What You Need to Know About Menopause Cramps

Perimenopause is the transitional period a person goes through prior to reaching menopause (when a person’s menstrual cycle has stopped for a period of 12 months). During perimenopause, the female sex hormone estrogen often rises before falling dramatically as a person gets closer to menopause.

Typically, perimenopause begins around age 45 and can last between two and 10 years. Many people experience a variety of different symptoms during this transitional period, one of which is cramping.

This article discusses the various causes of perimenopause and menopause cramps and how they can be treated.

Perimenopause and Cramping

When cramping occurs during perimenopause, it's due to changing hormone levels. Prior to the transitional period, the body uses the glands known as prostaglandins to contract the uterus to help shed the uterine lining.

During perimenopause, more prostaglandins are produced as a result of higher levels of estrogen. Cramps tend to be worse with higher levels of prostaglandins.

Ovarian Cysts

Ovarian cysts are another reason why someone going through perimenopause would experience cramping.

Ovarian cysts are sacs filled with fluid attached to the ovaries or inside the ovaries. While ovarian cysts are common and can go unnoticed, in some cases, they cause cramping that may become severe.

If you have an ovarian cyst, you will likely feel other sensations along with cramping, such as bloating and pressure within the abdomen. You could also notice that your abdomen is swollen.

Ovarian cyst pain can be both sharp or dull and is often sporadic. If a cyst ruptures, you will experience a quick onslaught of severe pain in the low abdomen.

When to See a Healthcare Provider

You should see your healthcare provider for an ovarian cyst if it is causing pain or any other symptoms. If a cyst is present, your healthcare provider may also want to keep an eye on it to see if it gets bigger or smaller following your next menstrual cycle.

In some rarer cases, cysts may be surgically removed to help ease symptoms.

If a rupture occurs, it can cause excessive bleeding that may constitute a medical emergency. Symptoms that warrant a trip to your healthcare provider include:

• Pain that is accompanied by either vomiting or a fever
• Pain that comes on suddenly and is severe
• Feeling faint, dizzy, or weak
• Breathing rapidly

Treating Perimenopausal Cramps

There are ways to treat perimenopausal cramps that don’t involve any extensive treatment plans or trips to your healthcare provider, including over-the-counter medication and home remedies.

Home Remedies and Lifestyle 

Since higher estrogen levels during perimenopause may lead to more cramping, you can try to eat a diet that lowers estrogen levels naturally. Certain types of foods can raise natural estrogen levels and should be avoided. These include:

• Alcohol
• Red meat
• High-fat foods
• Dairy products

Foods that may help balance estrogen levels in the body include:

• Flaxseed
• Green tea
• Pomegranate
• Soy products, such as tofu
• Whole grains
• Legumes
• Seeds
• Berries
• Cruciferous vegetables 

When cramps strike, using natural pain aids, such as a hot water bottle or heating pad, can offer instant relief.

Studies have also found that implementing a regular exercise routine during the transitional period can help reduce cramping and other symptoms because it can naturally reduce and balance estrogen levels within the body.  

Over-the-Counter (OTC) Therapies

Along with home remedies, over-the-counter pain medications can also help reduce cramps when they come on.

Typically, the best options for pain relief include ibuprofen (Advil and Motrin), acetaminophen (Tylenol and Midol), and naproxen (Aleve).

You can discuss which option is the best for you with your healthcare provider.

Menopause and Cramping

Cramping can occur during menopause as well, but for different reasons than with perimenopause.

Fibroids

Fibroids are masses of tissue and muscle cells that grow within the uterus.

The masses are typically associated with higher levels of estrogen, so it is rare that they develop after a person has reached menopause. When they do, however, they can cause symptoms including cramping and abdominal pain.

Endometriosis

Endometriosis is a uterine disorder that develops when the endometrium (the tissue that lines the uterus) grows where it’s not supposed to. The lining begins to grow in areas outside the uterus, such as the fallopian tubes, ovaries, and the pelvic lining tissue. The tissue still acts as it would inside the uterus, meaning it gets thick and bleeds.

It was previously thought that endometriosis could only affect those of childbearing age. However, recent research has found that is not the case.

Roughly 2%-5% of postmenopausal people experience endometriosis. When it develops after a person has reached menopause, it is typically associated with hormone replacement therapy that is used to help curb menopausal symptoms.

Endometriosis after menopause presents with symptoms, such as:

• Pelvic pain
• Intestinal distress
• Ovarian cysts

Gastrointestinal Issues

Gastrointestinal issues include any sort of problems that affect the function of the gastrointestinal tract, which includes:

• Mouth
• Throat
• Esophagus
• Stomach
• Small and large intestines
• Rectum
• Anus

Abdominal pain and cramping are trademark symptoms of various gastrointestinal issues.

Estrogen can influence the way the GI tract functions, so when estrogen decreases during menopause, it can cause disruptions that lead to GI issues like cramping.

Treating Cramps After Menopause

Treating postmenopausal cramps depends on what’s causing them.

Fibroids

Fibroids can be treated in a variety of ways, including:

• Medications: Leuprolide acetate can be taken to essentially shrink and eliminate fibroids. It works by hindering the body’s ability to produce high levels of estrogen that essentially fuels the development of new fibroids.
• Hysterectomy: In some cases, a hysterectomy may be required if the fibroids are exceptionally large. A hysterectomy surgery removes the entire uterus, taking the fibroids with it.
• Myolysis: A myolysis procedure involves shrinking the fibroids surgically, using energy sources, lasers, radio frequency, or freezing.
• Embolization: Embolization works by blocking blood flow to the fibroid so it can die. To perform embolization, small particles are placed into the artery that supplies the fibroid with blood so that a clot creates a blockage.
• Hormone therapy: Hormone therapy can help reduce symptoms of fibroid pain due to its effect on the hormones that regulate the menstrual cycle. However, hormone therapy does not cure fibroids.

Endometriosis

Treating endometriosis after menopause typically involves surgical removal of the tissue that has grown outside of the uterus. If a person doesn’t opt for surgery, or the endometrial lining grows back outside the uterus, other treatment options may be explored.

Other ways endometriosis in menopause may be treated include:

• Progesterone therapy to help manage hormones
• Aromatase inhibitors that decrease estrogen levels to stop the overgrowth of the tissue
• Hysterectomy (though rare)

GI Issues

Treating GI issues can be complicated. The main goal of treating postmenopausal GI issues is to restore proper gut health through the use of various interventions.

Some treatments that have been explored for postmenopausal GI issues include:

• A medication known as metformin can alter the composition of the gut bacteria in the hopes of restoring proper gut health
• A fecal-microbiome transplant introduces healthy bacteria into the GI tract to help restore balance 
• Bariatric surgery is designed to reduce overall weight to help reduce symptoms of digestive disease
• Increasing estrogen levels through various avenues to help restore the health of the gut microbiome

When to See a Healthcare Provider

Any abdominal pain after menopause that isn’t associated with a known condition or continues for at least seven days should be investigated by your healthcare provider. While not all abdominal pain or cramping is cause for concern, there could be a condition driving it that requires treatment.

Summary

Cramping during perimenopause and menopause can be both mild or severe depending on what is causing it. Typically in perimenopause, cramping is caused by the hormonal changes your body goes through to prepare you for menopause.

After you have gone through the transitional period, the cramping may ease or stop depending on what was causing it. Cramping after menopause is most likely associated with a treatable condition, such as endometriosis or fibroids. While these conditions are not life-threatening, they can be serious and require more in-depth treatment.

See a healthcare provider for cramping that does not go away, gets worse, or is accompanied by other symptoms, such as a fever.

A Word From Verywell

Experiencing cramps during perimenopause or after menopause can be uncomfortable and painful. In some cases, the pain can be so severe that it disrupts your ability to go on with your regular life. While this cramping may not be serious, it’s important to remember that any pain is your body’s way of telling you something. So don’t ignore cramping during this time unless you already know what’s causing it.