) is a chronic disease that affects mostly women aged 15-49. It is thought to be linked to a combination of hormone imbalances (including the overproduction of testosterone in women) and insulin resistance, both of which can become worse due to the hormone imbalances associated with perimenopause [7,8].

• Fibroids or polyps are different types of benign (non-cancerous) growths that can cause cramping or abdominal pain in women. Fibroids are made up of muscle cells and connective tissues and can grow in or on the uterus [9]. Endometrial polyps, on the other hand, contain glands and blood vessels and grow out of the lining of the uterus (endometrium), projecting into the uterine cavity [10]. Depending on their location and size, they can be associated with worsened period pain and abdominal cramps in perimenopausal and postmenopausal women.

If you are diagnosed with any of the above conditions and have questions about how the symptoms of perimenopause may affect you, it’s a good idea to start a conversation with your healthcare provider. 

Lifestyle Factors

There are also parts of your lifestyle that can play a role in how you experience cramping during the menopause transition and after.

• Diet: scientists have examined how certain diets can affect how hormones act in our bodies, finding that in some cases consuming large amounts of sugar and caffeine can worsen menstrual cramps [11,12]. Certain foods can also contribute to inflammation for some, which can affect aches and pains like cramps.  

• Physical activity: both low and high intensity exercise have been shown to help relieve menstrual cramp symptoms in women [13]. Regular exercise can also be used to regulate stress, which can worsen cramps. 

• Stress: while under stress, the body produces excessive estrogen and prostaglandin, which can lead to worse menstrual cramps. At the same time, stress also increases adrenaline, which can stimulate tension in muscles, like in the uterus, restricting blood flow and worsening pain [14]. 

Can perimenopause cause cramps?

You might already be familiar with the most common symptoms of perimenopause, like hot flashes, night sweats, irregular periods, joint pain, and brain fog. But what about cramping? 

During perimenopause, you are still getting your period, even as more and more time might pass between cycles. In addition to frequency, there are other changes, like how long your period lasts, the color of your bleeding, and the intensity of your cramping symptoms. While some might experience cramping alongside their period (as you might before you began perimenopause), it’s also possible during perimenopause to experience cramping without an actual period.

Perimenopausal cramps can sometimes feel worse or more intense than menstrual cramps due to increased levels of prostaglandin, a hormone that increases when estrogen levels change (like during perimenopause).

What do perimenopause cramps feel like?

In most cases, perimenopause cramps will feel similar to menstrual cramps: pain or discomfort that is mainly in your lower belly or pelvis that is experienced in the days just before and during when you expect you would normally get your period. They can be more intense or painful than menstrual cramps but typically respond to treatments like over-the-counter pain medication or heating pads, just like pre-perimenopause menstrual cramps.

However, if the cramps are significantly more painful, last longer, come at unexpected times, or you are also experiencing pain in any other parts of the body, it’s important to contact your healthcare provider. 

If you’re using NC° Perimenopause you can keep track of the frequency and intensity of cramps in the Natural Cycles app. You can also log other lifestyle factors such as exercise, sleep quality or diet trackers to see how these influence your symptoms. 

Menopausal cramps vs. other health conditions

Cramps during perimenopause tend to feel like menstrual cramps, but can be more intense for some women. However, like menstrual cramps, menopausal cramps should respond well to over-the-counter pain medication, heating pads, massage, or light exercise [15].

Cramping can also be the result of gastrointestinal or digestive issues, requiring different treatments. Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are two common conditions that can cause abdominal cramps. These can sometimes develop later in life, influenced by a number of different factors, including hormonal fluctuations, stress, aging, BMI (body mass index), physical activity, and your gut biome [16]. Some studies have suggested that IBS can worsen post menopause [17].

If you are ever concerned about your menopausal cramps, or if you suspect they might be the symptom of another issue, it’s important to contact a healthcare provider. They can diagnose the cause of your cramps and discuss treatment options with you.

When to see a doctor

If cramping or any other symptoms of perimenopause or menopause begins to disrupt your day-to-day life, it’s important to speak with a healthcare professional. They can diagnose the cause of your symptoms, offer advice, and prescribe treatments that can alleviate pain and discomfort. 

After menopause, cramping is much less common. If you are still experiencing abdominal pain, or if the nature of the pain changes after menopause, a doctor can determine the cause and work with you to build a treatment plan that fits your lifestyle. 

Finally, if you experience any bleeding or spotting after you have reached menopause (I.e., after you have gone a full year without experiencing your period), you should always contact your doctor.

Navigate perimenopause with Natural Cycles

The menopausal transition can be complicated and confusing, but you don’t have to do it in the dark. NCº Perimenopause has been developed to help you learn more about what stage of perimenopause you might be in, track irregular periods, monitor patterns in your symptoms, and more.  

The NC° app makes it easy to track symptoms and lifestyle factors, and everything is easily accessed in one downloadable Cycle Report, making it easy to start constructive conversations with your doctor. Click “Start my journey” to find out how Natural Cycles can help you today.