Perimenopause Cramps: Why They’re Intense (and Sometimes Without a Period)
Unexpected cramps during perimenopause? Here’s what’s happening and how to stop the pain.
Perimenopause can be a wild time for your hormones. Along with hot flashes, mood swings, and vaginal dryness, fluctuations in estrogen and progesterone can cause cramps without your period. Frustratingly, they can be more painful than your pre-perimenopause menstrual cramps.
According to Alyssa Dweck, M.D., an OB-GYN focusing on menopause and sexual health, cramps that occur during the menopause transition—aka perimenopause cramps—can occur for a variety of reasons. Here’s what might be causing them and what you can do about it.
About the Experts
Alyssa Dweck, M.D., is a board-certified gynecologist practicing in Manhattan.
Elizabeth Lyster, M.D., is a board-certified OB-GYN and women’s midlife health expert.
What Causes Perimenopause Cramps?
Fluctuating hormone levels, particularly the erratic shifts in estrogen and progesterone, are the primary drivers of perimenopause cramps. 1
During your reproductive years, estrogen levels rise and fall in a predictable rhythm during different phases of your menstrual cycle. As estrogen increases during the follicular phase, it stimulates the release of prostaglandins—hormone-like compounds that trigger uterine contractions, says Dweck. 2
But in perimenopause, which typically begins in your 40s (and sometimes as early as your mid-30s), these types of cramps can also occur between periods because your hormones don’t follow a steady monthly pattern. 3
Estrogen spikes can be unexpectedly high, and high estrogen may lead to a rise in prostaglandin production. 4 More prostaglandins lead to more uterine contractions and more cramping. And because these hormonal fluctuations are unpredictable, perimenopause cramps can strike between periods.
However, there are other reasons you may be experiencing cramps during perimenopause without your period, including:
- Endometriosis, a condition that causes the lining of the uterus to grow outside of it, often in the pelvic area, the ovaries, or the fallopian tubes. Though not directly related to perimenopause, this can cause severe pain and cramping because of hormone fluctuations.
- Uterine fibroids are benign growths in the uterus that can cause pelvic pain and pressure. “They are notorious for causing bad cramps during menstruation but also beforehand or just randomly,” says Dweck. During perimenopause, symptoms associated with uterine fibroids can get worse.
- Pelvic inflammatory disease is an infection of the reproductive organs that can cause mild to severe cramping. 5
- Ovarian cysts are sacs filled with fluid in an ovary. Most of the time, they’re harmless, but they can become twisted or rupture, causing severe pain.
- Clots in your uterus can cause cramping as they build up in your uterus. “It hurts because these are bigger than liquid blood, and as they build up, they are stretching the uterus before they pass through,” says Dweck.
What Do Perimenopause Cramps Feel Like?
Perimenopause cramps can feel like a mild, dull ache or like sharp pain in the lower abdomen or low back, similar to menstrual cramps. They can come in brief waves or be consistent and prolonged.
How long do perimenopause cramps last?
Some women experience cramping at various times throughout the month, while others will experience cramps only on occasion. They can occur for a few days before menstruation or stick around for longer in your cycle. 6
Because perimenopause cramps happen for a variety of reasons, there’s no hard and fast rule for how long they can last.
“As women get closer to the transition into menopause, fluctuations can be more significant,” says OB-GYN Elizabeth Lyster, M.D. Since perimenopause can last from four to eight years, women may have to cope with these cramps for a long time.
Phantom period cramps
Cramps with no period are sometimes referred to as “phantom period cramps,” or by the medical term “secondary dysmenorrhea.” 7 Women in perimenopause may experience cramping without a period because higher levels of estrogen increase the production of prostaglandins, causing uterine contractions. If estrogen levels drop before the uterine lining has a chance to build up, a woman might experience period symptoms like cramping without having an actual period.
“Even if you’re not having a menstrual cycle, you can still be having an ovarian cycle, which can cause phantom cramps,” says Lyster.
What Helps Perimenopause Cramps
Women can manage perimenopause cramps with a combination of lifestyle changes and medication options like HRT or birth control.
Start by monitoring your cycle to see whether you’re experiencing irregular periods, spotting between periods, and/or heavy bleeding. Carefully describe your symptoms to your doctor, and ask for further testing to make sure you walk away with the correct diagnosis. “We can’t always precisely tell the origin of the pain, but women need to advocate for themselves [nonetheless],” says Lyster.
HRT for perimenopause cramps
Hormone replacement therapy (HRT) may help with cramps by reducing the severity during perimenopause by regulating fluctuating hormones. While not FDA approved for cramps specifically, HRT may be an option if you’re dealing with other perimenopause symptoms like hot flashes, insomnia, vaginal dryness, and loss of bone density.
Other medications and supplements for perimenopause cramps
Some women take birth control pills in perimenopause for cramps to regulate hormones like estrogen and lower prostaglandin levels. 8 “Birth control pills prevent ovulation and therefore prevent wild fluctuations of hormones and prostaglandin release,” says Dweck. Hormonal IUDs are another option.
Medications like Motrin, Advil, and non-steroidal anti-inflammatories can also ease perimenopause cramping. “They block the prostaglandin activity, and that’s how the pain is alleviated,” says Dweck. She also suggests using a heating pad or a hot water bottle to relax muscles and minimize the need for OTC medications.
Magnesium supplements may also help prevent cramping by relaxing uterine muscles. One study found that pre-menopausal women who took 300 mg magnesium stearate during the second half of their cycle (starting on day 15) had significantly fewer cramps. 9
Movement for perimenopause cramps
Exercise helps the body and the brain by triggering endorphins—the body’s natural pain reliever—which can reduce pain, including the ache of menstrual cramps. One 2018 study found consistent exercise over an eight-week period reduced cramps. 10 Walking, swimming, aerobic exercise, yoga, and weight training all increase blood flow to the uterus and relax abdominal muscles, which help alleviate cramps. 11
The Bottom Line
During perimenopause, fluctuations in estrogen and progesterone can lead to cramping without a period. Higher estrogen levels produce more prostaglandins, a hormone that triggers uterine contractions. Women can manage perimenopause cramps with a combination of medications like HRT and lifestyle changes like exercise.
Allshouse A, Pavlovic J, Santoro N. (2019) Menstrual cycle hormone changes associated with reproductive aging and how they may relate to symptoms.
↑Barcikowska, Zofia. Et al. (2020) Inflammatory Markers in Dysmenorrhea.
↑Allshouse A, Pavlovic J, Santoro N. (2018) Menstrual Cycle Hormone Changes Associated with Reproductive Aging and How They May Relate to Symptoms.
↑Jiang J, et al (2023). The Association of Reproductive Hormones During the Menstrual Period with Primary Dysmenorrhea.
↑Barcikowska Z, et al (2020). Inflammatory Markers in Dysmenorrhea and Therapeutic Options.
↑Callan, N.G.L., Mitchell, E.S., Heitkemper, M.M. et al. (2019) Abdominal pain during the menopause transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study.
↑Hassan Nagy; Karen Carlson; Moien AB Khan. (updated 2023). Dysmenorrhea.
↑Choksey R, Mangal RK, Stead TS, Jones T, Flores R, Ganti L. (2023) Quantifying the Impact of Dysmenorrhea Symptoms on Quality-of-Life and Access to Oral Contraceptives by Income.
↑Yaralizadeh, M., Nezamivand-Chegini, S., Najar, S., Namjoyan, F., & Abedi, P. (2021). Effectiveness of magnesium on menstrual symptoms among dysmenorrheal college students: a randomized controlled trial.
↑Denavi, Zahra et al. (2018) The Effect of aerobic exercise on primary dysmenorrhea: A clinical trial study. 2018.
↑Tsai, I-Chen, et al. (2024). Comparative Effectiveness of Different Exercises for Reducing Pain Intensity in Primary Dysmenorrhea: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
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About the author
Aileen Weintraub is an award-winning author, journalist, and editor who specializes in women's health. Her essays and articles have appeared in The Washington Post, Oprah Daily, HuffPost, NBC, AARP, Glamour, and other publications. She also writes regularly for hospital systems and wellness brands.
About the reviewer
Natalie Kunsman, M.D., is a board certified physician specializing in functional, anti-aging, and regenerative medicine. She is a fellow of the American Academy of Anti-Aging medicine and the American Academy of Family Physicians.
