More than half of all women report menstrual cramps before their period beginning in their teenage years. Once you reach perimenopause, it is not uncommon for your menstrual cramps to worsen. This is mainly because of the hormonal imbalance between estrogen and progesterone. Learn how to manage perimenopause cramps and thrive during your perimenopause periods and beyond.

What’s up with perimenopause cramps?

Just when you think you are nearing the end of having to deal with monthly menstrual cramps, they can worsen before they cease altogether. Many women report they experience worse cramping once they are in perimenopause, even when they do not bleed regularly.

Menstrual cramps are caused by the uterine muscle and the endometrial lining of your uterus releasing prostaglandins in your bloodstream that cause the uterus to spasm. Prostaglandins are a unique type of hormone that sends signals throughout your body to garner attention at a specific area. What makes these hormones particularly unique is they are released from the site that specifically needs attention as opposed to an endocrine gland. They are commonly associated with pain and inflammation.

Prostaglandins also help regulate the female reproductive system by controlling ovulation, the menstrual cycle, and they induce labor.

When your uterus is getting ready to shed its endometrium, prostaglandins cause your uterus to spasm to begin pushing out it’s lining. The spasms you experience can be painful and certainly can worsen in perimenopause because your hormones can behave more erratically. Indeed, the higher the level of prostaglandins, the more pain you can experience.

There are certain factors that can worsen perimenopause cramps. Indeed, you can even be more susceptible to or experience a worsening of, certain conditions in perimenopause.

• Endometriosis
• Adenomyosis
• Pelvic inflammatory disease
• Cervical stenosis
• Uterine fibroids

Feel like you have perimenopause cramps all month long?

Unfortunately, this uncomfortable symptom can be normal in perimenopause. High levels of estrogen cause you to produce more prostaglandins, which in turn can increase the intensity and duration of uterine spasms. If your estrogen levels are higher than normal throughout the month as part of your hormonal imbalance in perimenopause, it can not only cause cramping but also sore breasts and joint pain.

While estrogen levels are trending downward in perimenopause, your estrogen levels can actually experience a general increase before falling to low levels in menopause.

What if I have this problem: Perimenopause missed period but cramps 

What?!? Perimenopause cramps no period? Yes, this too can be normal in perimenopause. Some women experience “phantom PMS” symptoms, meaning they have the usual symptoms indicating their period is coming but it never arrives. If this happens, keep track of your symptoms on a calendar so you can track your periods, or lack thereof.

How to manage perimenopause cramps and bloating

Most women muddle through cramps because…well, that’s what we’ve always done, right? But if your cramps are severe and impacting your quality of life, consider these strategies:

• Turn to your diet – There are certain nutrients that can naturally lower prostaglandins, including fiber, omega 3’s, zinc, magnesium, and a selection of vitamin B. Try to incorporate foods with these prostaglandin-reducing properties. And try to limit or remove foods that can aggravate cramps including caffeine, alcohol, and salt.
• Walk it out – Exercise, even just taking a walk, can decrease circulating prostaglandins. Along with improving cramps, it can increase your circulation and release endorphins.

• Hot and cold therapy – Most women turn to a heating pad when their cramps get intense, and for good reason. Heat has a way of relaxing the muscles and increasing blood flow. Ice can also help reduce inflammation which can also cause pain
• Relaxation Techniques – A warm bath, deep breathing, biofeedback, and massage are just a few suggestions for how to naturally manage cramps.
• Over-the-counter (OTC) analgesics – Unless you have a medical condition that interferes with pain medication, OTC pain relievers such as ibuprofen and acetaminophen can offer relief of severe cramping.
• Birth control pills – Providing steady, predictable hormone patterns can be of tremendous relief for many women throughout their reproductive years, including in perimenopause. Your doctor will help you decide if birth control pills will benefit your specific symptoms.

While it is normal for cramping to worsen in perimenopause, worsening cramps can also be a sign of other pelvic conditions including ovarian cysts, certain cancers, and endometriosis, If you notice your cramps worsening or if they interfere with your quality of life, meet with your doctor. Together, you can rule out conditions besides perimenopause and talk about how best to manage your perimenopause cramps.

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.