Cramps After Menopause: What You Should Know

Why Do Some Women Experience Cramps After Menopause?

Menopause marks the end of your reproductive years and a complete cessation of your monthly menstrual cycles. However, some women may continue to experience cramping similar to those during menstruation or even bleeding. Here are some potential causes behind these symptoms:

1. Hormonal Fluctuations:

• Significant hormonal changes after menopause, especially fluctuations in estrogen and progesterone levels, cause uterine contractions and cramping.

2. Uterine and Ovarian Issues:

• Conditions like uterine fibroids and ovarian cysts can lead to cramps.

3. Infections or Inflammations:

• Infection of your uterus, fallopian tubes, or ovaries, called Pelvic Inflammatory Disease (PID), can cause abdominal pain and cramping.

4. Menopausal Changes:

• Very rarely, stress and anxiety, along with physical menopause symptoms like hot flashes and disturbed sleep, can manifest as cramps.

5. Digestive Issues:

• Abdominal pain, bloating or discomfort caused by digestive issues can mimic cramps.

Common Causes of Postmenopausal Cramps

“Postmenopausal cramps are very rare and affect only very few women, but if it occurs, it could be a sign of a more serious underlying health condition which needs medical attention. Postmenopausal cramps are usually caused by conditions affecting menstruating women that continue even after menopause.” - Dr Sruthi Radhakrishnan, Ayurvedic Doctor and Health Coach Manager at Nirva.

Common causes of postmenopausal cramps are:

1. Endometrial Hyperplasia:

• In this condition, the innermost lining of your uterus (endometrium) becomes abnormally thick. When accompanied by hormonal fluctuations, endometrial hyperplasia can result in postmenopausal bleeding and cramps.

2. Fibroids:

• These non-cancerous growths in the uterus are very common in women during their reproductive years. Fibroids usually shrink and sometimes disappear completely postmenopause due to the natural decline of oestrogen and progesterone. However, in some women, it can cause postmenopausal pain and cramping.

3. Ovarian Cysts:

• Ovarian cysts are fluid-filled sacs formed inside or on the surface of your ovaries. Usually, ovarian cysts are harmless, but if the cyst ruptures or if it is large in size, it may cause cramp-like pain. 

4. Pelvic Inflammatory Disease (PID):

• PID is an infection of the female reproductive organs and affects your uterus, fallopian tubes, ovaries and the surrounding tissues. It usually occurs when untreated vaginal infections spread up into your pelvis. PID can lead to cramps accompanied by abnormal vaginal discharge or spotting.

5. Cancers:

• Certain cancers like uterine, ovarian or cervical cancers can cause inflammation and obstruction, causing cramps or dull, persistent pain.

Impact of Hormone Replacement Therapy (HRT) on Cramps

Before we dive into the details, let us understand what HRT is.

After menopause, the levels of oestrogen and progesterone fall, causing menopausal symptoms like hot flashes, night sweats, sleep disturbances, mood swings and so on. HRT is a treatment that replaces these hormones to manage symptoms of menopause and may be administered in the form of pills, skin patches, gels or injections.

While HRT is very useful in managing postmenopausal symptoms, it can sometimes cause undesired effects like cramps if the dosage is not correctly determined. HRT may cause hormonal fluctuations, thickening of the endometrium and increased prostaglandins (hormone-like chemicals produced by the body that induce uterine contractions), which leads to uterine cramping.

When to Be Concerned About Postmenopausal Cramps

If you are experiencing slight abdominal discomfort or cramping after menopause, it is usually not a cause for concern. This discomfort is brought on by the hormonal changes during this phase of life. 

However, if the pain is severe or associated with symptoms like vaginal bleeding, fever or abrupt weight loss, it is important to consult a doctor. 

• If you notice spotting or heavy bleeding along with cramps after menopause, it could be a sign of serious underlying health issues like endometrial hyperplasia or cancers.
• If you experience severe cramps and pain which do not relieve with over-the-counter painkillers, you should get yourself examined. Sudden and severe pain may indicate a ruptured ovarian cyst, ovarian torsion (twisting of the ovaries on the ligaments that hold it, leading to a cut-off of blood flow), or severe PID.
• Postmenopausal cramps, along with other symptoms like fever or chills, weight loss, vaginal bleeding or spotting, or pelvic pain, maybe a signal of serious infections or even cancers and require immediate medical attention.

Other Factors Contributing to Cramps After Menopause

Are underlying health issues the only cause of postmenopausal cramps? Hold on; simple things like your diet and mental health can also contribute to it. Here are more factors that can lead to cramps after menopause:

• A poor diet can cause nutritional deficiencies, weaken the pelvic muscles and cause inflammation, making cramps worse.
• Lack of physical exercise can lead to obesity, causing hormonal imbalances and increased pressure on the pelvis, leading to cramps.
• Anxiety and depression make you more sensitive to pain and cause hormonal imbalances, leading to painful cramps.
• Long-standing health conditions like PID, endometriosis (a condition where tissue similar to the inner lining of the uterus starts growing outside the uterus, like on the ovaries, fallopian tubes and other parts of the pelvis),  Irritable Bowel Syndrome (IBS), arthritis of the hip, and diabetes can cause cramps.

How to Manage Postmenopausal Cramps

Is postmenopausal cramps making your life uncomfortable? Here are some simple but useful tips you can explore to get relief from your symptoms:
 

• Eat a healthy and balanced diet, including foods that reduce inflammation, like omega-3-rich fish and nuts, berries, fresh fruits, green leafy vegetables, and whole grains.
   
• Stay hydrated by drinking plenty of water.
   
• Manage your stress levels through calming methods like yoga, meditation and deep breathing exercises.
   
• Stay active and exercise regularly to improve blood circulation, strengthen your muscles and maintain a healthy body weight.
   
• Apply a warm compress or a heating pad on your abdomen to reduce cramps.

Medical Treatments for Persistent Cramps After Menopause

If your cramps are persistent and severe, their management becomes difficult. Treatment of such a condition requires tests, medicines and sometimes even surgery for lasting relief from the troublesome symptoms.

Diagnostic Tests:

• Your doctor may ask you to get an ultrasound or hysteroscopy (a procedure where a flexible tube called a hysteroscope is inserted through the cervix into the uterus to visualise internal structures) for a detailed image of your pelvic area to identify conditions like uterine fibroids, ovarian cysts, changes in endometrial thickness, tumours or cancers.

Medicines:

• After confirming what causes your cramps, the doctor will prescribe medicines like hormonal or non-hormonal medications, antibiotics in case of infections and other specific treatments for the underlying health issue.

Surgery:

• In severe cases, especially if there is a risk for cancer or if the condition is not responding to medications, then surgery may be advised. Surgeries are usually recommended for severe uterine fibroids, endometrial hyperplasia and tumours.

The Role of Hormonal and Non-Hormonal Treatments

“Menopausal hormone therapy is the most effective treatment for menopausal symptoms. Non Hormonal medications may improve symptoms for women who have contraindications to, or do not wish to take menopausal hormone therapy.” - Management of menopause, PubMed.

While hormonal treatment for postmenopausal cramps aims to balance the hormone levels in your body, non-hormonal treatments focus on giving symptomatic relief through pain management and making changes in your lifestyle.

Hormonal treatments include hormone replacement therapy and progestin therapy to replace oestrogen and progesterone, thereby reducing menopausal symptoms and cramps.

Some women opt for non-hormonal treatment methods to manage cramps. They include:

• Antidepressants to relieve anxiety and depression.
• Antispasmodic medications to reduce muscle spasms and cramps.
• Heat therapy in the form of heating pads or warm compresses to relieve cramps.
• Lifestyle modifications like a healthy diet, exercise, and stress management.
• Alternative therapies like acupuncture for symptomatic relief from pain.
• Ayurvedic herbs and supplements (like turmeric and ginger) to reduce inflammation and pain.

Why Should Regular Check-Ups Be Done?

Have you been experiencing postmenopausal cramps? If so, it is important that you undergo regular gynaecological check-ups to detect any underlying health conditions like uterine fibroids, ovarian cysts or endometrial hyperplasia. Identifying these conditions can ensure timely management and relief from cramps.

Preventive Measures and Healthy Habits

Isn’t prevention always better than cure? Here are some practical tips to maintain good health and prevent discomfort.

• Exercise regularly.
• Maintain a healthy body weight.
• Eat a well-balanced and nutritious diet.
• Stay hydrated by drinking plenty of water.
• Get adequate sleep.
• Manage stress through yoga and meditation.
• Include anti-inflammatory Ayurvedic herbs in your diet.
• Limit alcohol and caffeine intake.
• Limit processed and high-sugar foods.
• Get regular medical check-ups done.

Before making any major changes in your routine and lifestyle, make sure to consult your doctor to know what’s right and most suitable for your health and well-being. 

Read more about Ayurvedic postmenopausal health tips and remedies.

The Bottom Line

Though it is very rare, cramps after menopause can occur as a result of various factors. Monitor your symptoms carefully, and do not hesitate to get medical advice if necessary. Identifying the cause of postmenopausal cramps at the earliest makes its management more easy and effective. 

You deserve to live a healthy and active life after menopause. Don’t let postmenopausal cramps hold you back. Get treatments done, make simple and healthy lifestyle modifications, and follow tips to manage cramps at home to reduce discomfort and lead a healthy, disease-free life.