Many people experience pelvic cramps as part of their menstrual period. But cramping may still occur after menopause and can sometimes be a sign of an underlying condition, such as uterine fibroids, endometriosis, constipation, or ovarian or uterine cancers.
In this article, we look at the possible causes of cramps after menopause, as well as their diagnosis and treatment.
Menopause refers to the time in a person's life when their monthly periods stop. In the United States, most people go through the menopause between the ages of 45 and 55 years old, with the average being 51 years of age.
A person has reached menopause when their monthly periods have stopped for 12 months in a row. Other symptoms vary from person-to-person and can include:
- hot flashes and difficulty sleeping
- mood swings and irritability
- vaginal dryness
- less interest in sex
The months leading up to menopause is known as perimenopause. A person may notice their periods begin to get lighter and less frequent during this time. While this happens, it is perfectly normal to experience period-like cramping before bleeding occurs.
Many different conditions can cause pelvic cramps postmenopause.
If a person has been through menopause and has pelvic cramps, they may also experience the following symptoms:
- light or heavy vaginal bleeding
- abdominal swelling or bloating
- swelling or pain in the legs
- lower back pain
- pain during sex
- pain when urinating or during bowel movements
- extreme tiredness, or fatigue
- unexplained weight loss or gain
- nausea, vomiting, or diarrhea
A person should see a doctor if they have any vaginal bleeding after the menopause or have gone 12 months without a period. They should get diagnosed right away.
While pelvic cramping that occurs after menopause may not be of concern, it can sometimes be a symptom of a more severe condition that may need medical treatment, such as:
Uterine fibroids are small growths that can occur in the wall of the womb, or uterus.
These growths are usually benign, which means they are not cancerous. Although uterine fibroids are more likely to develop before a person goes through menopause, it is still possible for older people to have them.
Fibroids usually stop growing or shrink after a person goes through menopause. However, someone may still experience symptoms of uterine fibroids, such as pelvic pressure or cramps, after their periods have ceased.
Endometriosis is a condition where the tissue that lines the womb starts to grow in other parts of the body, such as around the ovaries, fallopian tubes, or bowel.
Symptoms of endometriosis may include:
- pelvic pain and cramping
- pain in the lower back
- pain during or after sex
- pain when urinating or during bowel movements
For some people, endometriosis can have a significant impact on their lives and can lead to feelings of depression.
Also, undergoing hormone therapy for menopausal symptoms may make the pain of endometriosis worse.
Chronic constipation is also a common cause of lower pelvic pressure and pain and gastrointestinal upset.
Doctors define constipation as having fewer than three bowel movements per week. A person's stools may also be hard, dry, or lumpy and painful or difficult to pass.
Causes of constipation include:
- low fiber diet
- certain medications
- lack of exercise
- some medical conditions
Anyone who has severe or persistent constipation should see a doctor.
Gastroenteritis is an infection of the digestive tract that can cause abdominal and pelvic cramps alongside nausea, vomiting, and diarrhea.
Causes of gastroenteritis include:
- a viral infection, also known as viral gastroenteritis or stomach flu
- a bacterial infection, also known as food poisoning
While many cases of gastroenteritis resolve alone, severe cases may need medication and even hospitalization.
People who experience persistent vomiting and diarrhea can quickly become very dehydrated, which can lead to severe complications, including death.
Ovarian and uterine cancers
Other symptoms of these cancers can include:
- vaginal bleeding
- abdominal bloating
- extreme tiredness
- unexpected weight loss
Conditions that cause cramps after menopause may be more likely to occur in people who:
- started their periods before the age of 12
- began menopause after the age of 52
- take estrogen to help control the symptoms of menopause
- have a family history of ovarian or uterine cancers
If abdominal or pelvic cramps are accompanied by other concerning symptoms, especially vaginal bleeding, a person should see a doctor, as soon as possible.
Anyone who is concerned about abdominal or pelvic cramping should also see a doctor.
A doctor will ask a person about their symptoms and medical history and do a physical examination. They may recommend referral to a specialist for further testing.
To discover if an underlying condition is causing abdominal cramps, a doctor may perform one or more of the following tests:
- Transvaginal ultrasound scan: A doctor will insert a small device into a person's vagina to check for any problems.
- Hysteroscopy: A doctor will pass a thin tube with a camera, known as a hysteroscope, through the vagina, and into a person's womb to collect a tissue sample for testing. This will usually take place under a local or general anesthetic.
- Endometrial biopsy: A doctor will insert a thin tube into a person's womb to collect a tissue sample, which they will examine for signs of abnormal or cancerous cells.
- Sonohysterography: A doctor will pass a saltwater solution into a person's womb and then perform an ultrasound to check for problems.
- Dilation and curettage: A doctor will open the person's cervix and use a thin tool to collect a sample of the womb lining. An examination of the sample allows doctors to check for signs of abnormal growths, such as polyps, endometrial hyperplasia, or cancer.
Treatment for postmenopausal cramps will vary depending on the underlying cause. Some possible treatment options may include:
- Progestin therapy: Doctors usually prescribe progestin therapy to treat people with endometrial hyperplasia. Progestin is available as oral tablets, an injection, a vaginal cream, or an intrauterine device that a doctor fits.
- Dilation and curettage surgery: A doctor can perform dilation and curettage surgery to remove thickened parts of the uterine lining due to endometrial hyperplasia.
- Hysterectomy: This is surgery that removes part or all of a person's womb. Doctors usually use a hysterectomy to treat endometrial or cervical cancer or large fibroids, though they may also use it for treating a precancerous form of endometrial hyperplasia.
Other cancer treatments include radiation therapy, chemotherapy, and hormone therapy. A doctor may prescribe one or all of these treatments, depending on the type and stage of a person's cancer, and whether it has spread.
People with abdominal cramps may find benefit from the following home remedies:
- over-the-counter pain relievers, such as ibuprofen or acetaminophen
- a heat pack or hot water bottle
- gentle exercise, such as walking
- maintaining normal bowel movements
Cramps that occur postmenopause may be nothing serious. However, anyone who experiences abdominal pain or cramping with no apparent cause should arrange to see a doctor.