Overcoming Period Pain in Perimenopause: Tips and Treatments

Introduction

Hormonal changes during perimenopause can affect various aspects of your health, including the menstrual cycle, fertility, and overall well-being.  Period pain during perimenopause can be the result of these hormonal changes, as well as other factors.

The average age of perimenopause is around 45 years.  However, everyone’s journey is different.  1 in 100 women under 40 and 1 in 1000 under 30 can experience premature menopause. Some people experience menopause because of surgery, for example, when the ovaries are removed due to treatment such as chemotherapy. Menopause can also affect trans and non-binary people who may not identify as female.

Period pain can increase during perimenopause, and it can be helpful to understand why as well as know how to manage and treat this.

What causes period cramps and pain in perimenopause?

Period pains in perimenopause are primarily caused by hormonal fluctuations, particularly in oestrogen levels. The decline in oestrogen can cause the uterine lining to become more sensitive, leading to increased period pain.

Other underlying issues such as fibroids or pelvic inflammatory disease can also contribute to increased pain experienced during perimenopause. 

Additionally, conditions like endometriosis, where tissue similar to the uterine lining grows outside the uterus, can worsen due to these hormonal changes, resulting in more severe and persistent period cramps in perimenopause.

Ovarian pain in perimenopause

Some people experience ovarian pain in perimenopause.  This pain can be caused by ovulation or changes in the ovaries as they produce less oestrogen. 

In some cases, the pain might be related to the presence of ovarian cysts, which are more common during this life stage.  These cysts can cause discomfort or sharp pain in the pelvic area.  Additionally, as perimenopause can lead to an irregular menstrual cycle, this can lead to mid-cycle pain. 

Do period pains get worse in perimenopause?

Many women find that their period pains get worse during perimenopause.  This can be due to the changes in oestrogen and progesterone levels that lead to more intense uterine contractions and increased pain.  The irregular nature of periods during perimenopause can also mean that when they do occur, they are more painful.

Condiions such as endometriosis and fibroids, which may have previously been mild, can become more symptomatic and contribute to more severe pain during this transitional phase. 

Why do I have period pain and no period in perimenopause?

It can be common to experience period pain and no period during perimenopause.  This can happen because the body is still going through the motions of a menstrual cycle, including uterine contractions, even if no bleeding occurs. Hormonal fluctuations can also trigger pain, similar to period cramps, without the onset of a period.

Additionally, conditions like endometriosis or fibroids can cause pain independent of the menstrual cycle. These factors combined with the irregularity of periods in perimenopause can result in cramping without actual bleeding.

How to manage and treat period pains in perimenopause

It is important to consider a combination of lifestyle changes and medical treatments to help manage and treat period pains during perimenopause.

Diet and nutrition

• Anti-inflammatory foods - Incorporate foods rich in omega-3 fatty acids, such as fish and flaxseeds, and antioxidants like fruits and vegetables.
• Stay hydrated - Drink plenty of water to help reduce bloating and discomfort.
• Limit caffeine and alcohol - Both can contribute to bloating and discomfort, so reducing intake might help alleviate symptoms.

Movement

• Engage in regular physical activity, such as walking, swimming, or yoga. Exercise can help reduce pain and improve mood by releasing endorphins.

Self-care

• Practice relaxation techniques like deep breathing, meditation, or mindfulness. Stress can exacerbate period pain and other perimenopausal symptoms.

Home Remedies

• Heat Therapy - Applying a heating pad or hot water bottle to the lower abdomen can help relax muscles and reduce cramping.
• Herbal Teas – Shop bought herbal teas such as chamomile or ginger can have anti-inflammatory properties and help ease pain.
• Massage - Gentle abdominal massage can increase blood flow and relieve muscle tension, which may help alleviate cramping.

Treatment options

• Pain relief medications - Over-the-counter pain relievers such as ibuprofen or naproxen can be effective for managing cramping and pain. Always follow the dosage instructions and consult with a healthcare provider if needed.
• Hormone Replacement Therapy (HRT) - For some, HRT can help balance hormone levels and reduce symptoms associated with perimenopause, including period pain. Your healthcare professional can help determine if this is an appropriate option for you.
• Birth Control Pills - Hormonal contraceptives can regulate periods and reduce the severity of menstrual cramps. Discuss this option with your healthcare professional to find the best type for your needs.
• Other Medications - In some cases, medications such as antidepressants or anti-seizure drugs may be prescribed to help manage pain or other perimenopausal symptoms.

By combining these strategies, you can effectively manage and alleviate period pains during perimenopause.

However, you decide to manage your menopause, if your period pain is severe, persistent, or significantly impacts your daily life, it’s important to consult a healthcare professional. They can assess whether there may be an underlying condition contributing to your pain, such as endometriosis or fibroids.  In some case ovarian pain may also be linked to non-gynaecological issues

Seeking support and medical advice for perimenopausal period pain

Hormone changes during perimenopause can lead to many symptoms, including changes to your periods, difficulty sleeping and urinary symptoms.  These fluctuating hormone levels, particularly oestrogen, can lead to increased period pain.

Conditions such as fibroids, endometriosis, and ovarian cysts can worsen during perimenopause, contributing to more intense cramps and pelvic pain.  Additionally, some women may experience period-like pain even without bleeding due to the irregular menstrual cycles characteristic of this stage.

Managing these symptoms involves a combination of lifestyle changes, such as diet and exercise, self-care practices, and medical treatments like pain relievers or hormone therapy.   Your healthcare professional can recommend appropriate treatment options for you to consider.

It is important to track your menstrual cycle and act on any change.

Use The Menopause Charity symptom checker to help you and your healthcare professional work out whether you may be experiencing perimenopause and offer advice for further care.

For severe or persistent pain, it's important to consult a healthcare professional to rule out underlying conditions.