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Perimenopause

What do Perimenopause Cramps Feel Like and Why Do I Have Them?

Zoe Kaplan
Zoe Kaplan

Cramping unfortunately doesn’t end even if your period does. Here’s how to get relief.

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Dec 2, 2023
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Published:
Sep 9, 2025
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Cramping unfortunately doesn’t end even if your period does. Here’s how to get relief.

Perimenopause
Hormones
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Cramping unfortunately doesn’t end even if your period does. Here’s how to get relief.

You might unfortunately be familiar with premenstrual syndrome (PMS) symptoms like cramping. It’s natural to assume that during perimenopause—the transition to having no more periods—you might not experience these types of PMS symptoms. However, that’s not always the case.

Perimenopause cramps are cramps that happen as you transition to menopause. Unlike period cramps, they might not happen during a specific time in your cycle, but instead happen when hormone fluctuations occur during perimenopause. Learning more about your perimenopause cramps can help you navigate symptoms and ensure cramping isn’t a sign of something more serious—and seek professional help if you need it.

What are perimenopause cramps?

Perimenopause cramps are feelings of discomfort in your abdominal area during perimenopause, which usually starts around your late 30s to early 40s, and continues for four to eight years. These cramps can vary in intensity and duration throughout this transition; some people may experience waves of mild discomfort, while others might endure more intense and prolonged pain.

What causes perimenopause cramps?

During perimenopause, your hormones—specifically estrogen and progesterone—fluctuate, leading to a hormonal imbalance that can cause all kinds of horrible perimenopause symptoms. These fluctuations are responsible for psychological symptoms like mood swings and brain fog, but also for physical symptoms like hot flashes, joint pain, and cramps.

Perimenopause cramps occur when hormonal shifts affect the production and regulation of prostaglandins, which are involved in signaling uterine contractions. An increase in estrogen—which is a common fluctuation during perimenopause—can elevate levels of prostaglandins, and therefore increase the level of cramping you feel.

While natural perimenopause hormonal fluctuations can directly cause increased cramping, perimenopause cramping can also happen as a result of:

  • Irregular menstrual cycles: Irregular cycles are common during perimenopause, especially as you near the end of this transition. The fluctuations in the duration and frequency of menstrual periods can contribute to the occurrence of perimenopause cramps. The unpredictability of these cycles may intensify the cramping sensations, causing discomfort for some women.
  • Ovarian function changes: During perimenopause, the ovaries produce fewer eggs, leading to changes in reproductive function. The reduced ovarian activity contributes to the hormonal imbalances that, in turn, manifest as perimenopause cramps. The ovaries' declining ability to regulate hormonal levels plays a pivotal role in the onset of various perimenopausal symptoms, including cramping.
  • Lifestyle factors: Chronic stress, sedentary habits, and poor dietary choices can contribute to the severity and frequency of cramps.
  • Underlying medical conditions: In some cases, perimenopause cramps can be influenced by conditions like fibroids or endometriosis. These conditions can coexist with perimenopause and contribute to increased cramping. It is crucial for women experiencing persistent or severe cramps to consult with a healthcare professional to rule out any potential underlying issues.

Perimenopause cramps but no period: What’s happening?

Yes, you can still get perimenopause cramps even if you’re not getting a period. This is because cramping isn’t a result of your period, but rather hormonal fluctuations.

When you still have a regular menstrual cycle, estrogen increases the few days before your period during your luteal phase. This increase in estrogen triggers the production of prostaglandins, which are involved in signaling uterine contractions.

During perimenopause, you don’t have this natural increase in estrogen because your period is about to come. However, estrogen still rises during this transition as your hormones fluctuate. Whenever estrogen rises, you may be at risk for cramps—even if there’s no period coming after.

What do perimenopause cramps feel like?

Perimenopause cramps and period cramps tend to feel the same physically, yet the main difference is when they occur. Perimenopause cramps typically will start anywhere from your early 30’s to mid 40’s, when perimenopause begins. They also might be a duller, more persistent ache rather than the sharp, intense contractions you’re used to. Some women describe a feeling of heaviness or pressure in the lower abdomen or pelvis. Others might experience sharp, fleeting pains that come and go without warning, or a constant, low-level cramping sensation that lingers for a day or more.

The key difference often isn't in the sensation itself, but in its unpredictable nature. While period cramps usually follow a predictable pattern—appearing right before or during your period—perimenopause cramps can strike unexpectedly, regardless of where you are in your cycle. They can be a surprise wake-up call in the middle of the night or a persistent distraction throughout the day. This inconsistency is another hallmark of the hormonal fluctuations that define this transition period, making the experience of cramping less predictable but no less manageable.

Perimenopause Cramps Treatment

Perimenopause cramps treatment is similar to how many women might approach dealing with PMS cramps: a mix of lifestyle changes, pain medications, and, in more extreme cases, hormone therapies. 

Natural remedies for perimenopause cramp treatment

To soothe perimenopause cramps naturally, you can make lifestyle adjustments like:

  • Dietary changes: Eating magnesium-rich foods, like leafy greens, nuts, seeds, and whole grains can help reduce cramps and discomfort.
  • Regular physical activity: Regular exercises can improve blood circulation and reduce muscle tension. This exercise does not need to be strenuous—even a brisk walk to get your blood circulating can help. Yoga and stretching, specifically, can target areas prone to cramping.
  • Warm compresses or baths: Applying heat to your abdominal area, whether through a compress or hot water, can help relax your muscles.

These remedies can help address cramping pains as they arise by reducing muscle tension.

Medical interventions

Over-the counter medications, specifically nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve menstrual cramps. These medications, like Ibuprofen and Aleve, help relieve cramps by reducing the production of prostaglandins, which signal uterine contractions. 

Healthcare professionals may also prescribe muscle relaxants for people who have more intense cramping to help ease pain. Be sure to discuss the potential benefits and risks with your doctor.

Hormone therapy

In some cases, doctors may recommend hormone therapy to help balance the hormonal fluctuations (like increases in estrogen) that can contribute to perimenopause cramps. While this therapy has its own risks, it can also address other perimenopause symptoms that happen due 

When it comes to treating perimenopause cramps, it’s common to use a combination of lifestyle adjustments and medical interventions. Every person is different, so working closely with a healthcare providers can help ensure you’re using the right strategies for you. 

Perimenopause cramps: the bottom line

While perimenopause is about the end of your menstrual cycle, that doesn’t mean the end of some symptoms that come with that cycle—specifically, cramping. While cramps are a common PMS symptom, they’re not caused by your period, but rather because of the hormonal fluctuations that happen before your period. During perimenopause, the same hormonal fluctuations happen even if you’re not getting a period, which means you may experience cramps during this time.

While cramping is never fun, there are various strategies to help navigate this symptoms—and chances are, what’s worked to help your pain pre-perimenopause can still help alleviate discomfort now. Whether you use lifestyle adjustments, over-the-counter medication, or hormone therapy, there are many ways to find relief.

About the author

Zoe Kaplan
Zoe Kaplan is a writer and content strategist passionate about creating content that helps people navigate the world a little more easily. Zoe has worked across verticals, from women's career development to reproductive health. You can check out more of her work at zoeakaplan.com.

Sources

https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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