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Cramps with Menopause: Everything You Need to Know

Article Content
Johannah Gregg
Medically Reviewed byJohannah GreggDNP FNP-CRead Bio
Written ByWinona Editorial Team

The menopause transition is a natural part of aging for women, usually beginning between the ages of 35 and 45 and lasting between 10-20 years in total. This biological transition, while completely normal, often brings a host of physical and emotional changes. 

Many women experience discomfort in the form of various symptoms, which can add to the challenge of navigating this new phase of life. This article will discuss menopausal cramps - one such symptom - as well as how to manage them.

What is menopause?

Menopause marks the end of a woman's menstrual cycle and her reproductive years. It’s the second stage of the menopause transition, which begins with perimenopause and ends with postmenopause. Perimenopause begins when the production of female hormones like estrogen and progesterone begins to decline. 

This leads to irregular menstrual cycles, with some women going many months in between periods. Once a woman has gone 12 consecutive months without a period, she is considered to have officially entered the postmenopausal phase. While the term “menopause” is widely used to describe this entire process, it technically only describes the exact moment when a woman transitions from perimenopause to postmenopause.

This hormonal shift can cause a wide array of symptoms, the most common of which include hot flashes, night sweats, and mood changes. However, there are also many less common symptoms of menopause. Though not as widely recognized as hot flashes or mood swings, menopausal cramps are a reality for many women.

What causes menopausal cramps?

The experience of menopause can significantly differ from woman to woman, with some experiencing severe symptoms and others facing minimal discomfort. Cramps, often similar to those experienced during menstrual periods, are one symptom that can occur.

So, why do some women experience cramps during menopause? The answer lies in the hormonal fluctuations that define this transition. 

The ovaries might occasionally release an egg during perimenopause, triggering a buildup of progesterone. However, as women progress through the menopause transition, this buildup becomes weaker and weaker.

Eventually, low progesterone levels can cause an imbalance between estrogen and progesterone. This excess of estrogen can cause the endometrium to thicken more than normal. When this happens, the uterus must contract more forcefully to expel the extra material.

This extra estrogen can also cause more prostaglandins, which are hormone-like lipids that can cause pain. While the body needs prostaglandins to trigger uterine contractions, excessive levels of these can cause painful cramps.

Additionally, comparatively high levels of estrogen can increase levels of histamines, which also contribute to painful menstrual cramps. Unfortunately, high histamine levels can stimulate excessive estrogen production, thus perpetuating an uncomfortable cycle of symptoms.

How to Manage Cramps During Menopause

Fortunately, while uncomfortable cramps during menopause are a reality for many women in the perimenopausal stage, there are several approaches for managing them:

Regular Exercise

Regular exercise is not just beneficial for maintaining physical health, but it also helps in mood improvement and symptom management during menopause. Activities like walking, swimming, or yoga can boost endorphin levels, improve sleep, reduce stress, and alleviate menopausal discomfort like cramps.

Exercise regimens should be tailored according to comfort and preference and include both aerobic and strength training exercises for balanced fitness.

A Balanced Diet

A balanced, nutrient-rich diet plays a pivotal role in managing menopause symptoms. Including a variety of fruits, vegetables, lean proteins, and whole grains in each meal can ensure a consistent intake of essential vitamins and minerals. 

Specific foods that can support hormonal health during the menopause transition include the following:

  • Sweet potatoes, which are high in vitamin C and can support progesterone production

  • Carrots, which contain a certain type of fiber that helps prevent the reabsorption of estrogen

  • Salmon, which is high in iodine and can support the production of thyroid hormones

  • Dark chocolate of 70% or more cacao, which is high in magnesium and can support progesterone production while balancing cortisol levels

  • Cruciferous vegetables, like kale, broccoli, and Brussels sprouts, which contain sulforaphane and help the body metabolize estrogen 

Avoiding processed foods, high-sugar drinks, and excessive caffeine can also help prevent exacerbating menopause symptoms, including cramps. Additionally, a balanced diet can support overall health and encourage a healthy weight during menopause.


Hydration is key during menopause. Drinking adequate water can help maintain skin elasticity, aid digestion, and alleviate bloating, which often accompanies menopausal cramps. 

Many health professionals recommend aiming for at least eight glasses of water a day, but it’s important to keep in mind that more is often required for those who are physically active or live in a hot climate. Water also helps flush out toxins from the body, contributing to overall well-being.

Heat Therapy

Applying heat to the lower abdomen can provide immediate relief from cramps. Using a hot water bottle, a heating pad, or even taking a warm bath can relax the uterine muscles and alleviate discomfort.

Heat therapy is a simple, non-pharmacological approach to managing menopause symptoms that can be easily incorporated into a daily routine.

Mind-Body Techniques

Incorporating mind-body techniques like deep breathing exercises, yoga, or meditation into a daily routine can help manage stress, promote relaxation, and reduce menopausal symptoms like cramps. 

These techniques can not only alleviate physical discomfort but also foster emotional well-being during menopause. Regular practice can improve sleep, enhance mood, and contribute to overall health and wellness.

The Right Clothing

Wearing tight clothing, especially around the waist, can exacerbate bloating and discomfort associated with menopausal cramps. 

Instead, loose, comfortable clothes made from natural, breathable fabrics can help ease discomfort and facilitate better body temperature regulation. This is another crucial aspect during menopause when hot flashes are common.

Limit Alcohol and Tobacco

Both alcohol and tobacco can intensify menopause symptoms. Alcohol can trigger hot flashes and disrupt sleep, while smoking can increase the risk of heart disease and osteoporosis, both of which women are more susceptible to after menopause.

Reducing or quitting alcohol and tobacco can significantly improve a woman’s ability to manage menopausal symptoms.

Seek Medical Advice

If menopausal cramps are severe, persistent, or affecting quality of life, it's time to seek professional help. Medical providers specializing in menopause can provide personalized treatment strategies, including lifestyle modifications and medications.

Bioidentical Hormone Replacement Therapy (HRT)

Bioidentical HRT can help manage menopausal symptoms by restoring hormone balance. Bioidentical HRT, using estrogen and progesterone identical to those naturally produced by the body, can help manage menopausal cramps and many other symptoms.

What is bioidentical HRT?

When it comes to managing menopause symptoms like cramps, HRT is often recommended. HRT replenishes declining hormones, helping to balance hormone levels and alleviate symptoms — but not all hormones used in HRT are created equal.

HRT has historically used synthetically-formulated hormones, which, while helpful, are not chemically identical to the hormones the body naturally produces. 

In contrast, bioidentical hormones are designed to be chemically identical to the hormones the body naturally produces. This similarity can result in better absorption and fewer side effects, leading to more effective relief from menopause symptoms, including cramps.

How hormones are delivered to the body is just as important as the type of hormones used. Hormones can sometimes be delivered via invasive methods, like pellets implanted under the skin. While these delivery methods are popular, they are not always the best for patient comfort. The following are common methods of HRT delivery.

Oral Delivery

In this delivery method, hormones are taken in the form of pills or tablets. When hormones are taken orally, they're processed by the digestive system before entering the bloodstream. This means that the hormones must withstand the acidic environment of the stomach and pass through the liver, where they may undergo some metabolism before reaching their target tissues. The liver's involvement in this process is known as the "first-pass effect."

One advantage of oral delivery is that it provides a systemic effect, impacting the entire body. It allows hormones to be distributed throughout various tissues and organs, which can be beneficial for individuals experiencing widespread menopause symptoms. 

However, it's important to note that the liver's metabolic activity can alter the hormone's composition and potency. This could potentially lead to variations in effectiveness and an increased risk of certain side effects compared to other delivery methods.

Transdermal Delivery

Transdermal delivery — applying hormones through the skin — is an effective, non-invasive delivery option. Transdermal delivery ensures a steady release of hormones into the bloodstream, helping maintain more stable hormone levels and potentially reducing side effects. 

Methods include patches and creams prescribed by a healthcare professional or sometimes purchased over-the-counter.

Vaginal Delivery

Vaginal delivery of hormones is an alternative option for HRT that may be suitable for certain women. This method involves the use of vaginal creams, gels, or suppositories that contain hormones to be absorbed directly through the vaginal tissues.

One of the primary advantages of vaginal delivery is that it allows for localized treatment, primarily targeting the vaginal and urogenital tissues affected by menopause. This can be particularly beneficial for addressing symptoms like vaginal dryness, discomfort during intercourse, or urinary tract issues. By delivering hormones directly to the affected area, vaginal delivery may provide relief with potentially fewer systemic side effects.

Additionally, vaginal delivery bypasses the liver's first-pass effect, meaning that hormones are not significantly metabolized or broken down by the liver before reaching the target tissues. This can result in a higher concentration of hormones reaching the vaginal tissues, potentially enhancing the effectiveness of treatment.

Intravenous Delivery

Intravenous (IV) delivery of hormones is a less common method used for HRT. This delivery method involves the administration of hormones directly into the bloodstream through a vein, usually with the assistance of a healthcare professional.

IV delivery offers the advantage of immediate and precise hormone absorption. By directly infusing hormones into the bloodstream, this method bypasses the digestive system and the liver's metabolic processes, resulting in a higher bioavailability of hormones. As a result, it can potentially lead to faster relief from menopause symptoms and precise control over hormone levels.

However, intravenous delivery of hormones is generally reserved for specific medical situations and not typically used as a primary method for HRT. It’s often used in clinical settings or under the guidance of healthcare professionals when immediate hormonal intervention is necessary.

The Bottom Line

Understanding the changes that the body goes through during menopause can be empowering. With this knowledge, women can take proactive steps to manage symptoms and ensure that this phase of life is as comfortable as possible.

Through lifestyle changes and medical treatments like bioidentical HRT, symptoms of menopause, like cramps, can be lessened over time. As with all medical conditions, any lifestyle changes or treatments should be conducted under the guidance of an experienced medical professional.

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