Perimenopause cramps: why they happen, cramps with no period, and when to see a GP

It starts as a dull ache low in your tummy, the kind you've known since your teens. You reach for a hot water bottle and wait for your period. Sometimes it comes. Sometimes it doesn't, and you're left wondering what the cramps were for.

Perimenopause cramps are something lots of women search for, and you're not imagining them. Period pain is still common while you have periods, and in perimenopause your periods change. The NHS says they may come more often or less often, and bleeding may get heavier or lighter. So cramps can turn up at odd times too.

Most cramps aren't serious. But some need checking, and cramps after your periods have stopped always do. This page explains what's usual, what else it could be, and when to see your GP.

What do perimenopause cramps feel like?

They usually feel much like period pain always has. The NHS describes period pain as:

• cramps in your tummy that can spread to your back and thighs
• a sharp pain, or a dull ache
• pain that starts just before your period, or at the start of it
• pain that usually lasts up to 3 days

What may be new is the timing. If your periods are all over the place, cramps can be harder to make sense of.

Why does perimenopause cause cramps?

Period pain happens when your womb tightens during your period, the NHS says. While you're still having periods, that can carry on.

In perimenopause, your hormone levels start to go up and down. Women's Health Concern says this is often when symptoms are most noticeable. Your periods can become irregular, heavier or lighter, so the pattern of your cramps can change with them.

To be honest, there isn't much good research on cramps in perimenopause itself. So if your cramps have changed, it's worth asking your GP to look for other causes rather than assuming it's "just your age".

Perimenopause cramps with no period

This is one of the most common worries. A few things can be behind it.

A period that's on its way, or late. Cramps often start just before a period. When your cycle is irregular, it can be hard to know if a period is coming, so cramps can feel like they've come from nowhere.

Adenomyosis. This is where the lining of the womb grows into the muscle of the womb wall. The NHS says it's more often diagnosed in women over 30. As well as painful, heavy periods, it can cause pelvic pain, bloating or a feeling of fullness at any time in your cycle. Some people have no symptoms at all.

Endometriosis. This is where tissue like the womb lining grows in other places. The NHS lists severe period pain and pelvic pain among its symptoms, including pain when you poo or wee.

Your bowel or bladder. Not all low tummy pain comes from the womb. The NHS lists constipation, irritable bowel syndrome (IBS) and urine infections as common causes of pelvic pain. See our page on perimenopause constipation.

Pregnancy. It's easy to forget, but you can still get pregnant in perimenopause. Women's Health Concern says to keep using contraception until you've had no periods for two years if you're under 50, or one year if you're over 50. If there's any chance you're pregnant, do a test. Pelvic pain when you could be pregnant needs a call to 111.

Can perimenopause cause cramps with spotting or heavy bleeding?

It can happen. The NHS says bleeding may get heavier in perimenopause. But some causes of pain with bleeding need checking.

Fibroids are growths in and around the womb. The NHS says they mainly affect women who haven't been through the menopause. They can cause heavy or painful periods, tummy pain, lower back pain and needing to wee more often.

The NHS also says to see a GP if you bleed between periods, or if your periods get more painful, heavier or irregular. For more on this, see our pages on perimenopause period changes and perimenopause spotting.

Menopause cramps: cramps after your periods have stopped

Once you've gone 12 months or more without a period, you've reached the menopause. Period pain should be behind you.

So new cramps after the menopause are worth a GP visit. The NHS says endometriosis symptoms usually stop after the menopause, although they can carry on for some people. And fibroids mainly affect women who haven't been through it yet.

It may be something common, such as constipation or a urine infection. But the NHS also lists rarer causes of pelvic pain, including ovarian cancer and womb cancer. The symptoms of ovarian cancer are easy to mistake for IBS or "just the menopause". The NHS lists these main ones:

• a swollen tummy or feeling bloated
• pain or tenderness in your tummy or between your hips
• no appetite, or feeling full quickly after eating
• needing to wee urgently or more often

It also lists unusual bleeding from the vagina, including after the menopause.

None of this means your cramps are serious. It means they're worth checking. And the NHS says any bleeding after 12 months with no period should be seen by a GP, even if it's only spotting, brown or pink discharge, or happened once.

What can help with perimenopause cramps?

If your cramps feel like your usual period pain, the NHS suggests some simple things to try tonight:

• a warm bath or shower
• a heat pad, or a hot water bottle wrapped in a tea towel, on your tummy
• gently massaging your tummy and lower back
• gentle exercise, such as walking, swimming, cycling or yoga
• cutting down on alcohol, and not smoking

A few more ideas:

• Keep a record. Note when you get cramps, how bad they are, and any bleeding, bloating, or changes in your bowels or how often you wee. This helps you and your GP see a pattern, especially when your periods are irregular.
• Ask a pharmacist. The NHS says painkillers such as paracetamol or ibuprofen can help with period pain. A pharmacist can tell you what's suitable for you, especially if you take other medicines.
• Look after your bowels. If you're often constipated, that can add to tummy pain.

What your GP can offer

Your GP will ask about your pain and your periods, and may examine you. The NHS says you may have tests such as an ultrasound scan, depending on what they think is causing the pain.

Things you can talk to your GP about include:

• Prescription painkillers. The NHS lists anti-inflammatory medicines your GP can prescribe for bad period pain.
• Hormonal options. The NHS says some types of contraception, such as the pill, the implant or the injection, can make periods lighter and less painful. For adenomyosis, it says a hormonal coil (IUS) is one option.
• A TENS machine. This uses mild electrical pulses on your skin.
• Tests and treatment for a cause. If the pain isn't getting better, or your GP thinks there's a cause such as fibroids, they may refer you to a gynaecologist. Treatment depends on the cause.
• Menopause symptoms. If you have other perimenopause symptoms too, ask about HRT and other options.

If you take any medicines, don't stop or change them without talking to your GP or pharmacist first.

When to see a GP about cramps

As well as the signs in the box at the top, book an appointment if:

• your cramps are new, or different from your usual period pain
• cramps are stopping you doing your normal daily things
• you have pain during sex, or when you wee or poo
• you notice a change in your bowels or how often you wee
• you're losing weight without trying, or have lost your appetite
• you get any cramps or bleeding after the menopause

You might also find these useful: perimenopause period changes, perimenopause spotting and menopause bloating. Or see the full list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms