Menstrual cramps after menopause

What can cause cramps after menopause?

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
  • constipation
  • 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

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.

Endometriosis is most common in those aged between 30 and 40 years old, but rarely, symptoms can still occur postmenopause.

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

Share on PinterestCertain medications may cause chronic constipation.

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

Ovarian and uterine cancers can cause abdominal or pelvic cramping. Older people are at higher risk of developing these cancers than younger people.

Other symptoms of these cancers can include:

  • vaginal bleeding
  • abdominal bloating
  • extreme tiredness
  • unexpected weight loss

How Can I Still Have Cramps in Menopause?

Q1. I am 55 and have been menopausal for four years now. A few months ago, I started having pain that feels exactly like menstrual cramps. It’s getting more frequent. Is this still related to menopause, or something else? Is it normal to feel cramps? I haven’t had any diarrhea.

If by saying menopausal you mean that you haven’t had a period for four years, then it is not normal to be having pains like menstrual cramps unless, of course, you are on hormone therapy. Without estrogen, your female pelvic organs sort of go into hibernation. Once they are in this quiescent state, they should not cause any symptoms.

You mention diarrhea, and you are correct that a likely source of cramps in a postmenopausal woman is her gastrointestinal tract. You should see a doctor and have this evaluated. In the meantime, keep a diary of what activities and foods might provoke your cramps.

Q2. I have been told that it is very common for postmenopausal women to have a thickened uterine lining. Can you tell me the measurements of this thickening and what they mean? How high does the scale go?

— Pam, Rhode Island

In postmenopausal women, the lining of the uterus (known as the endometrium, or uterine lining) should really be no thicker than 4 to 5 millimeters. If you are truly postmenopausal and not on hormone therapy — which can thicken the uterine lining — and your measurement is above 4 to 5 mm, your doctor may want to investigate further.

A uterine lining thicker than 4 to 5 mm could be a sign of hyperplasia, or abnormal cell growth, and in some cases it could even indicate endometrial cancer. If a woman who has already gone through menopause suddenly has bleeding, and an ultrasound test shows that her uterine lining is thicker than 4 to 5 mm, she may need an endometrial biopsy to make sure there is no evidence of hyperplasia or cancer.

A postmenopausal woman who isn’t experiencing bleeding could have a slightly thicker measurement — say, 7 mm — before her doctor might want her to have a biopsy. Bleeding is really the worrisome symptom; it’s rarely necessary to check the thickness of the uterine lining unless you’re experiencing bleeding after menopause.

Bottom line: If you’re postmenopausal, experiencing bleeding, and your uterine lining measure is greater than 4 to 5 millimeters — you need to follow up with your doctor to rule out any serious problems

Learn more in the Everyday Health Menopause Center.

Uterine Cancer

What is uterine cancer?

Uterine cancer is a general term that is used to describe a cancer of the uterus (or womb). A uterine cancer that develops in the endometrium (inner lining of the uterus) is called an endometrial cancer. A uterine cancer that develops in the myometrium (muscle wall of the uterus) is called a uterine sarcoma. Uterine sarcomas are very rare.

What are the risk factors for uterine cancer?

The exact cause of uterine cancer is not known, but there are certain risk factors related to the disease. Most of the known risk factors are linked to the balance between the hormones estrogen and progesterone. Some risk factors include:

  • Obesity (being very overweight): Fat tissue in the body can change some other hormones into estrogens. Having more fat tissue can increase a woman’s estrogen levels and her risk for developing uterine cancer.
  • History of not being able to become pregnant or having never given birth: Women who have not been pregnant have a higher risk because of the increased exposure to estrogen.
  • Use of tamoxifen: This drug, which is used to treat women with breast cancer, acts like estrogen in the uterus and can increase the risk of uterine cancer.
  • Estrogen replacement therapy (ERT): This therapy (the use of the female hormone estrogen to counteract the effects of menopause) can increase uterine cancer risk if progesterone is not used to protect against precancerous changes in the endometrium.
  • Ovarian diseases: Women who have certain ovarian tumors have higher-than-normal estrogen levels and lower levels of progestins, which can increase a woman’s chance of getting uterine cancer.
  • A diet high in animal fat: A high-fat diet can increase the risk of several cancers, including uterine cancer. Because fatty foods are also high-calorie foods, a high-fat diet can lead to obesity, which is a definite uterine cancer risk factor.
  • Diabetes: Diabetes has been linked to weight, but some studies suggest that diabetes by itself could be a risk factor for uterine cancer.
  • Age: As women get older, the likelihood of uterine cancer increases. Most uterine cancers occur in women age 50 or older.
  • Early menstruation: If monthly periods begin before age 12, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Late menopause: If menopause occurs after age 50, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Total length (years) of menstruation span: The span (length in years) of menstruation might be a more important factor than the age at which periods started or ended.
  • Family history: Uterine cancer risk is increased in some families who are also at risk to develop a certain type of colon cancer.
  • Earlier pelvic radiation therapy: Radiation used to treat some other cancers can damage the DNA of cells, increasing the risk of a second type of cancer.

What are the symptoms of uterine cancer?

The following symptoms might occur with uterine cancer or other conditions:

  • Vaginal bleeding between normal periods in pre-menopausal women.
  • Vaginal bleeding or spotting in post-menopausal women, even a small amount.
  • Lower abdominal pain or cramping in the pelvis area.
  • Thin white or clear discharge in post-menopausal women.
  • Extremely long, heavy, or frequent vaginal bleeding episodes in women over 40.

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Pain at Midlife

Gynecologic Sources of Pain

Chronic pelvic pain in perimenopausal and postmenopausal women can be due to a variety of gynecologic disorders, including benign or malignant tumors, interstitial cystitis, pelvic adhesions, or vulvodynia. Nongynecologic conditions, such as colorectal tumors, colitis, irritable bowel syndrome, and diverticular disease, may also be causes of pelvic pain. Two of the most common causes of pelvic and vulvar/vaginal pain among midlife women are fibroids and vulvodynia/dyspareunia.

Leiomyomas, commonly referred to as fibroids, are common, benign pelvic tumors that are present in both premenopausal and postmenopausal women. These are the most frequent cause of gynecologic surgery in the United States, accounting for one third of hysterectomies each year. Fibroids are a common finding in women undergoing surgery for pelvic pain. Cramer and Patel found fibroids in 74% of premenopausal women and 84% of postmenopausal women undergoing hysterectomy not specifically for fibroids. Although this is a biased sample, it suggests the prevalence of fibroids is higher than previously appreciated, because symptoms are experienced by only 20% to 50% of women with one known fibroid. When fibroids are symptomatic, the most common symptoms reported include abnormal uterine bleeding, pelvic pain or pressure, decreased capacity of the urinary bladder, constipation, back pain, and reproductive dysfunction.

Fibroid tumors have both estrogen and progesterone receptors and respond to hormonal stimulation. Enlargement during the reproductive years may cause increases in severity and frequency of symptoms. Because fibroids are slow growing, significant changes in size may take months or years, and some may remain stable for long periods of time. After menopause, fibroids commonly regress because of the reduced levels of estrogen and progesterone. In a recent population study on fibroid-associated symptomatology, the question about the generalizability of pain symptoms and presence of fibroids has raised questions about data collected in the past, which was primarily derived from self-selected populations of women seeking gynecologic care.

The pain associated with fibroids is related to their location and size. Posterior fibroids can cause lower back pain, and those found in the broad ligament may cause unilateral lower abdominal pain or may compress the sciatic nerve. Anterior fibroids may cause bladder compression and may be felt by the woman as painful, especially during a bimanual examination. Very large fibroids can cause dyspareunia, difficulty with urination, and/or defecation.

Theoretically, women taking HT may be at more risk for postmenopausal pain if they have fibroids because HT can potentially stimulate fibroid growth. However, there are no data to indicate whether postmenopausal women note clinical changes in pain level. Generally, no treatment is necessary for fibroids after the menopause. If the patient is experiencing pain or postmenopausal bleeding, a workup for other possible causes, including neoplasm, is necessary.

Causes of Pelvic Pain

Chronic pelvic pain may have multiple causes, and there may be many contributing factors to pelvic pain in a single patient.

Common Causes in Women

The endometrial growths that occur in endometriosis are a direct cause of chronic pelvic pain (CPP). Due to complex nervous system interactions, CPP can still continue even when the endometriosis has resolved. Up to 54 percent of women treated for endometriosis continue to experience CPP, and five to 26 percent have reported continued CPP more than one year after hysterectomy. The symptoms include generalized pelvic pain and pain associated with sexual intercourse, and they sometimes are worse in the days before a menstrual period.

Pelvic inflammatory disease (PID)

Pelvic inflammatory disease is an acute infection that can affect the uterus, fallopian tubes and/or ovaries. It is usually caused by chlamydia and gonorrhea, which are sexually transmitted diseases. Up to 35 percent of women with PID go on to develop CPP with or without clear evidence of organ damage, regardless of treatment. PID can cause severe pelvic pain and other symptoms; however, some women do not experience any pain at all and may never know of their infection unless long-term consequences such as CPP develop.

Pelvic congestion syndrome (pelvic varicosity syndrome)

In pelvic congestion syndrome, the veins in the pelvis are unusually dilated and engorged, causing pelvic pressure and pain. This has been shown to be related to high levels of estrogen, as estrogen causes veins to dilate. There are often other signs of hormone imbalance, such as heavy and painful periods. Women of reproductive age are usually affected; the condition is very rare after menopause. The pain is usually dull and aching, although episodes of sharp stabbing pain can occur. It is typically worsened by prolonged standing, and painful intercourse is common. There is post-coital aching that can last hours or even one to two days, and lower back ache.

Pudendal neuralgia

The pudendal nerve is one of the nerves of the pelvic floor muscles. Pain can originate from spasm of the pelvic floor muscles with compression of the nerve or from causes of neuropathies (such as infections, metabolic disorders and autoimmune disorders) that can affect the nerve itself. Pudendal neuralgia is characterized by perineal pain that is aggravated by sitting and reduced by standing. It is often relieved by sitting on a toilet. It may be associated with bladder problems (overactive bladder, urgency, urinary retention), bowel problems (cramps, frequent bowel movements, constipation) and sexual problems (decreased libido, pain during intercourse). The diagnosis is confirmed by physical examination.


Vulvodynia is defined as chronic vulvar discomfort or pain, especially characterized by complaints of perineal burning, stinging, irritation or rawness. There is redness and inflammation of the area around the vaginal opening, and severe tenderness to touch. A common symptom is pain during intercourse. Some women report perineal hypersensitivity to clothing or touch, and sexual activities are restricted. Bladder symptoms such as urgency, frequency and dysuria can also occur. Daily activities such as walking and sitting can be affected. Patients may even develop other distant symptoms like burning of the tongue or facial pain.

Chronic prostatitis/penile pain

It is estimated that every 15 seconds, a man in the U.S. is diagnosed with CPP. Studies have suggested that the condition may be genetic and passed down from one generation to the next. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by pelvic or perineal pain without evidence of urinary tract infection that lasts longer than three months. Pelvic pain may radiate to the back and rectum, and sitting may be uncomfortable. Urinary habits can be affected, causing frequent urination and often a burning sensation during urination. Other symptoms include joint pain, muscle aches, unexplained fatigue and abdominal pain. Sexual activity can affected, and some patients develop low libido, sexual dysfunction and erectile difficulties. A constant burning pain in the penis can occur. A hallmark of the condition is post-ejaculatory pain.

Common Causes in Both Women and Men

IBS is defined as abdominal pain that lasts at least three months during the last year. It is estimated that up to 60 percent of women who visit a gynecologist for pelvic pain have IBS. Altered bowel habits occur, and the pain can be relieved by a bowel movement. Up to 80 percent of patients with CPP will have symptoms consistent with IBS, including abdominal pain, bloating, belching, diarrhea, constipation, painful defecation, dyspareunia, pelvic pain, cramping and left lower quadrant pain.

Interstitial cystitis (IC)

Interstitial cystitis (IC), also known as painful bladder syndrome. IC is a chronic condition in which the walls of the bladder are irritated and inflamed. It is often diagnosed as a bladder infection, although it is not directly caused by an infection. Ninety percent of those diagnosed with IC are women, but it can affect men as well. The main symptom is pain that increases as the bladder fills and may be relieved by urination. There also can be constant pain in the bladder, abdomen, lower back, vagina or thighs. People with IC may need to urinate more urgently, more frequently or both.

Musculoskeletal causes

A wide range of issues can occur when the muscles of the pelvic floor are underactive or overactive, or if the skeletal system is impaired. Nerves in the pelvic area can be pinched by tight muscles, or by scars or fascia tissues. Chronic pain can be created by spasm of the pelvic muscles lining the pelvis. There are many different causes for this spasm, including fibromyalgia, anterior abdominal cutaneous or pudendal nerve entrapment, iliopsoas muscle spasm, Tarlov cysts, and lumbar spine and muscle injuries.

Post-surgical pain

Post-surgical pelvic pain can occur as result of tissue or nerve injuries from surgery, or from healing and adhesion formation. Nerve entrapment can result from a surgery or an accident. A nerve that is cut or damaged during surgery may be trapped or compressed in the muscle layer of the abdomen, which can cause pain. Adhesions may form after surgery or as a result of infections; these are bands of scar tissue that can occur between internal organs. Normal body movements can pull on these adhesions and cause pain.

Period pain and menopause

An introduction to period pain and menopause

Most women experience period pain at some stage during their life. It can be a common symptom among menstruating women and part of PMS (Pre-menstrual syndrome). However, as you approach the menopause, period pain may become worse again. One worrying symptom of the menopause is experiencing period pain, but having no periods. However disconcerting this may be, it is a common experience.

Period pain occurs when the muscles in the womb contract. This compresses the blood supply and reduces the level of oxygen in the tissues. This then causes you to experience pain in the lower abdomen, and sometimes in the back and thighs.

Why does the menopause cause period pain?

The menopause is a time when the hormones that regulate your menstrual cycle, in particular, oestrogen, begin to fluctuate. Naturally, this causes changes to your menstrual cycle, your periods become irregular and eventually stop. Alongside this, you may also experience period pain. However, it is also possible to experience period pain even when you are not having a period. Although it is not known exactly why this is, it is thought to be a result of conflicting messages being sent by your hormones. Eventually, as your hormones settle again, these symptoms should disperse.

It is important to remember that period pain may also be an indication of a more serious health condition, such as endometriosis or ovarian cysts, so if you are concerned, it is important to speak to your doctor.

What home remedies are there for period pain?

Generally speaking, if the period pain does not last for more than a day or two and is not too serious, then you should be able to treat it at home.

  • Exercise – although the last thing you want to do when suffering from period pain is move, sometimes exercise is beneficial. It helps to stretch and relax your muscles. Additionally, aerobic exercise gets the blood pumping faster around your body, releasing more endorphins, the body’s natural painkiller
  • Heat pad or hot water bottle – heat is an excellent relaxant, and applying heat to the tense muscles in the uterus can bring the quickest relief. You need to be careful however, that you do not burn your skin, particularly if you are using a hot water bottle
  • Warm bath or shower – much like the heat pads, warm water will help to relax all of your muscles. This will also give you the opportunity to de-stress
  • Diet – there are certain foods, such as those which are greasy and fatty, which are likely to cause abdominal bloating and cramps. If your tummy is already feeling tender, you should avoid any foods which are going to make it worse
  • Magnesium – this has been shown to help reduce muscle cramps. It acts as a muscle relaxant and also lowers the level of prostaglandins, a group of compounds which cause pain.

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Are there herbal remedies to help me?

If your period pains are mild and accompanied by other symptoms of the menopause, try a supplement containing soy isoflavones in the first instance. This can help with a variety of general menopause symptoms.
TIP: Menopause Support contains isoflavones from fermented soy as well as hibiscus and magnesium. Use it to help as a general supplement to help you through all stages of the menopause.

“Menopause support tablets have eased my problems. I would recommend them to any one suffering the effects of the menopause.”

Read more customer reviews

If your periods are still regular and period pains are your main menopause symptom, use Agnus castus. This is the herb of choice for PMS in younger women, but can also be very useful for a woman in the early stages of the menopause, known as the peri-menopause.

TIP: Use Agnus castus throughout the month, rather than just before your period. It is not a painkiller and needs a little time to get into your system in order to balance your hormones.

“Very helpful with troublesome periods.”
Read more customer reviews

What about conventional remedies?

Unless your period pain is severe and is interfering with your everyday life, then you should not need to resort to conventional medicines. However, if you are concerned you should speak to your doctor to rule out any underlying health conditions, such as endometriosis or cysts.

Generally, your doctor will suggest pain-killers or the contraceptive pill. You should discuss with your doctor which type of treatment is best for you, as you may find some to be more effective than others.

While there are many uncomfortable side effects of menopause —hot flashes, mood swings, and weight gain, to name a few — the one upside is that you no longer have to deal with that pesky monthly bleed. So, if you find that you’re bleeding after menopause — and we’re not talking spotting but menstrual-like flow — then you need to do more than simply brush it off as an annoyance: You need to see a doctor.

As you begin menopause, you might find yourself spotting or bleeding on and off. “We know that menopause occurs over a period of time that is different for each woman,” Elissa Gretz Friedman, MD, Director of Menopause in the Department of OB-GYN at the Mount Sinai Health System, tells Woman’s Day. “The initial changes can begin five years before the final menstrual period; it is a transition.”

During this transitory time, your bleeding pattern may start to change due to some wild fluctuations in your hormone levels, Jessica Chan, MD, an assistant professor of OB-GYN at Cedars-Sinai Hospital in Los Angeles, tells Woman’s Day. “At first, you usually have a shortening of the cycle. Then you may have a change in bleeding pattern. It can be lighter. Then there’s a lengthening of the cycle. You may skip some periods, before you stop altogether.”

As you enter menopause, your bleeding pattern will change, likely lightening. ljubaphotoGetty Images

You are officially menopausal when there is no menstrual period for one year, says Friedman. “This occurs when the number of eggs in the ovary have decreased to almost no functional eggs, which in turn stops the normal monthly cycling of hormones,” she explains. Friedman notes the average age women enter menopause is 51 and a half years. But again, this age is unique to you, and can range from 40 to 58.

If you are bleeding after you’re in menopause, Friedman says you need to see your doctor “100 percent of the time,” adding that “any postmenopausal bleeding is abnormal.”

“Any bleeding will be evaluated to make sure it is not cancer,” Friedman says. “But the most common reason for post-menopausal bleeding is atrophic changes to the tissues of the uterine lining or vagina.” This means they might be thinning, drying or inflamed. “The tissues can become thin from the lack of estrogen, and become more prone to tearing or bleeding.”

Any diagnosis will require a visit to your OB-GYN and, fortunately, there are treatments for most issues. Keith BrofskyGetty Images

Vaginal atrophy like this can be diagnosed with a pelvic exam, urinalysis, and a test for the acid balance in your vagina. Fortunately, there are plenty of treatments to try. These include vaginal moisturizers and lubricants, topical estrogen, medication targeting the pain and discomfort, estrogen therapy, and vaginal dilators.

Other reasons for bleeding also exist. “Sometimes, the cause of bleeding can be a fibroid or a uterine polyp, which can be removed,” says Chan. “There can also be bleeding if you’re having hormone therapy. But the one you don’t want to miss is endometrial cancer” .

Since “the most common symptom of uterine cancer is bleeding,” Friedman says you’ll want to get that ruled out as soon as possible. Around 10 percent of postmenopausal bleeding experience it due to cancer. “It can usually be diagnosed early, when it is curable, since it presents itself early with bleeding,” Friedman says.

But the bottom line is: If you’re bleeding at all after menopause, call your doc and get an appointment.

Menstrual Cramps and Pelvic Pain

Starting in the teenage years, half of all women suffer from menstrual cramps (dysmenorrhea). During perimenopause, the tendency toward cramping may worsen because of hormonal imbalance and the conditions associated with it, such as fibroids and adenomyosis.

Sometimes, cramps are a sign from your body that you need to slow down, rest, and tune in to yourself. In many ancient cultures, and even in some contemporary societies such as parts of India, women were expected to take it easy during their periods. But in our society all of us have been taught to try to be efficient, upbeat, and at 100 percent energy all the time. No wonder our wiser bodily processes try to get our attention!

Though this has been considered a sign of female weakness, once you begin to listen to your body, you will find that your cyclic energy shifts are a source of inspiration. If we have not been doing this regularly in our twenties and thirties, our pain can become particularly acute during perimenopause, when the wake-up call to health becomes louder. As you learn to slow down during your premenstrual and menstrual times, your cramps diminish, and in addition you will often find your intuition at an all-time high.

What Causes This

Cramps result when the uterine muscle and the endometrial produce too much of the eicosanoids called prostaglandin E2 and F2- alpha. When these prostaglandins are released into your bloodstream (usually within an hour or two after the onset of your period, but sometimes even before) you begin to experience the effects of these hormones: spasm in the uterine muscle, sweating, hot flashes, feeling cold alternating with feeling hot, loose stools, and possibly feeling faint. This eicosanoid imbalance is affected by the food you eat and the amount of stress you’re under, among other factors.

Healing Alternatives

Birth control pills often help menstrual cramping. All pelvic conditions tend to quiet down when the natural hormonal cycles are put to sleep by the steady state synthetic hormones in birth control pills. Take the lowest dose pill available. However, avoid birth control pills altogether if you are a smoker.

Spiritual and Holistic Options

Follow a diet high in protein and healthy fats and low in high-glycemic carbohydrates. Avoid trans fats found in partially hydrogenated oils.

Try eliminating all dairy foods (including cheese, ice cream, cream, milk, and yogurt) for two months. Though I do not have any statistics on this, I’ve seen many women get rid of their menstrual pain altogether (even in cases of severe endometriosis) by eliminating dairy foods, which are high in arachidonic acid, from their diets. Some are able to prevent cramps by avoiding dairy just for the two weeks before their periods. During perimenopause, when periods so often become irregular, you may need to stop dairy altogether for a few months to experience the benefits.

Try eliminating red meat. Red meat, like dairy foods, is high in a fatty acid eicosanoid precursor known as arachidonic acid, which results in symptoms such as cramps and arthritis in susceptible individuals. Eliminating it from your diet can cut down on the inflammatory eicosanoids associated with cramping and endometriosis pain.

Take a good multivitamin and mineral supplement, with special attention to the following:

  • Magnesium: 100 mg taken as frequently as every two hours during times of actual pain has been shown to help relax smooth muscle tissue and therefore decrease cramping. Do not exceed 1,000 mg per day, otherwise stools may become too loose.
  • Omega-3 fatty acids: Omega-3 fats are precursors for series 1 and 3 eicosanoids. Consume one of the following: fatty fish (3–4 oz) three or four times per week; fish oil, 1,000 to 2,000 mg per day; DHA, 100–400 mg per day; 4 tbsp ground fresh whole organic flaxseed per day; 1 tbsp fresh flaxseed oil daily.
  • Vitamin C: 1,000–5,000 mg per day. Increase when cramping occurs.
  • Vitamin B-6: 100 mg per day, in combination with B complex.
  • Vitamin E: 50 mg. in the form of d-alpha tocopherol three times a day during the entire cycle.

Acupuncture has been scientifically shown to alleviate menstrual cramps and pelvic pain. If you cannot locate a trained practitioner of Traditional Chinese Medicine near you, it is safe to try Bupleurum (Xiao Yao Wan, also known as Hsiao Yao Wan). This patent medicine is widely available, and many of my patients have done very well with it. Take four or five of the tiny tablets four times per day during the two weeks before your period is due, and continue through the first day of bleeding. It may take two to three months to see full results. Yun Nan Bai Yao is a traditional Chinese medicine that can stop heavy bleeding within one to two weeks—sometimes sooner. Take one to two capsules, four times daily.

The active ingredient in Menastil (an over-the-counter, topically applied, homeopathic product) is calendula oil—an essential oil extracted from marigold petals. The United States Food and Drug Administration and the Homeopathic Pharmacopoeia U.S. recognize this pure grade of essential oil for the temporary relief of menstrual pain. This all-natural product, which comes in a small roll-on applicator bottle, is designed to relax the uterine muscle, which increases the flow of blood and oxygen to the uterus, which in turn reduces pain.

Black cohosh, or “cramp bark,” can also be used as a preventive. This herb is available in tablet or tincture form in natural food stores.

Lying down with a castor oil pack on your lower abdomen for sixty minutes two to four times per week is often very helpful for both treatment and prevention of cramps and pelvic pain.

Moderate exercise helps lower stress hormone levels, which decreases cellular inflammation. Yoga is also good and often relieves cramps.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil), naproxen sodium (Anaprox, Aleve), and ketoprofen (Orudis) work by partially blocking your body’s production of prostaglandin F2-alpha. (So do aspirin and acetaminophen , but through a slightly different mechanism.) For best relief, NSAIDs must be taken before you get uncomfortable. If you take them only after the pain has begun, the prostaglandin will already be in your bloodstream. The drug stops production of prostaglandin F2-alpha, but it cannot stop the effect on your cells once the prostaglandin has been released.

Maya Traditional Massage is another helpful treatment. Indigenous Mayan healers in Central America have long used a technique called Maya abdominal massage to treat many conditions of the pelvic organs, including painful periods. The technique involves a gentle massage of the muscles and ligaments in the pelvic region and realignment of any pelvic organs that have shifted position (such as in a tilted or prolapsed uterus). When these organs are not properly aligned, the flow of blood, lymph, nerve, and Qi (roughly translated as “life-force”) is disrupted, which then compromises the function of other pelvic organs.

Learn More — Additional Resources

  • Women’s Bodies, Women’s Wisdom, by Christiane Northrup, M.D., Chapter 6, “The Uterus”
  • The Wisdom of Menopause, by Christiane Northrup, M.D., Chapter 8, “Creating Pelvic Health and Power”
  • Maya Traditional Massage

Last Updated: October 8, 2006

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