When I hit perimenopause and menopause, surely, many of us think, surely menstrual pain will start to fade!

Well, yes and no. For some women, cramps do fade, but for many others, the pain can intensify, even in months where there’s no bleeding. Having perimenopause cramps all month is not a foreign concept to many women.

Dr. Rebecca Dunsmoor-Su

Dr. Rebecca Dunsmoor-Su

Because the increase in cramping and other unusual pain with menstruation is fairly common in perimenopause, we turned to our Director of Health, OB/GYN Dr. Rebecca Dunsmoor-Su, to explain the pain.

I’m in perimenopause and still having periods, but the pain is much greater. Why?

Dr. Rebecca: Often the periods have become more irregular and can be heavier. When blood escapes from the uterus, the pain is caused by the cervix opening to let it pass. This can be more painful if the bleeding is heavier. It can also be more painful if the lining of the uterus has grown more. Sometimes there are fibroids or polyps that can make it more painful as well.

Is increased pain normal?

Dr. Rebecca: It can be normal, or it can be a sign of a problem, so it is worth mentioning it to your physician.

I’ve always had pain with periods, and now I’m entering perimenopause. Will my pain go away or get worse?

Dr. Rebecca: It is impossible to predict. Every woman has a different experience of perimenopause.

When is the pain bad enough or weird enough that I need to see my OB/GYN?

Dr. Rebecca: If it is impacting your life, please come and see us. We have many medications that can help.

What can I do about the pain? I don’t like taking a lot of pain pills – are there other solutions?

Dr. Rebecca: Ibuprofen is actually the best medicine for this type of pain, and may make the bleeding less as well. Aleve works for some women as well. Stronger pain medications are not really the best medicine for this.

There are some lifestyle choices you can make that may help with menstrual pain as well. High-fiber foods and foods with Omega-3 may help reduce cramps by helping regulate hormones. Certain nutrients like vitamins B and E and magnesium and zinc have given some women relief. Reduce caffeine, alcohol, and salt, and try to get at least some exercise. Walking is great for the cramps women experience at any age.

Will hormonal birth control help with the pain?

Dr. Rebecca: Yes, birth control and progesterone IUDs can both make the bleeding and pain much better. Pain and cramps after menopause can also be ameliorated with these methods.

I haven’t had a period in months, but sometimes I get phantom cramps? Why? Is it bad?

Dr. Rebecca: No, it is your uterus letting you know it is still building some lining. You’ll likely have bleeding at some point, and it might be heavy. If you go more than 12 months without a period and then have bleeding, please call your OB/GYN for evaluation.

Could a cyst cause menstrual pain?

Dr. Rebecca: Ovarian cysts are most commonly benign, and they are generally not painful unless they twist or burst. When that happens, the pain is sudden and severe, not something you might mistake for bad cramps.

Are there other issues that could be causing the pain?

Dr. Rebecca: Realistically, period pain is most often caused by the uterus, so heavy bleeding, fibroids and polyps are the most common culprits.

If you’re experiencing general, constant pelvic pain, that can be caused by the ovaries, but is much more commonly related to the GI tract or pelvic floor muscles. You should check with your doctor to discover the source of the pain and determine a treatment plan.

Sometimes patients express concern about ovarian cancer, but that pain is different. First, ovarian cancer is called the “silent killer,” because there isn’t much pain until the disease has progressed. Second, this pain is likely to be more constant and severe and is commonly associated with decreased appetite and severe abdominal bloating.

But it’s always good to exercise caution. If you’re concerned about the pain you’re feeling, make an appointment with your OB/GYN – we can help you find relief and peace of mind!

Get more expert answers from Dr. Rebecca! Read up on vaginal issues in menopause; get help with those horrible, annoying recurrent UTIs; learn how the MonaLisa Touch laser is helping women with sexual pain and incontinence; let her guide you through the questions of your personalized Menopause Assessment.

If you’re dealing with menstrual pain, what are you doing to manage the discomfort? Please share! Leave us a comment below, or talk to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.