Perimenopause cramps: Why do they happen, and how can you ease them?

If you get periods, you may well know what period cramps feel like. More than half of us experience menstrual pain — medically known as dysmenorrhea — for a few days every month, and cramping is considered to be a normal part of your monthly cycle. 

That said, period-related aches and pains are different for everyone. Some people remain happily pain-free, while others experience cramping of different intensities throughout the month. But for up to 15% of us, cramping is so severe that it gets in the way of everyday life. 

Wherever you sit on the scale, it can be worrying — not to mention uncomfortable — if cramping suddenly ramps up or strikes at unexpected times. But if you’re anywhere between your late 30s and your 50s, there could be another reason behind painful cramps, especially if you’ve got them alongside other symptoms like irregular periods, hot flashes, and brain fog. There’s a chance it could be a sign that your hormones are changing, signaling the start of your journey toward menopause, known as perimenopause. 

Here, Dr. Angela Jones, obstetrician, gynecologist, and attending physician, Jersey Shore University Medical Center, New Jersey, US, shares everything you need to know about cramps during perimenopause. But if you have any questions or concerns about period pain or other pain, or if cramping has started to interfere with your quality of life, reach out to your doctor for advice.

Key takeaways

• More than half of us experience some degree of period pain every month, known as dysmenorrhea.
• Irregular periods are the main sign of perimenopause, but it can cause other symptoms too.
• Changing hormone levels are thought to be the biggest cause of painful cramping during perimenopause.
• Taking over-the-counter pain relief and trying relaxation techniques, including gentle exercise, heat therapy, and meditation, can help to relieve painful cramps.   

If cramping or any other perimenopause symptom is disrupting your life, remember you have options. Treatments are available, so chat with your doctor to figure out what could be right for you.

Why do cramps happen?

When you get your period, your uterus contracts to shed its lining, which is why you bleed. Some people have painful cramps as a result, says Dr. Jones. “Prostaglandins are chemicals produced by the uterus that cause [its] muscles to tighten and relax,” she explains. 

During perimenopause, changes to your hormones can also lead to cramping. And if your periods are already pretty painful, it can make it worse. But while the type of pain is similar, the mechanics of cramping during perimenopause are slightly different. 

You’ve probably heard of the term menopause before, but if you’re not clear on what perimenopause is, we’ll explain. They’re actually two separate things. Perimenopause is the years leading up to menopause (your final period). But perimenopause also extends to one year after your last period because that’s when you’ll know for certain that your cycles have stopped. 

Perimenopause can start anywhere between your late 30s and 50s, but it most often happens in your 40s. It can take between four and eight years before your periods stop altogether — everyone’s different — but on average, perimenopause lasts about four years.

When you haven’t had a period for 12 months, you’re classed as having gone through menopause (this part usually happens between the ages of 45 and 55). From then on, you are postmenopausal.

You might be more familiar with some of the signs of perimenopause, such as hot flashes, night sweats, and mood swings. Like these, cramping in the run-up to menopause can generally be due to your hormone levels changing. “Increases in estrogen levels that may [happen] during perimenopause can cause an increase in the levels of prostaglandins released by your body,” explains Dr. Jones. And as we now know, that can cause contractions in the uterus, which can feel crampy.

Your cramps might get worse during perimenopause for other reasons, too, says Dr. Jones. “[Certain] conditions, such as endometriosis, adenomyosis, and fibroids, can also cause cramps to be more intense.” 

If it’s something that keeps bugging you, it’s a good idea to find out the cause of your cramping — whether it’s perimenopause or anything else. A good first step to take is to schedule an appointment with your doctor, and they can look into what’s causing your pain.

What can help soothe cramps during perimenopause?

If you’re finding cramps or any other perimenopause symptoms tricky to deal with, don’t assume you have to put up with them. In fact, there are a number of options that may help. 

Similar to menstrual cramps, treatment for perimenopause-related cramping involves a combination of changes to lifestyle habits and diet, and in some cases, your doctor may prescribe medications to help with symptoms.

Tips for managing cramps at home 

• Get moving: If you’re able to, gentle exercises such as aerobics, cycling, or walking can help with cramps. “[It] is a good way to decrease pain as it increases blood circulation and releases endorphins, the feel-good chemicals that are natural pain relievers,” says Dr. Jones. 
• Try heat therapy: Warming the area can be an effective way to treat period pain, so it might help with perimenopause cramping, too. “Heat via a hot-water bottle or heating pad will help with cramps. A warm bath or shower will help as well,” Dr. Jones suggests. 
• Have a massage: To help ease the pain, ask a friend or family member to give you a rub, or you could try going to a professional. “Massage of the lower abdomen/back will help,” says Dr. Jones.
• Take over-the-counter pain relief: Using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may work better than other over-the-counter options like acetaminophen (paracetamol). “Medications such as NSAIDs help decrease prostaglandin production, which can contribute to cramping,” says Dr. Jones. They’re not recommended for everyone, though, so check with your doctor first.
• Think about your diet: Eating slightly differently may help, as certain foods can make cramps more intense, says Dr. Jones. “Lifestyle [changes] that can help with cramps include avoiding sugars, salt, trans fats [like fried food], caffeine, and other things that can cause inflammation in the body,” she explains. It’s not always easy to cut things out of your diet, so you could always try to limit them as a starting point. And before making any major changes to the way you eat, it’s always a good idea to chat with your doctor.
• Drink more water: Dropping estrogen levels during perimenopause can affect your sense of thirst, meaning you drink less. “[Consuming more] water will help prevent dehydration and decrease bloating,” says Dr. Jones. The general advice is to consume (either via eating or drinking) about 11.5 cups (2.7 liters) of water per day. But more recent research shows that everyone needs to take in a different amount of water, so talk to your doctor about what’s right for you.
• Practice relaxation techniques: Lots of us are juggling different life stresses by the time we reach perimenopause, such as caring for aging parents, working demanding jobs, or parenting. Stress has been found to affect perimenopause symptoms, which may include cramping. “Stress reduction through relaxation techniques such as meditation will help with sleep,” says Dr. Jones. “Sleep is important in reducing stress as well.”

Treatments your doctor might prescribe

• Hormonal birth control: Birth control pills can help to keep your periods more steady in the early stages of perimenopause. “Hormonal contraception such as birth control pills can also help with cramping through hormonal regulation,” says Dr. Jones.
• Intrauterine device (IUD): Having a hormonal IUD fitted, which is a small, T-shaped birth control device, can help ease your cramps, so this could be an option for you.
• Hormone therapy (HT): Previously known as hormone replacement therapy or HRT,  HT for perimenopause wouldn’t typically be offered for cramping alone. But if you have other perimenopause symptoms like hot flashes or vaginal dryness, then it may help. Chat with your doctor to figure out what treatment could be right for you.

When to see a doctor about cramps during perimenopause

If you get occasional perimenopause cramps, taking over-the-counter pain relief usually does the trick (remember, though, not everyone can take this). But if these pains are affecting your daily life, it’s definitely worth seeing a health care professional. The best solution for you will depend on a number of factors, so discuss your options with your doctor.