Perimenopause is a time of transition. As you near the end of your fertile years and get closer to menopause, you may have uncomfortable symptoms like night sweats, hot flashes, mood swings, and cramps. Although perimenopause symptoms like cramping are often a normal part of this transition, they may affect your quality of life. You may ask yourself whether what you’re feeling is normal.

Several women surveyed by ThisIsMenopause have commented on their experiences with perimenopause cramps. “I’m getting bad sleep, more bleeding with periods, and more cramping. I’m exhausted with extreme fatigue,” one wrote. “I never know when, or if, I’m going to have a period. Bloating and cramps seem to be almost constant,” another woman noted. “I’m tired, and I’m having more abdominal cramps and hot flashes,” another said.

Here, we discuss perimenopause cramps, including why they may feel worse than what you’re used to and when to check in with your doctor.

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Why Cramps May Be Worse During Perimenopause

Many women experience cramping during their periods. In fact, cramping is the most common symptom reported during menstruation. During your reproductive years, your body goes through menstrual cycles every 28 days or so. Your cycle begins the first day you menstruate.

After ovulation (when your ovary releases an egg), an egg travels to the uterus to be fertilized by sperm. If you don’t become pregnant, levels of the hormones estrogen and progesterone fall. This tells your body that it’s time to shed the uterine lining, and your period begins.

Period cramping is called primary dysmenorrhea. It happens when the lining of the uterus produces chemicals called prostaglandins. These chemicals make your uterus and blood vessels contract so that you can shed the lining of your uterus. Usually, you’ll have the highest level of these chemicals on day one of your cycle.

During perimenopause, your estrogen levels don’t drop the same way. Even if a released egg isn’t fertilized, estrogen levels during perimenopause may stay higher than usual or fluctuate (change) unpredictably. Higher estrogen levels may trigger the release of prostaglandins, which can lead to uterine contractions and cramps.

Prostaglandins and the hormonal changes of perimenopause may cause painful cramps that feel worse than usual. They can also cause cramping in women who aren’t used to menstrual cramps.

Cramping Without a Period

Painful cramping can also happen when you’re not having a period. In some cases, this may be linked to hormone changes during perimenopause or to an underlying condition.

“I keep feeling like my period is coming. I get cramps, but no period,” one woman surveyed by ThisIsMenopause wrote. Like so many symptoms of perimenopause, cramping without menstrual bleeding can be caused by hormone fluctuations.

During perimenopause, menstrual cycles become irregular, and hormone levels fall until menopause. Hormone levels that are different from what your body is used to can trigger cramping that’s unrelated to your period. Women with these types of cramps often have them over more days of their cycle than they would regular period cramps. Also, according to the American College of Obstetricians and Gynecologists, this cramping pain often becomes more severe over time.

Other Possible Causes of Cramping

Hormonal changes due to perimenopause aren’t the only reason you might experience cramping. Other potential causes of cramps include:

• Endometriosis — Tissue similar to the lining of the uterus grows outside the uterus. This can lead to pain and swelling during your periods.
• Uterine fibroids — These are noncancerous growths in the uterus that are common in women of reproductive age. They don’t always cause symptoms but can lead to painful cramps, heavy periods, pressure in the pelvis, an enlarged stomach, and painful sex.
• Ovarian cysts — These fluid-filled sacs, located inside or on the surface of an ovary, are common, usually resolve on their own, and don’t cause symptoms. Ovarian cysts may lead to pain on one side of the lower abdomen that comes and goes, bloating, and abdominal pressure or fullness.
• Pelvic inflammatory disease — This infection of the reproductive organs can cause symptoms like painful sex and abdominal pain.
• Other health issues — Some conditions you’re born with, such as an abnormally shaped uterus, can cause more painful cramps. Other medical conditions, like urinary tract disorders, Crohn’s disease, and having a narrowed cervix due to surgery or other causes, can also lead to cramping.

If you have painful cramps both with and without menstrual periods, a condition called adenomyosis may be to blame. With adenomyosis, tissue similar to the lining of the uterus grows into the wall of the uterine muscle. This can lead to longer, more painful cramps as well as heavy bleeding when you do get your period.

When To See Your Doctor

If you’re having cramping that’s worse than you’re used to or that’s new, talk to a doctor. A healthcare professional who specializes in women’s health is best suited to help you get to the bottom of what’s causing your cramps.

Seeing a doctor is important to prevent other health conditions that can stem from fluctuating hormones. High estrogen levels due to perimenopause can worsen or trigger other conditions, such as:

• Adenomyosis, when tissue from the lining of the uterus grows into the uterine muscle
• Breast cysts or breast pain
• Endometriosis, when tissue similar to the uterine lining grows outside the uterus
• Uterine fibroids, noncancerous growths in or on the uterus
• Migraine headaches
• Endometrial hyperplasia, a thickening of the uterine lining that can raise the risk of endometrial cancer

Managing Perimenopause Cramps

Talk to your doctor about how to relieve the pain and discomfort caused by perimenopause cramps. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal birth control are treatment options commonly used to reduce pain from cramps.

Other options that may help to manage perimenopause cramps include exercising regularly, getting enough sleep, using a heating pad, and practicing relaxation techniques like meditation and deep breathing.

Acupuncture might help relieve menstrual cramps, but there aren’t many high-quality studies available. Other alternative therapies like acupressure and herbal medicine might also provide relief, though their effects on menstrual cramps haven’t been well studied.

Research has shown that vitamins E, B1, and B6, omega-3 fatty acids, and magnesium may be helpful for relieving cramps. Be careful with supplements, as they’re not regulated by the U.S. Food and Drug Administration (FDA).

Perimenopause cramps can be uncomfortable and sometimes surprising, especially if they feel different from the cramps you’ve had in the past. In many cases, they are linked to hormone changes that happen during this stage of life. However, severe or unusual pain shouldn’t be ignored. If your cramps are new, worsening, or affecting your daily life, talk with your doctor to find out what’s causing them and what treatments may help.