What is perimenopause?
You might think of perimenopause as the twilight of your reproductive years. It’s when your body starts to transition to menopause — the time when estrogen production drops and menstrual periods stop.
Women often enter perimenopause in their 40s, but some start earlier or later. The transition typically lasts from four to eight years. You’re said to be in perimenopause until you haven’t had a period for 12 months in a row. Then, you’re in menopause.
Although your estrogen level drops in menopause, it swings up and down during perimenopause. That’s why your menstrual cycles become so erratic. When your estrogen level is high, abdominal cramps — along with symptoms like heavy periods and tender breasts — are common.
Here’s a look at what to expect as you move through this major life transition.
How does cramping change?
Cramps are a monthly ritual for many women during their menstrual periods. They’re a result of the uterus contracting to push out its lining.
Some women naturally have more painful cramps than others. Conditions like endometriosis, uterine fibroids, and pelvic inflammatory disease can also cause painful cramping during your reproductive years.
During perimenopause, these cramps may intensify. So can other period symptoms, like tender breasts and mood swings.
What causes this change?
The cramps you feel during perimenopause are related to your hormone levels. Prostaglandins are hormones released by glands lining your uterus. These hormones direct your uterus to contract during your period. The higher your prostaglandin levels, the worse your cramps will be.
You produce more prostaglandins when your estrogen level is high. Estrogen levels often rise during perimenopause.
What can you do?
If your cramps are intense enough to bother you or affect your daily life, there are a number of things you can do to get relief. Here are some suggestions you can try.
Switching up your diet is an easy way to relieve menstrual cramps without medication.
Eat foods that are high in fiber, such as vegetables, fruits, and whole grains. Fiber lowers the amount of prostaglandins in your body.
Omega-3 fatty acids found in fish, like salmon and tuna, reduce your body’s production of these hormones.
Foods that are high in nutrients, like vitamins B-2, B-3, B-6, and E, and zinc and magnesium, might also offer some relief from cramps.
You can also try to:
- Avoid caffeinated coffee, tea, and soda. Caffeine can worsen menstrual cramps.
- Stay away from alcohol, which also intensifies cramps.
- Limit salt intake. Eating too much salt causes your body to hold onto more water, which makes you bloated. Bloating can worsen cramps.
- Walk or do other exercises every day. Exercise improves blood circulation and reduces cramps.
Home and natural remedies
A Cochrane review of evidence suggests that certain herbs may help with cramps. This includes:
That said, the evidence is very limited. Supplements can sometimes have side effects or interact with medicines you take, so you should always check with your doctor before adding them to your routine.
You can also try these home remedies:
- Put a heating pad or hot water bottle on your abdomen. Research finds that heat is as effective for relieving cramps as ibuprofen (Advil).
- Massage your belly. Gentle pressure can offer some relief from the pain.
- Practice stress-reducing techniques, like deep breathing, meditation, or yoga. One study found that period pain was twice as common in women who were stressed out than in women with low stress. Stress can also make the cramps you have more severe.
If lifestyle changes and home remedies aren’t enough to ease your cramps, ask your doctor about trying an over-the-counter pain reliever. These include:
Stronger medications like mefenamic acid (Ponstel) are available by prescription to treat more severe pain.
To get the most benefit from your pain reliever, start taking it right at the beginning of your period, or when your cramps first start. Keep taking it until your symptoms improve.
Taking birth control pills can also help control period pain. The hormones in birth control lower the amount of prostaglandins produced in your uterus. A drop in prostaglandins can reduce both cramps and blood flow.
Other reasons for ovarian pain in perimenopause
Not all pain during perimenopause is the result of period cramps. A couple of health conditions can also cause this symptom.
Ovarian cysts are fluid-filled sacs that form on a woman’s ovaries. Normally, cysts don’t cause any problems.
But if a cyst is large or it ruptures, it can cause:
- pain in your abdomen on the side of the cyst
- a feeling of fullness in your belly
A cyst rarely causes cramping. Usually, the pain is sudden and sharp.
During your reproductive years, cysts can be caused by:
After your periods stop, the most common causes of cysts include:
- fluid buildup in the ovary
- non-cancerous growths
Although most cysts are harmless, symptoms can indicate you have a larger cyst. And since your risk for ovarian cancer increases as you age, it’s worth seeing your doctor to have your symptoms checked out. You can see your primary care doctor or a gynecologic oncologist.
- Epithelial cell tumors start from cells lining the surface of the ovary.
- Germ cell tumors start from cells that produce eggs.
- Stromal tumors start from cells that produce the hormones estrogen and progesterone.
Your risk for ovarian cancer increases as you get older. Most ovarian cancers start after menopause.
Symptoms of this cancer include:
- pain in your abdomen or pelvis
- feeling full quickly after you eat
- an urgent need to urinate
- pain during sex
- changes in your menstrual cycle
Many other, noncancerous conditions can also cause these symptoms. Still, if you have symptoms, it’s a good idea to see your doctor for an exam.
When to see your doctor
If your cramps are severe, life-disrupting, or persistent, see your doctor. You should also make an appointment if:
- You just started getting cramps for the first time in your life, or they’ve become more severe.
- You’re experiencing other symptoms, like heavy bleeding, weight loss, or dizziness.
During the exam, your doctor will ask about your medical history and symptoms. Your doctor will also check your reproductive organs. You may get imaging tests, such as an ultrasound or CT scan, to find out if a problem with your ovaries is causing your cramps.
What to expect
Perimenopause is a transitional period that typically lasts for a few years. Your cramps should subside once you fully transition to menopause and your periods end. If your periods stop but the cramps continue, see your doctor.