Perimenopause is the transition period leading up to menopause, when a woman’s body begins producing less estrogen and progesterone. This natural decline in hormones causes a variety of symptoms, and abdominal pain is one of the most common.
What causes abdominal pain during perimenopause?
There are a few key culprits behind abdominal discomfort during perimenopause:
As estrogen levels drop, this can trigger abdominal cramping and bloating similar to menstrual cramps. The fluctuating hormones cause the muscles of the uterus and intestines to contract spasmodically.
The ovaries begin to “power down” in perimenopause, producing fewer eggs and less estrogen/progesterone. This process can sometimes cause aching or twinging sensations in the ovaries and pelvis.
Many women with endometriosis find their symptoms worsen during perimenopause as hormones decline. The abnormal endometrial tissue becomes irritated, leading to severe pelvic pain.
Fibroids are non-cancerous tumors that grow in or on the uterus. Fibroids are estrogen-dependent, so they may shrink during perimenopause as estrogen drops. This shrinking can cause abdominal cramping.
Lower estrogen levels can slow gut motility, causing constipation, gas, and bloating that leads to abdominal discomfort. Declining hormones also weaken the muscles supporting organs in the abdomen.
Reduced estrogen causes tissues in the urethra and bladder to lose strength and tone. This can result in stress incontinence which puts pressure on surrounding abdominal muscles.
What does perimenopausal abdominal pain feel like?
Abdominal discomfort during perimenopause can vary from woman to woman. Here are some of the most common descriptions:
- Cramping, aching, or “twinging” sensations similar to menstrual cramps. This often occurs during ovulation.
- Bloating, fullness, pressure, or soreness in the abdomen, lower belly, or pelvic region. Bloating may come and go.
- Sharp, stabbing, or intermittent pain in the ovaries/pelvis. This may switch from one side to the other.
- Dull ache or heaviness low in the abdomen, similar to the feeling before a period but without the bleeding.
- Intense uterine cramping, squeezing, or contracting sensations during ovulation.
- Burning discomfort or soreness in the bladder area. This may occur during urination.
- Rounded, swollen, “poochy” abdomen that increases by the end of day due to bloating. Clothes may feel tighter.
When does the pain occur during perimenopause?
Abdominal discomfort due to perimenopausal hormonal fluctuations often follows a cyclical pattern:
Many women experience cramping, achiness, or twinging mid-cycle when they ovulate. As the ovarian follicle ruptures to release the egg, it triggers mini “period-like” cramps.
In the days before your period, dropping estrogen and rising progesterone can mimic PMS and cause abdominal bloating, fullness, and cramps.
During hormone withdrawal bleeding
When estrogen and progesterone drop suddenly, it triggers shedding of the uterine lining. The resulting bleeding often goes along with cramps.
Some women find their abdominal pain is worst at night. This may be due to spending hours upright during the day, causing blood to pool and congest the pelvic region.
Bloating, gas, and abdominal pain may flare up after eating foods that trigger gut issues like dairy, gluten, FODMAPs, and excess sugar.
Sexual activity can cause cramping in conditions like endometriosis and fibroids. Changing positions may help ease discomfort.
When should you see a doctor?
Occasional minor abdominal discomfort is normal during perimenopause. However, see your doctor if you experience:
- Severe, debilitating pain that impacts work, sleep, or daily life
- Pain accompanied by fever, vomiting, or abnormal discharge
- Bleeding between periods
- Pain that persists for more than 2 weeks
- Pain alongside other concerning symptoms like unusual bleeding, spotting, unexplained weight loss, changes in bowel/bladder habits, etc.
- No relief from over-the-counter pain medications
Severe abdominal pain can signal serious conditions like endometriosis, adenomyosis, fibroids, ovarian cysts, pelvic infection, irritable bowel syndrome, diverticulitis, urinary tract infections, and more. Proper diagnosis and treatment can help resolve the underlying cause.
How to relieve perimenopausal abdominal pain at home
For mild to moderate discomfort from hormonal fluctuations, these self-care tips may help provide relief:
Try placing a hot water bottle or heating pad on your abdomen or lower back. Heat helps relax cramped muscles.
Gently massaging the lower abdomen in a clockwise motion can help soothe aches and stimulate blood flow.
Low-impact activities like walking, swimming, or yoga help reduce prostaglandins that cause uterine cramps.
Avoid tight clothing that puts pressure on your abdomen. Opt for loose, breathable fabrics.
Practice relaxation techniques
Meditation, deep breathing, visualization, and progressive muscle relaxation can help your body unwind.
Take OTC medication
Ibuprofen, naproxen, or acetaminophen may relieve cramping and discomfort.
Premenstrual and ovulatory pain may be less bothersome if you steer clear of triggers like caffeine, alcohol, sugary or gas-producing foods.
Get enough sleep
Aim for 7-9 hours per night, maintaining a consistent sleep-wake cycle. Adequate sleep enhances pain tolerance.
Drink plenty of water and herbal tea to prevent constipation and help flush out bloat-causing sodium.
Lifestyle changes to reduce abdominal pain
Certain diet and lifestyle modifications can help minimize perimenopausal abdominal discomfort over the long run:
- Balance your hormones naturally – Herbs like maca, vitex, black cohosh, and DIM support hormonal balance without drugs.
- Cut back on salt – Excess sodium causes fluid retention and bloating. Limit processed foods and restaurant meals.
- Choose gas-releasing foods – Onions, garlic, ginger, fennel and fermented foods can relieve trapped intestinal gas.
- Reduce added sugars – Refined carbs and sweets feed bad gut bacteria linked to gas, bloating and inflammation.
- Load up on fiber – Soluble fiber from oats, nuts, seeds, and produce softens stool and improves regularity.
- Manage stress – High stress aggravates GI issues and menstrual cramps. Try daily meditation, journaling, or talk therapy.
- Get moving – Regular exercise reduces cramp-causing prostaglandins and boosts feel-good endorphins.
- Improve pelvic floor strength – Kegels and other exercises provide support to the pelvis and abdomen.
When does the abdominal pain usually subside?
For most women, bothersome perimenopausal abdominal pain is temporary. Discomfort due to hormonal changes tends to improve after:
- Menstrual cycles stop completely (12 months of amenorrhea)
- Estrogen levels bottom out and normalize
- The body adjusts to lower hormone levels (usually 1-2 years)
- Underlying conditions like endometriosis or fibroids are treated
However, some women continue battling abdominal discomfort, bloating, and GI issues through menopause and beyond. Remaining active, managing stress, and eating a healthy diet can help minimize symptoms long-term.
FAQ about abdominal pain and perimenopause
Is cramping normal in perimenopause?
Mild to moderate cramping during perimenopause is very common and not necessarily a cause for concern. More severe or prolonged pain may signal an underlying problem.
How long does perimenopause last?
Perimenopause lasts an average of 4 years but can range anywhere from 2-8 years before menopause. It ends when a woman has gone 12 months without a period.
Can perimenopause cause frequent urination?
Yes, declining estrogen weakens the urethral lining and pelvic floor leading to urinary urgency and incontinence that can create lower abdominal pressure.
What helps bloating during perimenopause?
A low-sodium diet, probiotic foods, magnesium supplements, digestive enzymes, and peppermint or ginger tea may help relieve bloating.
Is it normal for periods to be irregular during perimenopause?
Yes, it’s very common for menstrual cycles to become unpredictable in length as hormone levels rise and fall unevenly. Periods may be closer together, farther apart, or very erratic.
When should you see a gynecologist?
It’s a good idea to have a gynecological check up if you experience severe, recurrent, or persistent abdominal pain. Your doctor can check for any underlying problems.
The bottom line
Mild abdominal discomfort is par for the course with perimenopause due to declining ovarian function and estrogen withdrawal. Yet severe, chronic, or progressive pain should not be ignored. See your doctor promptly for evaluation if home remedies and over-the-counter pain relief aren’t sufficient. Working together, you can identify any underlying issue and find effective solutions for managing discomfort through this transitional life stage.