During perimenopause, estrogen levels fluctuate, which can cause heavy, irregular periods and cramping.

Perimenopause refers to the years before menopause, when the ovaries gradually start to make less estrogen.

In most cases, changes in the menstrual cycle are not a cause for concern and can be managed using at-home remedies and over-the-counter (OTC) medication.

But if severe pain occurs in the abdomen, especially if it is chronic, sudden, unexplainable, or continues after menstruation, a person should talk to their doctor.

In this article, we take a look at perimenopause, ovary pain, and when further investigation may be needed.

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Perimenopause may occur between the ages of 30 and 50.

Perimenopause refers to the years before menopause when a person begins to experience fluctuations in their menstrual cycle.

The female body is said to reach menopause when there have been 12 consecutive months without menstruation. This marks the end of their reproductive years.

Most people enter into this transitional period at some point in their 40s, though some reach it in their 30s or even 50s. It is common for individuals to experience perimenopause symptoms for between 4 and 8 years.

In the early years of perimenopause, a woman will typically experience some changes in the timing or heaviness of her period. In the later stages, a woman will usually start missing at least two menstrual cycles in a row.

During perimenopause, reproductive hormones produced by the ovaries, primarily estrogen and progesterone, begin to fluctuate.

Although estrogen and progesterone levels drop during menopause, levels may be higher or lower than usual for lengths of time during perimenopause.

In the case of testosterone in the female body, most research shows that circulating levels of this hormone are more related to age than to menopause.

Many women’s testosterone levels begin to fall during her 30s, dipping to half their initial levels by the time she reaches menopause.

Most people who menstruate will experience abdominal cramping to some extent, including pain around the womb or uterus and the ovaries.

Uterine muscles contracting to help the uterus shed its lining each month is what causes menstrual cramps.

Prostaglandins are released when the uterine lining cells break down at the start of the menstruation process.

These lipids cause blood vessels in the uterus to constrict or get smaller, causing its outer muscular layer to constrict also.

As this constriction takes place, it causes a cramping sensation.

Many women experience intensified pain during their periods because of underlying medical conditions, most commonly:

During perimenopause, a woman may experience heavier, longer periods of bleeding and more severe cramping during menstruation.

The reasons for these changes are fluctuations in estrogen and lowering progesterone levels.

Some women may not experience any physical symptoms of perimenopause aside from more irregular menstruation. For others, fluctuations in reproductive hormones can cause a wide variety of symptoms.

Usually, the symptoms associated with changes in hormones relate to the functions they serve in the body.

High estrogen levels can often cause:

  • bloating
  • cramping
  • heavier than normal bleeding
  • breast tenderness

Low levels of estrogen can cause:

  • vaginal dryness
  • insomnia
  • hot sweats and night sweats
  • headaches
  • unexplained exhaustion
  • reduced thickening of the uterus lining, resulting in less regular shedding and menstruation
  • osteoporosis or loss of bone density and integrity

Ovulation and menstruation are associated with progesterone. Thus, during perimenopause, women tend to experience lower levels of this hormone.

Low levels of progesterone can cause:

  • heavier than usual menstruation
  • irregular menstruation
  • longer than usual menstruation

How mood changes and depression are related to hormones is still unclear.

Women who are under a lot of stress, in poor health, or have a history of depression may be more likely to experience depression symptoms during perimenopause and menopause.

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A warm shower or bath may help to relieve cramping.

There are several ways to help treat painful cramping at home. Some of the most popular and effective recommendations include:

  • placing a heated bag, heating pad, or hot water bottle on the abdomen for 20 minutes or until it cools
  • taking a warm bath or shower
  • practicing deep breathing
  • exercising gently with activities such as walking, swimming, or yoga
  • drinking plenty of water to stop dehydration, which can intensify pain and muscle cramping
  • massaging the abdomen gently

If at-home remedies do not relieve the pain enough, many OTC medications are available to help reduce abdominal pain and cramping.

These include:

  • non-steroidal anti-inflammatory medications or NSAIDS
  • non-narcotic analgesic or pain-relieving medications
  • medications with acetylsalicylic acid, such as Asprin
  • analgesic transdermal pads or gels with camphor, menthol, capsaicin, or methyl salicylate

For women with severe cramping, a doctor may prescribe a low-dose birth control pill, patch, ring, or IUD to help regulate periods and make them less heavy.

In rare cases, women with very severe pain related to menstruation or perimenopausal may be given prescription grade pain medications temporarily.

Dietary and lifestyle changes can also help to manage or reduce perimenopause symptoms. A person can try the following:

  • staying hydrated to reduce overall inflammation and pain
  • eating a healthful, balanced diet rich in a wide variety of nutrients
  • eating plenty of high-fiber foods, such as whole beans, nuts, grains, cereals, vegetables, and fruits to ease digestion and help the body digest and eliminate waste estrogen and prostaglandins
  • eating foods and drinks low in fat or limiting overall fat intake, especially saturated or trans-fats
  • trying to limit intake of refined wheats and sugars
  • choosing lean proteins, such as fish, skinless chicken, and plant proteins instead of red meats
  • avoiding fried, packaged, processed, and preserved foods
  • exercising regularly
  • limiting stress when possible

Some alternative therapies may also help reduce perimenopausal and menopausal symptoms, including:

  • mindfulness practices, such as meditation and visualization
  • yoga
  • acupuncture
  • massage
  • hypnotherapy

Though there is limited clinical evidence to support their use, many supplements and high doses of certain vitamins are thought to help manage pain and cramping. However, supplements can potentially cause adverse side effects or interfere with medications, so people should always talk with a doctor before using them.

Herbal and vitamin supplements that may be useful in treating pain, inflammation, and cramping include:

  • vitamin D
  • omega-3 fatty acids
  • vitamin E
  • calcium
  • black cohosh
  • fenugreek
  • red clover
  • dehydroepiandrosterone (DHEA)
  • phytoestrogens
  • dong quai
  • wild yam
  • evening primrose oil
  • ginseng
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Cysts can cause ovary pain during perimenopause.

A woman may experience pain around the ovaries during perimenopause for several reasons that are not directly related to menstruation. These include:

  • ovarian or uterine cysts or abnormal fluid-filled pockets that are often harmless but can rupture and cause pain and cramping if large
  • non-cancerous ovarian or uterine growths that press on the pelvic organs
  • polycystic ovary syndrome (PCOS)
  • PID
  • pelvic infections

A woman may be more likely to develop certain types of ovarian cancer after menopause.

Although non-cancerous growths can cause the same symptoms, some of the more common signs of ovarian cancers include:

  • chronic pain
  • feeling bloated and full suddenly after beginning eating
  • feeling the need to urinate urgently and frequently
  • unexplained exhaustion
  • menstrual changes
  • pain during sex sometimes

Women who experience severe, chronic, or unexplainable abdominal pain should always talk to a doctor.

Women who begin to experience irregular menstruation or periods that are heavier than usual should also consult a doctor.

A person can also ask their doctor for information about how to relieve other symptoms of perimenopause, such as hot flashes, vaginal dryness, night sweats, or insomnia.